GPs lose PBS adrenaline prescribing exemption

An exemption held by some GPs to initiate adrenaline under the Pharmaceutical Benefits Scheme (PBS) has been scrapped in a move some experts fear may cost lives.
 
In an email seen by newsGP, the Pharmaceutical Benefits Advisory Committee (PBAC) last month wrote to GPs classified as ‘non-specialist prescribers’ of adrenaline, advising that they could no longer initiate the PBS-subsidised treatment.
 
‘The Department of Health, Disability and Ageing, in collaboration with the PBAC, recognises that for many years, exemptions to PBS restriction criteria were available to prescribers in certain circumstances,’ it read.
 
‘However, it is important to note that this practice was not supported by the National Health Act 1953.’
 
As a result, GPs can now only initiate PBS-subsidised adrenaline if done in consultation with a listed specialist, or if a patient has been discharged from hospital or an emergency department after treatment with adrenaline for an acute allergic reaction with anaphylaxis.
 
‘We understand these changes may have an impact on your practice and your patients, and we want to assure you that the Department is actively assessing the scope of these issues,’ the PBAC said.
 
‘The PBAC has requested that the PBS restrictions for adrenaline be reviewed, and the Department will seek feedback from relevant clinical groups for PBAC’s consideration at a subsequent meeting.’
 
But RACGP Expert Committee – Quality Care Deputy Chair Professor Rowena Ivers said affordability and access must remain key.
 
‘Access to adrenaline is about saving lives and this needs to be the first consideration,’ she told newsGP.
 
‘For many people with allergies, if they are unable to afford adrenalin, it may be too late to receive adrenaline by the time an ambulance reaches them, or by the time that they reach an emergency department.’
 
Dr Nick Cooling, Chair of RACGP Specific Interests Allergy, told newsGP it is a ‘very concerning and surprising decision’.
 
He said several rural and regional GPs have received the letter ‘out of the blue’, stating that ‘the ability to grant exemptions was discontinued in May 2026’.
 
Dr Cooling said they had received an exemption around 15 years ago to initiate adrenaline, to overcome access barriers for GPs and patients, and to alleviate demand on existing non-GP specialists.
 
‘The whole idea of that exemption was to allow greater access in rural and remote areas,’ he said.
 
Between 2015–20, hospital presentations and admissions for anaphylaxis increased by 51% and 35% respectively, according to the Australian Commission on Safety and Quality in Health Care, growing to more than 11,500 presentations annually.
 
Dr Cooling said the loss of his exemption will create a ‘domino effect’ on other GPs in his under-serviced region in Tasmania, who had previously consulted him to initiate adrenaline in new patients.
 
‘For the other GPs in my community who are consulting me as the initiation prescriber, it’s much easier to get to me rather than see or consult a specialist,’ he said.
 
He also fears the exemption has been removed from other GP prescribers of other PBS-listed medications.
 
A Department of Health, Disability and Ageing spokesperson told newsGP exemptions to the circumstance under which a PBS medicine is listed are not supported under the National Health Act 1953.
 
‘PBS listings, including any restriction criteria, are recommended by the independent PBAC, based on clinical and financial data from the pharmaceutical company supplying the medicine and input from health professionals and consumers,’ they said.
 
‘The PBS restrictions for adrenaline require prescribing by, or in consultation with a specialist.’
 
Professor Ivers said the change ‘may be a case of cost-shifting to consumers away from the PBS’.
 
‘Normally PBS covers much of the cost of auto injectors, with patients paying $25, and pharmacists can also dispense adrenaline auto-injectors as private scripts,’ she said.
 
‘However, a typical cost for adrenaline auto-injector or [Neffy] might be $120 to $190, which many people will not be able to afford.’
 
She said geographical isolation also meant longer waiting times for specialists, and longer trips to emergency departments.
 
‘The issue is that in rural areas there may not be immunology services, and there are long waits to see paediatricians and respiratory physicians,’ she said.
 
‘As an example, wait times to see public paediatricians might be three years. As a GP who has worked in rural and remote settings knows, transport times to emergency care are also longer in rural areas.’
 
Dr Cooling also believes the decision may be an attempt to rein in costs, but says this could instead be achieved by enabling GPs to initiate adrenaline prescriptions.
 
‘There may be a cost factor they’re concerned about, but at the end of the day, a person either has anaphylaxis risk or they don’t,’ he said.
 
‘It’s going to be much more effective for the health system to get GPs to initiate. It might be slightly different in terms of the PBS cost overall, but certainly in terms of health costs to the community, this is going to save a lot of money if GPs can prescribe the initiation of adrenaline.’
 
Dr Cooling said GPs are ‘very well versed in the diagnosis of anaphylaxis’ and are responsible when prescribing.
 
Potential barriers to adrenaline access were mentioned in the PBAC’s May meeting, when it was updated on the Post-Market Review workplan.
 
Dr Cooling said the recent addition of the Neffy nasal spray adrenaline to the PBS would be a ‘gamechanger’, but only for existing patients; all new patients will continue to have to see a specialist to initiate a prescription for any emergency adrenaline device.
 
‘It’s an ongoing inequality that GPs can’t prescribe a simple drug like adrenaline, which is effective, incredibly safe, and gives patients empowerment to control their allergies,’ he said.
 
‘People really want these devices because they want to feel safe, and they want to have it in their pocket. Now with Neffy, they can give it to themselves earlier, in a much more comfortable way.
 
‘This is a concern beyond the plight of previous adrenaline initiation approved GPs in rural and regional areas.
 
‘All GPs in Australia must be allowed to initiate adrenaline on the PBS as an access, cost and equity issue.  People with new allergies, at risk for anaphylaxis, deserve better than the current situation.’
 
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allergy anaphylaxis Epipen Neffy non-specialist prescriber PBAC PBS Pharmaceutical Benefits Advisory Committee