Dosing on the agenda

Decision on PPI double dosing deferred by PBAC, but support given to antibiotic listing changes

The Pharmaceutical Benefits Advisory Committee (PBAC) has deferred a decision on whether to allow twice daily dosing of PPIs for approved patients.

PBAC had been asked to consider changes following feedback received by the Department of Health concerning the PBS restrictions for PPI medicines, implemented on 1 May 2019.

At its August 2019 meeting, the results of which were release on Friday 5 October, PBAC “did not recommend making further changes to the PBS PPI restrictions which have been in place for less than four months at this time,” the meeting notes stated.

The May 2019 restrictions for standard dose PPIs do not allow twice daily dosing.

“The Australian Therapeutic Guidelines suggest that if high dose therapy is required for symptom therapy in GORD, then the standard dose given twice daily is more effective than a high dose given once daily,” PBAC noted.

“PBAC expressed concern that under the 1 May 2019 revised restrictions there may be some unintended movement of those patients unable to achieve symptom control with standard dose PPIs prescribed
daily to the high dose PPI (esomeprazole 40 mg) taken daily.

Conversely… re-allowing PBS-subsidised increased maximum quantities of standard dose PPIs for GORD risks returning to the situation where high daily doses of PPIs were overused for longer than necessary”.

The ability for individuals requiring twice daily dosing to be prescribed increased quantities of low dose PPIs remains an option via telephone authority, PBAC noted.

It agreed to “review the concerns raised” on a regular basis and requested that the Department of Health continue to monitor the situation and provide an update to the December 2019 PBAC intra-cycle meeting.

Meanwhile, PBAC did recommended changes to antibiotic listings for high use items on the PBS with repeat prescription options.

“PBAC recommended the removal of repeat options for a range of listings where no repeats were deemed necessary as per the Therapeutic Guidelines,” the committee decided.

“The PBAC also recommended aligning the listings for specific indications to the Therapeutic Guidelines where increased quantities are clinically indicated.

It said the recommended changes, “aligned as best possible with the current version of the Therapeutic Guidelines (version 16), would support antimicrobial stewardship and quality use of medicines as well as assist in the reduction of antimicrobial resistance”.


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