Effect and illustrative costs of downscheduling on government subsidised dispensings of triptans in Australia: a 10-year analysis
Jack Janetzki
A B * , Jacinta Johnson A B , Lisa Kalisch Ellett A B , Jun Ni Ho A B , Kelly Hall A B , Michael Ward A B and Nicole Pratt A B
A
B
Abstract
Acute migraine episodes affect >18% of Australians. Triptans are most effective when taken early in migraine attacks, making timely access critical. Before February 2021, triptans were prescription-only, but a downscheduling policy change enabled over-the-counter (OTC) purchase with pharmacist advice. This study examined the effect on subsidised Pharmaceutical Benefits Scheme (PBS) dispensing rates and illustrative patient costs.
Aggregated PBS dispensing data were used to estimate monthly triptan dispensing rates per 1000 people using population data from the Australian Bureau of Statistics. As PBS data excludes OTC supply, we projected dispensings, and illustrate potential costs based on pre-downscheduling trends to estimate the potential shift to OTC. PBS beneficiaries include concessional (social security recipients/low-income earners) and general (those ineligible for concessions). Prescription costs were based on a four-tablet PBS pack of sumatriptan 50 mg (A$7.70 concessional; up to A$24.60 general). OTC costs were estimated using a two-tablet pack (A$10.00 standard pharmacy, A$7.00 discount pharmacy).
Before downscheduling, triptan dispensings grew 1.4% monthly, slowing to 0.6% post-downscheduling. By illustration, we estimate that shift to OTC access would have led to a cost saving of up to A$2 million for general patients, but an increased cost of A$2.3–5.8 million for concessional patients, depending on pharmacy pricing models.
Downscheduling slowed PBS dispensing growth. If reduced PBS dispensing was offset by OTC access, the policy may have improved timely migraine treatment, although PBS use remains high. Cost benefits depend on patient concession status and potential offsets, such as reduced doctor visits, which should be considered in further policy evaluations.
Keywords: dispensing rates, pharmacy, downscheduling, migraine, over-the-counter, patient costs, Pharmaceutical Benefits Scheme, triptans.
References
1 Migraine Australia. Burden of Migraine. 2024. Available at https://www.migraine.org.au/burden
3 Goadsby PJ, Zanchin G, Geraud G, de Klippel N, Diaz-Insa S, Gobel H, et al. Early vs. Non-Early Intervention in Acute Migraine — ‘Act When Mild (AwM)’. A Double-Blind, Placebo-Controlled Trial of Almotriptan. Cephalalgia 2008; 28(4): 383-91.
| Crossref | Google Scholar | PubMed |
4 Lantéri-Minet M, Mick G, Allaf B. Early dosing and efficacy of triptans in acute migraine treatment: the TEMPO study. Cephalalgia 2012; 32(3): 226-35.
| Crossref | Google Scholar | PubMed |
5 Australian Government Department of Health and Aged Care. Pharmaceutical Benefit Scheme. 2024. Available at https://www.pbs.gov.au/pbs/home
9 Booth S, Parsons R, Sunderland B, Sim TF. Managing migraine with over-the-counter provision of triptans: the perspectives and readiness of Western Australian community pharmacists. PeerJ 2019; 7: e8134.
| Crossref | Google Scholar | PubMed |
10 Pharmaceutical Benefit Scheme Australian Government, Department of Health and Aged Care. PBS and RPBS Section 85 Date of Supply Data. 2024. Available at https://www.pbs.gov.au/info/statistics/dos-and-dop/dos-and-dop
11 Australian Bureau of Statistics. National, state and territory population: Statistics about the population and components of change (births, deaths, migration) for Australia and its states and territories. 2025. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release
12 Australian Government Department of Health and Aged Care. Medical Costs Finder. Available at https://medicalcostsfinder.health.gov.au/about-mcf
13 Australian Government Department of Health and Aged Care. Analysis of galcanezumab and fremanezumab for chronic migraine, June 2024. 2024. Available at https://www.pbs.gov.au/info/industry/listing/participants/public-release-docs/2024-06/analysis-of-galcanezumab-and-fremanezumab-DUSC-June-2024
14 Eyre BLKD, Eadie MJ, van Driel ML, Ross-Lee L, Hollingworth SA. Triptan use in Australia 1997-2015: A pharmacoepidemiological study. Acta Neurol Scand 2017; 136(2): 155-9.
| Crossref | Google Scholar | PubMed |
15 Deloitte. Migraine in Australia WhitePaper. 2018. Available at https://www.deloitte.com/au/en/services/economics/perspectives/migraine-australia-whitepaper.html
16 Millier A, Cohen J, Toumi M. Economic Impact of a triptan Rx-To-OTC Switch in Six EU Countries. PLoS One 2013; 8(12): e84088.
| Crossref | Google Scholar | PubMed |
17 Parkinson B, Gumbie M, Cutler H, Gauld N, Mumford V, Haywood P. Cost-Effectiveness of Reclassifying Triptans in Australia: Application of an Economic Evaluation Approach to Regulatory Decisions. Value Health 2019; 22(3): 293-302.
| Crossref | Google Scholar | PubMed |
18 Gumbie M, Parkinson B, Cutler H, Gauld N, Mumford V. Is Reclassification of the Oral Contraceptive Pill from Prescription to Pharmacist-Only Cost Effective? Application of an Economic Evaluation Approach to Regulatory Decisions. Pharmacoeconomics 2019; 37(8): 1049-64.
| Crossref | Google Scholar | PubMed |
19 Parkinson B, Cutler H. Application of an economic evaluation approach to making regulatory decisions regarding access to medicines: advantages, challenges and recommendations. Aust Health Rev 2022; 46(2): 143-9.
| Crossref | Google Scholar | PubMed |
