$$ - Streamlined Authority

Introduction

On 1 July, Medicare Australia introduced changes to the PBS authority approval process in an effort to streamline the process of writing authority prescriptions.

Under this new “Streamlined Authority” system, prescribers will no longer have to obtain telephone or written approval from Medicare Australia or the Department of Veterans’ Affairs (DVA) before prescribing certain PBS authority medications.

Of the 450 PBS listings requiring authority approval, 200 now fall under the streamlined system. These 200 listings comprise the various indications (reason for prescribing) for 85 medicines.

Fosamax, Actonel, Ezetrol, Vytorin, Ezetimibe and Carvedilol are among the medications that can now be prescribed under the streamlined system. Norfloxacin, Bupropion Hydrochloride and Valacicilovir Hydrochloride are among the medications that still require telephone or written authority approval.

Benefits

The Streamlined Authority system has been devised to offset one of the major administrative burdens imposed on prescribers by Medicare Australia: telephone prescription authority approval.

A 2005 Access Economics study into the workforce implications of PBS authority scripts found that prescribers spent 439,500 hours per year requesting authority codes via the telephone or in writing. The report extrapolated this finding to conclude that time equivalent to 239 FTE doctors, or over 1.3 million patient consultations were being consumed by the authority script process.

As the driving force behind the changes, the Australian Medical Association (AMA) is enthusiastic about the initiative.

“We estimate that the changes will reduce the number of authority requests made via phone by 30%,” said A/Prof John Gullotta, Executive Councilor and Chair of the AMA Therapeutics Committee.

“Timing is everything in politics - we saw an opening and we darted through. It’s a good win for the AMA and a welcome wind back of red tape for GPs. The Government said we would never achieve this about 6 months before we achieved it. As soon as it is bedded down, we will be pushing for more streamlined listings and the complete removal of anachronistic listings. We point out it is still an Authority system but an efficient one and one we can live with.”

Dr Tony Hobbs, President of The Australian General Practice Network (AGPN) is also positive about the prospect of GPs spending less time having to phone for authority.

“We welcome the decision to remove 200 of the 450 approval medications. As a result an estimated 70% of approval prescriptions will be removed,” Dr Hobbs said.

Dr Hobbs also highlighted the benefits for patients, stating that, “They will be the big winners here. They will no longer have to wait around whilst their GP is on the phone to the approval hotline for scripts they are themselves very familiar with.”

According to a spokesperson for the Government agency, the reduction in PBS authority call volumes will enable Medicare Australia to better respond to more complex call enquiries and undertake additional education and compliance activities.

Streamlined Prescribing

The PBS has assigned four-digit codes to the 200 listings that can be prescribed under the streamlined system. Doctors will be required to include this code on their prescriptions. As before, prescribers must ensure that patients meet the PBS restriction criteria for the item.

Cautioning prescribers against abusing the streamlined system, A/Prof Gullotta said “It is important to highlight that the authority restrictions still apply and are subject to audit so doctors must still prescribe within the guidelines.”

There are several ways to access the streamlined authority codes, some more streamlined than others:

PBS Website

The PBS website contains a search function that allows up-to-date information on all PBS drugs to be retrieved. To access the Streamlined Authority codes via the web, practitioners need to:

  1. Visit the “Health Professionals” section of the PBS website.
  2. Enter the medication name into the “Search term” box and click “Search”.
  3. If the drug can be prescribed under the Streamlined Authority system, this will be indicated in red text towards the top of the screen. Clicking on this text will display one or more four-digit Streamlined Authority codes.
  4. The practitioner needs to note the code that corresponds to the indication for which the drug is being prescribed.
  5. This code needs to be added to the prescription, either via clinical software or by writing it on the script paper.

This process can be sped up slightly by bookmarking the page containing the search box. Alternatively, prescribers may prefer to make use of the “Watch list”, a feature that allows frequently prescribed drugs to be stored in a pick list for faster retrieval.

PBS Offline

As the name suggests, PBS Offline is a packaged version of the PBS website that can be viewed on computers without an active Internet connection.

While the vast majority of prescribers now have access to the Internet at their primary site of service, this resource may be of benefit to prescribers who need to access the Streamlined Authority codes at aged care facilities, during home visits, or at other times when Internet access is not available.

The PBS Offline resource is available as a free download from the PBS website, with versions available for Microsoft, Macintosh and Linux operating systems. It is also available for order on CD via the PBS website for $25.

Personal Digital Assistants (PDAs)

The PBS is available in formats suitable for PDAs running Mobipocket, Vade Mecum or Plucker.

The PBS website warns that due to the size of the Schedule document, the first search conducted each month on a PDA may take up to 10 minutes! Fortunately, subsequent searches will be much more efficient.

PDF File

The entire PBS is available as a 680 page PDF file. Whilst the Streamlined Authority codes are listed in this document, the size and complexity of the document make it less than ideal for quickly retrieving the requisite codes.

Hardcopy

Until December this year, a number of copies of the Yellow Book have been made available for prescribers at no charge. After this time, copies of the Yellow Book will cost approximately $28.

Clinical Software

Best Practice, Genie Solutions, Medical Director (HCN) and Zedmed have released updated versions of their software that automatically inserts the four-digit Streamlined Authority code when a compliant medication is prescribed.

Best Practice users need to upgrade to version 1.5.3.382, which is available from the Best Practice website.

Genie users need to upgrade to version 7.4.6, and then import the latest MIMS drug data. Both the drug data and software update can be applied using Genie’s built-in software update mechanism.

HCN released updates to both Medical Director 2 and Medical Director 3 on CD at the end of June. An overview of the Streamlined Authority process in Medical Director is presented on pages 26-27.

Zedmed Clinical users need to upgrade to version 3.19, and then import the latest MIMS drug data. Both of these updates are available at the Zedmed website via the “Private Support Area”.

Other vendors, including Mediflex, Medtech Global and the Practice Management Software Company have indicated that they are in the process of developing updates for their software to better facilitate the streamlined process.

A/Prof Gullotta is thankful for the timely response of these vendors, acknowledging that the efficiency of the system for prescribers is heavily dependent on software integration.

“The GPs that I have spoken to that have computer software integration find it fantastic, easy to use and increases the amount of time they have for face to face consulting with the patient. This is a win for the doctor who will have less red tape to deal with, and a win for the patient who has more time with the doctor.”

Phone

Doctors who are unable or unwilling to access Streamlined Authority codes via other methods are still able to call Medicare Australia or DVA for authority codes.

Limitations

As indicated earlier, not all authority medicines are able to be prescribed under the streamlined system. As before, a phone call will still be required to prescribe Section 100 medications, items listed on the Repatriation Schedule of Pharmaceutical Benefits (RSPB), short term use items and quantities or repeats above those specified in the PBS schedule.

Going forward, new items recommended for listing on the PBS by the Pharmaceutical Benefits Advisory Committee (PBAC) may be considered appropriate for inclusion in the Streamlined Authority process. The addition of such items will likely be partially dependent on whether doctors prescribe newly “streamlined” drugs at historical levels.

Performance To Date

Given that the system has only been in place for a month, Medicare Australia and the PBS chose not to provide Pulse+IT with statistical data on the impact of the Streamlined Authority system. Anecdotal evidence provided by both Government organisations suggests, however, that the Streamlined Authority system has made an impact on the number of telephone authority requests.

Conclusions

The Streamlined Authority system represents a positive first step in the AMA's efforts to reduce the red tape associated with authority prescriptions.

It is likely that most prescribers will find the PBS website to be slightly more efficient than using the telephone to access authority codes, however clinical software that makes allowances for the streamlined system is by far the most efficient option available to doctors presently.

Thanks to a conserted effort by several clinical software vendors, the vast majority of prescribers already have access to such software. Practices that haven’t updated their software recently should contact their vendor and find out whether such functionality has been added.

Unfortunately, there will be thousands of prescribers using antiquated, discontinued or niche software solutions that will have no prospect of seeing this functionality added to their software. In conjunction with other recent and forthcoming government initiatives that hinge on actively developed practice software (e.g. paperless DVA claiming, Medicare Easyclaim, electronic prescribing), the Streamlined Authority system may flag to some practices, that their practice software may have reached the end of its useful life.

Posted in Australian eHealth

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