PATIENTS in rural and regional Australia may have to pay more for medicines than their city counterparts if plans to deregulate the pharmaceutical co-payment go ahead, Health Minister Sussan Ley says.
But even as the Minister's admission is likely to anger her rural MP colleagues and constituents, the government's plans for pharmaceutical co-payments remain mired in confusion.
The Abbott government is in the final days of trying to negotiate a new agreement with the pharmaceutical industry and retail pharmacists about the pharmaceutical benefits scheme to replace the existing $15.4 billion agreement which runs out at the end of June.
It has floated changes which would see a range of drugs that can be purchased over the counter taken off the PBS schedule, supposedly saving $1 billion a year, as part of an overall saving the government is looking for from the PBS in next month's budget of between $3 billion and $4 billion.
However, it has tied the negotiations to proposals to change the co-payment patients pay for their medicines in what the government argues is a measure to boost competition. Signals are emerging that it may face fierce resistance to this point.
Making the government's case to allow chemists to discount the current PBS co-payment of $5.10 by up to $1 difficult to argue politically is the fact it currently has legislation sitting in the Senate from last year 's budget to increase the co-payment by up to $5 - meaning two policy proposals heading in opposite directions.
The spectre of rural consumers being forced to pay a larger co-payment than their city counterparts has now added a new complication to the issue.
Ms Ley told Sky News on Monday that "I suspect that if you're a pharmacist in an area where there are several others, you might choose to discount the co-payment".
"If you're in a lot of my electorate, which is rural and regional, and you're the only pharmacy in a town, your costs are probably higher and it's probably not appropriate for you to enter into that discounting. What underpins this is the market and the market is a sound basis on which we would go forward."
Opening up the discounting of the pharmaceutical co-payment, and removing subsidies from medicines that can be bought over the counter, are both seen as ways to dramatically reduce the burgeoning cost of the pharmaceutical safety net, under which patients with a concession card get free medication when they have spent more than $366, by slowing the pace at which they reach the safety net.
But such a move sits at odds with an increase in the PBS co-payment.