RACGP calls for online portal for PBS authority medications
The Department of Health (DoH) is holding public consultations on the authority requirements for prescribing certain PBS medications to gauge opinion on what items should be moved to the streamlined listing or whether prescribing should be unrestricted.
Long a bugbear for many GPs, the authority requirement means doctors must request approval in writing or more commonly by phone to prescribe certain PBS drugs. In addition to taking time during regular consultants with patients, it is seen as a particularly onerous burden for GPs visiting aged care facilities.
According to figures from 2009, of the 6.4 million calls made to the authority phone line, only 2.8 per cent resulted in an authority being denied.
In June, interested parties were asked to make submissions on the terms of reference for a post-market review of authority required PBS listings following the findings of an earlier review into chemotherapy funding arrangements. That review found that authority required listings caused a significant regulatory and administrative burden to prescribing oncologists.
The review into authority requirements is now open to public submissions. The submissions will be collated and presented to the Pharmaceutical Benefits Advisory Committee (PBAC) in time for its November meeting.
The department is recommending that the review be undertaken in three tranches based on the regulatory burden they currently place on prescribers. Those medications that represent that largest number of phone authority requests or the most complex form-filling will be looked at first.
These include drugs for the treatment of many cancers, multiple sclerosis, rheumatoid arthritis and other arthritis medicines. The department is planning to present these drugs to the PBAC in November, followed by a second tranche of drugs for eye conditions, psychiatric conditions and cardiovascular disease in March next year.
All of the other drugs on the list as well as medicines for palliative care will be presented in a third tranche in July 2015.
In its submission, the Royal Australian College of General Practitioners (RACGP) called for the current system to be replaced by an online portal to speed up the process and reduce red tape. The college said the introduction of an online portal to obtain authority approval would substantially reduce red tape and increase efficiency.
“The RACGP recommends that an online portal is considered in place of, or alongside the current phone authority system,” the college wrote in its submission.
It also recommended that telephone authority be removed when the prescriber wants to increase the quantity of medications after initial authority has been obtained for a number of classes of drug, including antidepressants, antipsychotics, anticonvulsants, antibiotics, antihypertensives, anti-reflux medications and antiemetics.
The submission said that a review of the move to the streamlined authority system in 2007 – in which a four-digit number needs to be recorded for medicines for stable long-term conditions with stable dosage requirements – showed no changes to prescribing patterns or rates, meaning GPs were not overprescribing these drugs.
“GPs are responsible prescribers,” the submission states. “The RACGP believes that the authority system is unnecessary as there are already established quality control measures in place to monitor and regulate responsible GP prescribing.
“Recent studies indicate over 90% of Australian general practices use electronic prescribing software, with in-built indicators of any authority listing and associated warnings.
“The National Prescribing Service is another support to GPs in their prescribing practices, aiming to improve the health of Australians through Quality Use of Medicines (QUM). The QUM principles assist GPs to select medication management options wisely; choose suitable medicines; and use medicines safely and effectively.”
It also recommended that all prescription medications commonly used in residential aged care facilities, including S8 drugs, be put on the streamlined list as a means to reducing the red tape and high cost and administrative burden on GPs, which the college says discourages many GPs from providing services to RACFs.
In its submission, the Australian Medical Association (AMA) said only about 70 per cent of calls to the phone line were answered within two minutes. It wants the full cost of the authority requirement to be assessed, and that if medicines still require an authority, the process be properly resourced.
The Pharmacy Guild said PBS items should not need an authority unless there were sound clinical or economic reasons for it. It also wants to do away with the necessity for streamlined items to be written on a special form when a regular form could be used and the streamlined code included next to the prescription.
This would necessitate a simple change to prescribing and dispensing software, the Guild said.
Posted in Australian eHealth