A prescriber’s guide to 60-day dispensing.
As of the beginning of this month, GPs can write scripts for 60 days’ worth of the 90 medicines that have been deemed eligible by the PBS for extended prescriptions.
This is the first of three tranches of medicines that will be approved for 60-day prescribing, with additional medicines to be included in the scheme next year.
Speaking at a webinar for prescribers yesterday, Department of Health and Aged Care health resourcing deputy secretary Penny Shakespeare said that which medicines will be available when is still under review.
There have now been 247 additional PBS items added, to represent 60-day prescriptions for different forms, strengths and presentations of the 90 medicines in the first tranche.
Ms Shakespeare noted that all prescribing software should now be updated to reflect these 60-day dispensing updates, but to contact the Department if yours isn’t.
Now, when prescribers search for one of the 90 medicines currently eligible for double dispensing, they should be presented with a PBS item code for 30-day and 60-day dispensing, both of which will remain available.
Handwritten prescriptions will need to specify whether 30 or 60-day quantities will be dispensed.
It remains up to prescribers to decide whether a patient is eligible for longer scripts.
“As prescribers you will make the clinical decision about whether 60-days prescriptions are appropriate for your patients with ongoing health conditions who are on a stable medication regimen,” said Ms Shakespeare.
According to Ms Shakespeare, the scheme is designed to benefit patients with chronic conditions.
“Only patients with certain chronic medical conditions who are stable on their current treatment regimen will be eligible for the increased quantity,” she said.
“The first stage of medicines eligible for 60-day dispensing are for patients living with chronic health conditions including cardiovascular disease, Crohn’s disease, gout, heart failure, high cholesterol, hypertension, osteoporosis and ulcerative colitis.”
She added that some medications may be available for 60-day dispensing for some indications but not others.
When asked why some combination strengths are available for 60-day prescribing and other are not – specifically for amlodipine and atorvastatin used to treat chest pain and high blood pressure – assistant secretary of the DoHAC’s pharmacy branch David Laffan said the question would be taken on notice and more information would be added to the DoHAC website soon.
For patients with multiple morbidities, they may be eligible for 60-day scripts for some conditions or some medicines but not others.
Patients on eligible medications will need to return to their GP for 60-day scripts – already written prescriptions will not be automatically updated.
Mr Laffan said that where prescribers were allowed to seek permission to increase maximum dose for medications – authority PBS prescriptions – this will still be allowed for 60-day scripts.
The DoHAC has created an information kit for prescribers on its website.
According to Ms Shakespeare, the 90 medicines that are now eligible for 60-day scripts will represent a third of all the medicines that will be available for 60-day dispensing.
In the webinar, she outlined why some medicines have been selected for eligibility and others haven’t.
Medicine whose stockpiling could pose a safety concern, such as narcotics or paracetamol and codeine, have not been included. Neither have medicines that require monitoring and regular dose titration, or if the disease is not expected to be stable for at least 12 months.
Medicines used for short-term-management diseases, medicines that have been listed for less than five years and high-risk drugs have also not been included.
Antidepressants can be prescribed for 60 days, where deemed clinically appropriate.
The medicines included in future stages of the rollout will likely include treatments for asthma, breast cancer, chronic obstructive pulmonary disease, constipation, chronic renal failure, depression, diabetes, endometriosis, endometrial cancer, epilepsy, glaucoma and dry eyes, hormonal replacement and modulation therapy, and Parkinson’s disease.
As established in previous webinars, Ms Shakespeare said that 60-day dispensing will not change the PBS safety net.
For some patients, the savings from the 60-day dispensing initiative will mean that they no longer reach the net threshold, she said. For others, they may reach the threshold later in the year. But no one will pay more than the threshold amount and monthly costs are likely to decrease in 2023, she added.
The PBAC is working on extending the time limit for the PBS safety net early supply rule – meaning that repeat scripts can only be dispensed with a gap of 50 days for 60-day scripts, rather than the current 20 days, to be contribute to the safety net threshold to hopefully curb stockpiling.
For patients, medicines priced over the $30 copayment amount will only incur the one copayment fee when picking up 60 days’ worth of medicines, meaning a $30 copayment will be saved with each prescription.
For medicines under the $30 copayment, they will remain priced by the pharmacy, meaning that patients may pay the same for a 60-day script as for two 30-day scripts.
“The size of the discount offered for under PBS copayments is at the discretion of each pharmacy and can vary from pharmacy to pharmacy and over time,” said Ms Shakespeare.
The move is expected to impact six million patients, affording a potential $180 of savings in copayments, or more if on multiple medications, and hopefully free up GP appointments.
Overall demand is expected to stay the same, but Mr Laffan said it’s “too early” to tell what the trends are.