This decision means more rural Australians will die from anaphylaxis, GPs warn.
The Pharmaceutical Benefits Advisory Committee has reportedly ended long-standing arrangements allowing GPs with special dispensation to initiate PBS-eligible adrenaline prescriptions for their anaphylactic patients.
One GP working in the allergy space called the decision “dangerous and regressive”, while a rural doctor warned that “more people will die”.
As reported by NewsGP, the PBAC wrote to GPs it classified as “non-specialist prescribers” of adrenaline in June to advise them that they could no longer initiate PBS-subsidised treatment.
This will include the newly PBS-listed adrenaline nasal spray, Neffy (CSL Seqirus).
All GPs will still be able to initiate PBS-funded adrenaline if they are working in consultation with a specialist immunologist or paediatrician or if their patient has been discharged from hospital after an acute anaphylactic reaction.
The only other way for patients to obtain a PBS-funded adrenaline script is to see a specialist paediatrician, immunologist or respiratory doctor.
GPs can continue to write private prescriptions for adrenaline, but patients will have to pay between $120 and $190 rather than the $25 PBS co-payment.
According to RACGP Quality Care Expert Committee deputy chair Dr Rowena Ivers, low-income and rural patients will wear the brunt of the decision.
“Probably the biggest issue for people in rural and remote areas, or people on low incomes, is the need to access public clinics,” she told The Medical Republic.
“The waiting lists are very long for any of those specialists – for respiratory specialists, for paediatricians – and many rural towns will not have access to an immunologist.
“Even for something like a paediatrician or respiratory specialist, it could be a two- or three-year wait list in the public system to get that first review for allergy or anaphylaxis, so … [certainly] it would be appropriate for it to be more widely available.
“Essentially, it’s about saving people’s lives.”
ACRRM president Dr Rod Martin called the PBAC decision “ridiculous” and pointed out that the risk to patients in rural areas compounds further when you consider that paramedics have to travel greater distances.
“The danger is probably the key part of it,” he told TMR.
“And what does the government expect – that we should be teaching people how to use vials and syringes instead?
“When they’re in the middle of anaphylaxis and they’re already panicked enough, they need to have a very simple thing – exactly the same thing that people in Sydney, Melbourne, and Brisbane get easy access to by, you know, getting probably an appointment within six or eight weeks to be able to get it done.”
He was under no illusions as to the likely consequences.
“I’m assuming the government … and PBAC in particular is just going to wear the fact that more people will die because they don’t get access to [adrenaline],” Dr Martin said.
And the reason for all of this?
The law which underpins the PBS – the National Health Act 1953 – does not support exemptions where a medicine is restricted to certain subspecialists.
“The withdrawal of PBS adrenaline initiation exemptions for rural and regional GPs is a dangerous and regressive decision that exposes patients to preventable harm,” GP and Australasian Society of Clinical Immunology and Allergy Medical Associates representative Dr Kathryn Heyworth told TMR.
“The PBAC has justified the change by citing provisions of the National Health Act 1953, policy developed for a very different healthcare system than today.
“The National Allergy Strategy has been clear that GPs are central to allergy care in Australia. Adrenaline prescribing policy should reflect that reality, not undermine it.”
Related
Dr Heyworth also raised coronial findings across multiple states which have highlighted the consequences of failing to prescribe adrenaline to patients at risk of anaphylaxis.
“This decision risks recreating the circumstances coroners have warned about: delayed access to adrenaline, missed opportunities for prevention, and potentially catastrophic outcomes during a first recognised anaphylaxis event,” she said.
“GPs are experts in assessing risk and managing uncertainty. Restricting their ability to initiate adrenaline does not improve safety.
“Instead, it increases inequity and places patients, particularly those in rural and regional communities, at greater risk of harm.”
According to NewsGP, the PBAC has requested that PBS restrictions for adrenaline be reviewed and stakeholder feedback be sought at a later date.
“As the PBAC reviews these restrictions, it is essential that all GPs regain the ability to initiate PBS-subsidised adrenaline when clinically indicated,” Dr Heyworth said.
Until such a time, she said, GPs can continue to write private prescriptions for patients at risk of anaphylaxis and continue to clearly document risk of anaphylaxis in patient records.
She also encouraged GPs to discuss the situation with their local allergy and immunology service to see what processes they may require to get rapid approval for initial PBS scripts and how they can work “in consultation”.
TMR contacted the Department of Health, Disability and Ageing for confirmation of and comment on the PBAC decision but did not hear back before deadline.
