Diabetes medication restrictions incoming

GPs will soon be forced to take additional steps to start their diabetes patients on saxagliptin with dapagliflozin (sold as Qtern 5/10) after its restriction level was upgraded.
 
As of 1 February, next year, the medication’s Authority Required listing will change from ‘streamlined’ to ‘telephone or electronic’, it was announced on Thursday.
 
The decision follows a Pharmaceutical Benefits Advisory Committee (PBAC) recommendation impacting medicines for the treatment of type 2 diabetes.
 
It comes after the Authority Required listing to initiate PBS prescriptions for glucagon-like peptide 1 receptor agonists (GLP-1 RAs) was similarly upgraded in June this year.
 
According to the Department of Health and Aged Care, those changes were made to ‘simplify and clarify’, despite long-held RACGP opposition to placing such restrictions on GPs.
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP he is worried about GPs having more red tape added to their already busy schedules.
 
‘My concern is that the change will again impact GPs’ workflow and time managing their diabetes patients,’ he said.
 
RACGP Expert Committee – Quality Care Member Dr Michael Tam told newsGP that while he understands the reasoning behind the decision, he agreed that it will bring with it an increase in workload.
 
‘What they’re saying is that some of the medicines appear to be prescribed not entirely within the restrictions of the funding guidelines, and there is a desire to want to do something about it,’ he said.
 
‘In particular, trying to move things so that the funding for those particular medicines is more aligned with the guidelines for the funding.
 
‘And the challenge here is that the funding guidelines are quite a bit narrower than the clinical utility of the medications themselves.’
 
The changes follow the 2022 DUSC review into the cost of medicines in treating type 2 diabetes, in which raised several significant issues related to prescribing outside of the pre-existing restrictions.
 
However, GPs are also reporting that their workload is already ‘immense’, with the annual Health of the Nation report finding the stress associated with red tape is among GPs’ greatest concerns.
 
It found that 60% of GPs are dissatisfied with the amount of administration involved in their work.
 
At the same time, about 12% of all GP appointments are for type 2 diabetes alone, 1% are for type 1 diabetes, and 1% for gestational diabetes.
 
With those numbers, already time-poor GPs fear the PBAC recommendation will significantly boost their administration burden and leave them to navigate a ‘outdated’ system.
 
Dr Tam has noticed GPs’ administrative workload creeping up over the years, and said it can begin to take time away from the heart of the role – seeing patients.
 
‘Some of this relates to, in the modern world, being able to justify decisions and having information in systems that are accountable and can be audited,’ he said.
 
‘I can understand all that, but that move has increased and those compliance costs have increased administration, definitely, and it is largely not the bit that the patient will take away as improving the care.
 
‘These are systems which do need to occur if you want to improve care and the system of care, but where I think the administrative load of and administrative systems are not really doing that, we really should be asking a question of, “why are we asking people to do that sort of work?”
 
‘Does it actually improve quality of care? And if it doesn’t, why are we asking people to do it?’
 
Dr Deed said there are several other approaches which are ‘much more seamless and less costly bureaucracy’.
 
‘Rather than utilising what is an antiquated and time-consuming system, why doesn’t the PBS invest in modernising approaches?’ he queried.
 
‘It should work with software prescribing developers to introduce “gatekeeping”, so that the combination drugs in question cannot be prescribed in the software without evidence of the use of metformin or sulphonylurea drugs in the patient record.’  
 
According to the PBAC, the total annual expenditure on type 2 diabetes medicines increased from $516 million in 2017–18 to $756 million in 2021– 22.
 
A recent landmark diabetes investigation also called for sweeping changes to treatment and medication access, with the number of people living with diabetes in Australia increasing 2.8-fold, from 460,000 to 1.3 million, in the past two decades.
 
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