‘Profession-wide confusion’ over handling of digital scripts

NSW, WA join Victoria in allowing pharmacists to supply medicines using digital images of scripts, but PSA shares pharmacists’ frustrations with the measures

WA doctors and other prescribers who conduct a telehealth consultation can now send a digital image of the prescription to the patient’s preferred pharmacy, to authorise dispensing.

Under normal rules, a prescriber must send the patient’s hard copy paper prescription to a pharmacy to allow dispensing by the pharmacist.

Effectively immediately from Saturday 11 April, the WA Chief Health Officer approved the emergency notice under the Public Health Act to amend prescription rules for telehealth consults conducted during COVID-19.

Upon receiving a digital image of a prescription from the prescriber, pharmacists in the state can now dispense the prescription and supply the medicine to the patient “without delay,” says the WA Department of Health.

Both the prescriber and pharmacist will still need to keep full records. This temporary arrangement will remain in place until 30 September 2020.

The arrangements are intended to complement special arrangements recently announced by the Commonwealth Government, that allow supply of PBS medicines through a digital image.

Meanwhile from Friday 17 April, doctors and nurse practitioners in NSW will be able to send digital images of prescriptions to pharmacists via email or fax.

NSW Minister for Health Brad Hazzard said the state’s rule only allowing scripts to be sent by email or fax rather than via text to a pharmacist will stop potential prescription forgery and diversion to the criminal supply chain.

“These changes are designed to make accessing your medications easier and safer, particularly for those in the community with chronic conditions,” Minister Hazzard said.

“It ensures people with compromised immune systems will not need to go to the doctor’s surgery in person and can get their script entirely through a telehealth appointment.”

NSW branch president of the Pharmacy Guild, David Heffernan, welcomed the changes and thanked the government for its “tireless” efforts during the COVID-19 health crisis.

“Telehealth has imposed extra challenges in pharmacy, so this will help alleviate some of those,” he told AJP.

“We’re getting overloaded with faxes and emails. This allows us to dispense medications with the image as a script, without the paper script being sent anymore.

“Each state and territory will have to do their individual part in getting the changes through. Ultimately it’s good for pharmacists and the patients, and it’ll prevent double handling and improve claiming times as well,” said Mr Heffernan.

He noted that GPs must send prescriptions to the pharmacy, and not to the patient.

Victoria was the first jurisdiction to pass the emergency measure allowing digital scripts alone, after the Federal Department of Health announced the new special arrangements.

PSA national president Chris Freeman applauded Victoria’s leadership, as well as the changes in WA and NSW, and called for all remaining states and territories to follow suit “as a matter of urgency”.

However he expressed frustration on behalf of pharmacists across the country.

“I am getting an enormous amount of feedback, concern and frustration from you all on the issue of digital image prescriptions and the increasing confusion, workload and stress that this measure is causing,” he said on Tuesday in a message to members.

“There is particular confusion given the Australian Government factsheets did not effectively communicate that state and territory regulatory changes were required prior to supplying of medicines under this arrangement become lawful,” said A/Prof Freeman.

“Many of you from all around Australia are being left in a quandary and are stuck in the middle between the federal legislative instrument and the state and territory regulations.

“This is causing profession-wide confusion, greater workload and more administration at an already frantically busy time.”

A/Prof Freeman had previously spoken to AJP about pharmacists being sent scripts by fax or email, with some GPs expecting pharmacies to then pick up the paper scripts or supply funds themselves to have them posted.

In some cases there has been a “complete lack of clarity” on where the script should be sent, with some patients being given the digital copy of the script.

Additionally there have been cases of GPs forwarding images of scripts in states and territories that have not yet passed the appropriate legislation.

A/Prof Freeman said he has made representations about these issues with both the Department of Health and Minister of Health’s office.

“I have made it clear that it is unacceptable that pharmacists are expected to break the law to provide patients with their medicines,” he said.

“GPs are heeding Commonwealth advice that they can send prescriptions electronically without forwarding a hard copy, with the legislation in the states playing catching up.

“PSA is working with the state and territory governments to accelerate this as quickly as possible in a way to minimise the additional burden this has caused you all. We understand what the Government is attempting to do in keeping the community safe – but this has to be done in a way that does not expose pharmacists to professional risks from being forced to break the law.”

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