Assessing the role of Australia's Pharmaceutical Benefits Scheme as a tool for addressing inequality in access to medications and allocation of public funds for pregnant women

Introduction: Medication use during pregnancy is common, and socioeconomic disparities in access may contribute to maternal and fetal health inequalities. This study examines socioeconomic disparities in access to and expenditure on medications dispensed through Australia's Pharmaceutical Benefits Scheme (PBS), evaluating its role in promoting equal access to medications for pregnant women. 

Methods: We analysed the Maternity1000 linked administrative dataset, which includes data on 57 443 women who gave birth in Queensland, Australia, between 1 July 2017 and 30 June 2018. Socioeconomic quintiles were assigned using the Index of Relative Socioeconomic Disadvantage. Medication prevalence rates, usage proportions and costs (2022/2023 Australian dollar) were calculated, followed by concentration curves and indices to assess inequality. 

Results: Medication prevalence was higher among more disadvantaged women (Q1 (most disadvantaged): 67% vs Q5 (least disadvantaged): 60%), who were also dispensed a higher average number of medications per pregnancy (Q1: 2.8 (95% CI 2.7 to 2.9) vs Q5: 2.4 (95% CI 2.3 to 2.5)). However, the total medication cost (patient contribution amount plus public subsidy) was, on average, lower for these women (Q1: $45 (95% CI 43 to 46) vs Q5: $52 (95% CI 50 to 54)), indicating potential disparities in access to newer, higher cost treatments. The unadjusted concentration index suggested mild pro-poor inequality in access (CI=-0.031; p<0.001), which was attenuated and statistically insignificant after adjusting for maternal demographic and clinical characteristics (CI NA =-0.007; p=0.089). Government expenditure on medications showed no significant socioeconomic inequality (unadjusted CI=0.001; p=0.965). 

Conclusion: The PBS facilitates equitable access to publicly funded medications for pregnant women. However, the uniform distribution of public funds across socioeconomic groups suggests possible limitations in progressivity, as public subsidies are not disproportionately benefiting the most disadvantaged women overall. This may reflect missed opportunities to distribute public funds more effectively and efficiently, particularly if disadvantaged women are under-represented in access to newer, higher cost therapies, and warrants ongoing evaluation.