The ANAO is looking at how to make the scheme more efficient, and the RACGP strongly suggests that the authorities system is a good place to start.
Abolishing – or at the very least, seriously revamping – the PBS authorities system would go a long way to freeing up GP time and capacity, the RACGP has advised the Australian National Audit Office.
The auditor is currently looking into the governance and oversight arrangements of the $215 million Pharmaceutical Benefits Scheme, which is jointly administered by the Department of Health and Aged Care and Services Australia.
GPs are arguably the most important group of stakeholders when it comes to commenting on how the PBS is administered, given they write 87% of all prescriptions dispensed through the scheme.
Despite making up the vast majority of system end users, GPs – as the RACGP would tell it – get the rough end of the “unnecessary inefficiencies and complexities” created by the PBS authorities system.
“This administrative and bureaucratic burden ultimately takes valuable time away from providing care to patients, limits GPs potential to work to their full scope of practice and contributes to GP burnout,” the college’s audit submission reads.
“While there are multiple ways that GPs can obtain authority, the system is unintuitive and has not been designed with end users in mind.”
There are three ways to get authority: online, on the phone or through the post.
The trouble with the online PRODA authority system, the RACGP said, is that it logs you out after five minutes of inactivity, requires dual authentication at every log-in, fails to save patient details and makes it hard to access codes for medicines with multiple authority access codes.
In fewer words, the site “lacks basic functionality”.
The phone process to obtain authority approval also tends to be time-consuming for GPs and their waiting patients, but the postal method probably wins the prize for most Byzantine.
To do a postal authority script, GPs have to print out a paper prescription, post it to the PBS, wait for authorisation and wait again for the prescription and authority number to be mailed back.
All up, the college estimates this takes about two or three weeks.
There are two types of authority prescriptions: regular and streamlined.
Streamlined authority prescriptions don’t require prior approval except where the script is for a quantity or repeat which is larger than the usual PBS quantity.
Regular PBS authority scripts do require prior approval, which generally entails calling up the PBS and speaking to an administrative officer.
It’s usually required when writing scripts for a larger-than-usual quantity of medicine, a medicine that requires additional monitoring, an expensive medicine or a medicine that has an equivalent but equally effective option which cannot be used.
“If authority is required, then Streamlined Authority is sufficient to highlight particular use-criteria and provide data gathering,” the RACGP says.
The college also offered criticism on the way the PBAC makes decisions about what gets added to the scheme, arguing that decisions should be based on clinical evidence of patient benefit rather than cost benefit.
“While submissions from sponsors to the PBAC currently require them to provide a clinical evaluation of their medication, the focus is primarily on demonstrating value for money rather than an evidence-based clinical practice guideline approach to medication rebates,” the college says.
The audit office is expected to report back in mid-2024.