The Government has moved on the continued dispensing instrument and therapeutic substitution – but do the changes announced today go far enough?
Pharmacy Guild Queensland branch president Trent Twomey has called for immediate removal of the “red tape” preventing full therapeutic substitution, and for the Government to ensure Australians continue to receive their PBS subsidy if accessing medicines under continued dispensing.
Federal Health Minister Greg Hunt announced on Tuesday that the Morrison Government had approved several temporary changes to medicines regulation, as a result of the COVID-19 pandemic.
These include continuing dispensing arrangements for the ongoing supply of PBS-subsidised medicines without a script, which will be extended to 30 June 2020.
“These temporary ‘continued dispensing’ arrangements allow people to obtain their usual medicines at PBS prices, even if they cannot get a new prescription from their doctor,” Mr Hunt said in a statement.
“Under strict conditions, pharmacists will be able to give patients up to one month’s supply of their usual medicine without a script, at the usual PBS consumer co-payment.
“The patient must previously have been prescribed the medicine and the pharmacist must be satisfied it is urgently needed.
“These measures were originally put in place in January in response to the widespread bushfires and were due to end on 31 March 2020, however will be extended following consultation with doctors and the community pharmacy sector.”
The Pharmacy Guild’s Trent Twomey said that this national arrangement differs from the arrangements previously announced in jurisdictions like NSW, Victoria and WA.
“Medication continuance or providing continuity of care requires changes at both a state and a national level,” he told the AJP.
“We have seen state and territory governments move in the last week to amend their emergency supply provisions that will, for the life of this crisis, enable pharmacists to ensure patients remain on their medications, regardless of whether they are able to obtain a prescription from their prescriber.
“The Commonwealth has today announced the extension of the continued dispensing instrument until the 30th of June, which is a welcomed announcement.
However, “The continued dispensing instrument only covers one supply in a 12-month period,” Mr Twomey noted.
“So whilst this crisis will go for many months, and the states have amended their legislation to ensure pharmacists can legally provide a month’s worth of medicine, after the patient has used their continued dispensing they will have to pay full private non-PBS prices for each subsequent supply.
“We are working with Minister Hunt’s office to ensure that if the restriction of one continued dispensing per month needs to be removed it will be so, to ensure that Australians not only receive their medication, but receive it at a price they can afford.”
He warned that under current severely adverse economic conditions including wide-ranging job losses, more Australians than ever may have difficulty affording their medicines.
“One core pillar of accessibility is price – which is why the Guild has been advocating for a lowering of co-payments,” he said.
“So if someone cannot receive their PBS subsidy, this decreases accessibility because some patients still simply choose to go without. It’s a big concern.”
The Pharmacy Guild has consistently opposed the optional $1 prescription co-payment discount since its inception, and for some time has instead suggested a $1 lowering of all prescription co-payments across the board.
Minister Hunt also announced that the Government is “implementing changes to allow community pharmacists to substitute dose strengths or forms of medicines without prior approval from the prescribing doctor, if a medicine is unavailable at the time of dispensing”.
“These changes will relieve pressure on busy doctors and allow patients to receive their medicines from their pharmacist without delay,” he said.
“The changes will allow, for example, a pharmacist to dispense different strengths of a product (such as two 20mg tablets in place of a 40mg tablet), or a different dose form of the same medicine (such as a capsule instead of a tablet).
“The changes will be implemented through the Scheduling Policy Framework and Poisons Standard, with implementation by States and Territories and the Government through the TGA.
“The Australian Government continues to consult on the implementation and the potential expansion of these substitution measures.”
Mr Twomey said that this was also a positive announcement, but more could be done.
“It does not help with the current situation regarding salbutamol metered dose inhalers, because there is no other form of salbutamol we can give,” he told the AJP.
“The Government and TGA are acutely aware of the Guild’s proposal to enable full therapeutic substitution which will enable pharmacists all around Australia, where salbutamol MDIs are unavailable, to substitute for the next closest thing, which may be a long-acting reliever instead of a shorter-acting reliever, and maybe a combination reliever and preventer.
“So the Government needs to immediately move on removing the red tape that prohibits us from ensuring continuity of care.”
Minister Hunt also commented on the new Home Medicines Service, which he said will complement the Government’s investment in telehealth, allowing people to consult with their doctor and receive a script remotely if this is appropriate, and have scripts filled remotely and the medicines delivered to their homes.
“The Government is fast tracking the roll out of electronic prescribing and dispensing through medical and dispensing software to make this even easier,” he said.
Overall, the Guild welcomed the changes.
“In the midst of a health crisis unprecedented in our lifetimes, this will help pharmacists across Australia to manage medicines for patients,” said national president George Tambassis.
“Australians need reassurance we’re on the frontline caring for them. This decision by Minister Hunt means pharmacists have a greater ability to care for our patients.”