Pharma-prescribing ‘not the way’ to improve access

5 minute read

Victorian pharmacists will receive two to seven hours of online training for each program and be ‘expected’ to keep GPs in the loop.

The Victorian government has release long awaited information on its community pharmacist pilot, which will commence next month without its “mild skin conditions” stream, which is delayed until later this year.

Speaking to The Medical Republic, AMA Victoria president Dr Jill Tomlinson said she remained concerned at the “ambitious array” of medications the pilot incorporates, and said the notion that sufficient training and guidance could be implemented to commence all four arms of the pilot by October was not practical.

“The number of conditions that pharmacists are being authorised to dispense medications for in Victoria is broader than in any other state despite there, to the best of our knowledge, being no clear needs case established for such a broad program,” she told TMR.

Victoria has now opened its door to EOIs for the pilot, inviting pharmacy owners who meet the eligibility criteria outline on the website to complete the around five-minute form to opt in to participate. 

Pharmacies that are validated and approved to participate in the scheme will receive a funding agreement from the Department of Health, allowing eligible pharmacists to begin training next month and prescribing later that month.

The pharmacist information pack, issue by Health Victoria on Friday, noted that training for the four services – treating uncomplicated UTIs or skin conditions, prescribing oral contraceptive or administering travel vaccination – should only take two to seven hours per service.

Dr Tomlinson raised concerns that time estimates of training module “may not be reflective of the real-world application”, noting that she was able to successfully complete the Queensland UTI pharmacist prescriber training in 15 minutes.

“One of the concerns is making sure that the training is appropriately rigorous, and that pharmacists will be able to understand and follow the criteria,” she said.

“Because we did see in the Queensland UTI trial examples where patients were treated outside the eligibility criteria, which brings up important safety risks for patients.”

According to the information pack, the protocols will clearly outline who will be eligible to participate in each of the pilot’s four streams and who will need to be referred to a GP.

“The protocols have been developed using evidence-based approaches by Safer Care Victoria and the department, with oversight from the pilot’s clinical reference group, and travel medicine experts,” the information pack said.

Each pharmacy will be able to independently decide which of the four services it will provide but are “encouraged” to offer them all.

The government has placed no requirements on when services start or operating hours for participating pharmacies.

Pharmacists will need to obtain consent from patients receiving pilot-related services to update their GP, and to update My Health Record.

“Integrated care is an important aspect of the pilot, and the patient’s usual GP is expected to be provided with information on the patient’s condition and treatment,” the pack read.

The pack also suggests pharmacists should encourage patients to find a regular GP.

As previously specified by the government, prices for medication provided through the protocol aim to reflect the expected price if the patient had accessed it via the PBS, with government reimbursing pharmacies any gap cost.

But the update has specified that the protocols for UTI, OCP and skin management prescribing will outline maximum prices that patients could be charged – including specification for general patients, concessional patients, those eligible for Close the Gap and those without a Medicare card.

“For international students and people without a Medicare card, the cost will be the same as if the medication was purchased under the PBS.”

Pharmacists will be required to notify patients that any medications access through the scheme will not contribute to the PBS safety net during their consent consultation.

For the vaccination services provided through the pilot, the reimbursement from the government of $20 per patient receiving at least one vaccination is designed only to cover admin and data entry.

“Pharmacies may charge the patient a consultation/vaccine administration fee, plus the cost of any administered vaccines. The department will not set any cap on this fee,” noted the pack.

While Dr Tomlinson said AMA Victoria acknowledged “that Victoria needs to address access and affordability problems in primary care”, she added that “this model is not the way”.

“The refusal by government to conduct this experiment as a registered clinical trial raises serious concerns about transparency and the rushed implementation of this election promise,” she said.

“Working to establish dispensing of medications in retail pharmacies without prescription, which is against the recommendations of the TGA – and in fact against the Pharmacy Guild’s own guidelines – does increase risks for Victorians.

“We should instead be working to embed pharmacists within general practice and primary health care settings, which is done successfully in other countries.”

In response to the AMA Victoria’s letter to the Victorian government expressing “serious concerns” over the pilot, the association was simply directed to the pilot’s website. No additional information responding to their concerns was provided, according to Dr Tomlinson.

The results of the pilot will be independently evaluated in October 2024.

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