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GPs concerned over ‘disruptive’ fluticasone PBS restrictions
Patients aged six and under will now have to be seen by a paediatrician or respiratory physician to access a PBS script for the asthma medication.
Patients aged six and older will no longer be eligible for a PBS subsidy for fluticasone propionate 50 micrograms.
GPs will no longer be able to prescribe fluticasone propionate 50 micrograms under the Pharmaceutical Benefits Scheme (PBS) to patients aged six and under, unless they have first been seen by a non-GP specialist.
The change, effective as of 1 April, applies to the General Schedule (Section 85) listing for fluticasone propionate 50 microgram/actuation inhalation 120 actuations medication (sold as Axotide Junior and Flixotide Junior), which is indicated for the prophylactic management of asthma.
It means patients aged under six who are starting the treatment will need to be initiated by a respiratory physician or a paediatrician, after which a GP or nurse practitioner will be able to prescribe continuing treatment.
Dr Kerry Hancock, Chair of RACGP Specific Interests Respiratory Medicine, told newsGP the changes are ‘disruptive’ to asthma management and come at a time when GPs are already inundated.
‘It’s confusing for GPs … [and] is just one more thing to have to deal with on top of everything else that GPs are dealing with at the moment,’ she said.
‘And, most importantly, it’s confusing for patients because they don’t understand the nuances of the PBS and the Pharmaceutical Benefits Advisory Committee [PBAC]. They just know that when they’re going to go to the pharmacy, they either cannot get their script dispensed or they have to pay extra.’
Dr Tim Senior, who is a member of Asthma Australia’s Professional Advisory Council, has been vocal about the changes on Twitter.
A GP at the Aboriginal Community Controlled Health Service in Southwest Sydney, he told newsGP the changes have real health equity consequences.
‘There are no bulk billing paediatricians in Campbelltown anymore and that’s going to be true for other areas as well,’ Dr Senior said.
‘So, for any patient who can’t afford the co-payment to see a paediatrician, essentially that means that they are unlikely to be able to afford a private prescription for fluticasone – and so they’re just blocked off from receiving that medication at all.
‘There are real health equity consequences to that where there’s the cost of seeking care and the cost of prescriptions that will prevent some people from getting appropriate treatment – and that has consequences.
‘Asthma that’s not managed well enough can be a really serious condition.’
Meanwhile, Dr Senior says even those patients who can afford to see a non-GP specialist to initiate treatment will likely have to endure a substantial wait to be seen by a paediatrician, adding to the pressure on already stretched services.
Having spoken to many of his GP colleagues and others working in the paediatric space, Dr Senior says they are all perplexed as to why the change has occurred, citing a lack of transparency from the Department of Health and Aged Care (DoH).
‘Everyone’s been saying the same things really … we’re managing this routinely and this puts significant barriers in the way of doing that,’ he said.
‘And the paediatricians I’ve spoken to say the same thing; they don’t want their lists to be filled with things that they don’t need to be managing – it’s not great use of their time either.’
Changes to the PBS listing will also impact patients who are aged over six, as they will no longer be eligible for a PBS subsidy for fluticasone propionate 50 micrograms.
‘They will be required to see their GP or primary prescriber, as they will have to switch to an alternative PBS reimbursed medicine or consider use of private prescriptions,’ the PBS website states.
‘Health practitioners can switch fluticasone propionate 50 micrograms per dose to an alternative PBS reimbursed medicine in patients aged six years and above.’
The DoH did not answer questions from newsGP as to why the decision to initiate patients aged six and under has been restricted to non-GP specialists. However, a spokesperson did say that the Federal Government ‘relies on the advice of the PBAC’ to make changes to the PBS.
‘The PBAC considered that patients aged six years and above would be able to switch to other PBS listed alternatives,’ the spokesperson told newsGP.
Alternative PBS reimbursed medicines with equivalent dosing to fluticasone propionate 50 micrograms twice daily for patients aged six years and above include:
- Budesonide 100 micrograms per actuation powder for inhalation, 200 actuations (twice a day for children aged six and above)
- Beclometasone dipropionate 50 micrograms per actuation breath activated inhalation, 200 actuations (twice a day for children aged six and above)
- Beclometasone dipropionate 50 micrograms per actuation inhalation, 200 actuations (twice a day for children aged six and above)
- Ciclesonide 80 micrograms per actuation inhalation, 120 actuations (once daily for children aged six and above)
While these alternatives are available under the PBS, Dr Senior notes that any change in medication comes with confusion for people and families.
The Sydney-based GP says the changes are ‘concerning’ and have come as other professions in healthcare are talking about working to the top of their scope of practice, while he says GPs’ scope appears to ‘constantly be being reduced’.
‘
We can’t bill Medicare for reading an ECG, we have restrictions on requesting MRI scans, [we’re] being
told that we can’t do mental health properly and [we have] restrictions on other medications like for ADHD and for acne,’ Dr Senior said.
‘It’s yet another restriction on practice that we would do every day and
the guidelines are aimed at GPs for management – that just seems weird. And it comes in that context for general practice – that under-appreciation of the work that we actually do, which is necessary for the health system.’
While the DoH spokesperson did not give any further insight into the PBAC’s advice, which underpinned the changes, they did say that the PBAC would ‘welcome any further submissions from medicine sponsors or clinicians to make any further amendments to these PBS restrictions at any time’.
GPs can access further information on the changes via the PBS website.
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