‘Never waste a good crisis:’ is rapid change good change?

The Pharmacy Guild has had its concerns about the “token” system for paperless scripts addressed, it says, but therapeutic substitution worries remain

COVID-19 has been a “catalyst” for rapid-pace change in the health sector, argues Suzanne Greenwood, executive director of the Pharmacy Guild of Australia.

She writes in Guild newsletter Forefront that “The internet can’t seem to agree on who first said, ‘never waste a good crisis’, but it is clearly an expression that has been taken to heart at many levels during this confronting and unwelcome COVID-19 pandemic”.

The pandemic has helped spur decisions which have cut through red tape as well as forced Governments and authorities to work together “in a way rarely seen in normal times,” she writes.

“In primary health, COVID has been a catalyst for change in quick time, much of it beneficial to consumers,” she says.

“For example, we have seen the advent of funded telehealth which has allowed doctors to diagnose and treat patients while isolating.

“We have seen the extension of continued dispensing which has allowed community pharmacists to ensure patients can continue to obtain their medicine at times when a doctor’s appointment is not available. There’s a strong case for the continued dispensing measure to be retained permanently.

“But while swift change in some areas can be refreshing and positive, we also need to ensure that it is handled carefully so that care is not disrupted, and patients benefit now and in the longer term.”

She highlights the issue of electronic prescribing with paperless scripts, which the Pharmacy Guild ultimately supports, though it has highlighted concerns with how this is to be implemented.

In late April it issued a statement saying that the “token” model could cause chaos, recommending that the Active-Script List (ASL) be prioritised “as it best supports a patient’s access to their medicines via electronic prescribing and best enables the community pharmacy to support this access”.

Ms Greenwood refers to these concerns in Forefront, and says they have been addressed following discussions with health agencies.

“The Guild publicly expressed caution about the unintended consequences that could flow from the accelerated introduction of electronic prescriptions, particularly at this time when community pharmacies are under so much pressure, and the prescribing of medicines through telehealth, with scripts faxed or emailed, is already requiring rapid adjustment of pharmacy systems,” she writes.

“I am pleased to say that after discussions with the Department of Health and the Australian Digital Health Agency, the Guild is now confident that the approach being taken towards the introduction of electronic prescriptions will involve appropriate testing and preparedness in relation to both the so-called ‘token’ model and also the ASL – Active Script List model – to ensure the feasible, efficient and safe introduction of the system for all patients, including those with chronic conditions requiring multiple medicines.

“We have had encouraging feedback from the Federal Department of Health regarding our concerns, and we believe a comprehensive testing and pilot phase will be undertaken of both the token and ASL models.

“With such a substantial change to existing paper-based prescriptions, it is inevitable that a range of unforeseen issues will arise.

“It is important that these issues are identified and addressed as early as possible in a safe and controlled environment prior to the commencement of any broader implementation of ePrescriptions.”

Ms Greenwood also highlights the issue of Serious Shortage Medicine Substitution lists, following the issuing of the first notice by the TGA last week, regarding metformin modified-release 500mg.

As reported by the AJP, both the Guild and the PSA have concerns about the way therapeutic substitution is now being handled in practice, including that substituted products will not attract a PBS subsidy, leaving patients to deal with extra out-of-pocket costs.

Also of concern is that each notice must be given effect under State or Territory law before pharmacists can supply according to the specified substitution.

Last week a Guild spokesperson said that “Pharmacists are medicines experts, and the straightforward dose and form substitutions these notices will allow are within the competence of every pharmacist in Australia to manage individually with their patients”.

“The Pharmacy Guild cannot support a complicated system.”

Now, Ms Greenwood reiterates that the Guild is concerned that the protocol for therapeutic substitution is too inflexible and cumbersome, as well as not attracting the normal PBS subsidy.

“We are also concerned that it does not allow community pharmacists to apply their professional skill, knowledge and discretion for which their training well equips them,” she writes.

“The Guild has been advised that each notice on the TGA’s new Serious Shortage Medicine Substitution list will likely require separate consideration of whether the substituted medicine will be eligible as a pharmaceutical benefit. If not covered, patients are faced with additional costs which are unacceptable.

“Pharmacists are medicines experts, and the straightforward dose and form substitutions involved are within the competence of every pharmacist in Australia to manage individually with their patients.”

She writes that the Guild plans to continue to work with the TGA and the health authorities across all Australian jurisdictions to “see if this change, therapeutic substitution – which we support in the interests of patients – can be implemented effectively in the most practical manner for the benefit of people increasingly affected by medicine shortages”.

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