News

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‘Historic’ funding changes for opioid dependency treatment

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Medicines prescribed for the treatment of patients with opioid dependence are set to become more accessible in the coming weeks.
 
As of 1 July, opioid dependence treatment (ODT) medicines currently listed on the PBS will be made available under the Section 100 Highly Specialised Drugs (HSD) Program (Community Access) arrangements.
 
This means that eligible patients – Australian residents eligible for a Medicare card and who meet the criteria for opioid dependence – will pay the PBS co-payment of $30 or $7.30 with a concession card for up to 28 days’ supply per pharmaceutical benefit prescribed. This will also contribute towards their PBS Safety Net threshold.
 
ODT medicines currently listed on the PBS Schedule include:

• methadone oral liquid
• buprenorphine sublingual tablets
• buprenorphine + naloxone sublingual films
• long-acting injectable buprenorphine products.

Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, was a member of the Post-market Review of ODT Program Medicines through the PBS.
 
She welcomed the changes as a ‘win for consumers’.
 
‘This is an historic move which I am in support of,’ Dr Wilson told newsGP.
 
‘These changes have the potential for great benefits for our patients [and] it brings this treatment into the mainstream and seeks to change the historical inequity of patients having to pay significant fees.’
 
Dr Paul Grinzi, who is a GP with a special interest in addiction medicine and medical educator delivering the RACGP’s Alcohol and Other Drugs (AOD) GP Education Program, agrees.
 
‘The biggest change is that it’s much more accessible to patients who need these treatments, particularly in terms of cost because the cost currently, on average, is up to $5 a day – that’s about $140 a month,’ he told newsGP.
 
‘So, it’s going to be significantly cheaper.’
 
Further to a reduction in cost, Dr Grinzi says he anticipates the new arrangements will simplify the prescribing process for GPs – a move he believes will help to reduce any stigma associated with the treatment of opioid dependence.
 
‘It will normalise it,’ he said.
 
‘It becomes a treatment of a long-term chronic relapsing condition like many other chronic diseases we already treat in a similar way. So, there’s no extra prescribing hurdles to try and prescribe it in a different way compared to our other regular medication.’
 
Prescribers will need to continue complying with state and territory ODT program policies, guidelines and regulations when writing PBS prescriptions for ODT medicines.
 
Authorised prescribers will be able to prescribe:

• methadone oral liquid – a maximum quantity of 4200 mg (840 mL) with two repeats (equivalent to up to a maximum dose of methadone of 150 mg per day for 28 days)
• sublingual buprenorphine and buprenorphine with naloxone – up to a maximum quantity equivalent to 32 mg of buprenorphine per day for 28 days with two repeats
• injectable buprenorphine – a maximum quantity equivalent to 28 days with two repeats.

Similar to the prescribing of other PBS medicines, buprenorphine-containing ODT medicines will be prescribed and dispensed on a per pack basis. In the case that different strengths are prescribed, each strength will attract one PBS co-payment.
 
‘Prescribers are encouraged to prescribe only the quantities and repeats that are suitable for the patient’s clinical needs, including during medication initiation, until their next review – to a maximum of three months,’ the PBS guidance for prescribers reads.
 
‘As per existing arrangements, prescribers should also include clear daily dosing instructions including dose variations and take away arrangements.’
 
These medicines will not be included in the 60-day pharmacy dispensing group.
 
However, with the funding changes set to be implemented in just a matter of weeks, Dr Grinzi says the RACGP is awaiting further guidance on the transition process.
 
‘This is both federally funded in terms of the medications, but state funded in terms of a lot of the other parts of the program,’ he said.
 
‘It’s two levels of government working together and the communication about how to prescribe, how the transition is going to go, has been lacking – at least in Victoria and I’m assuming [other parts of Australia] so far because it’s all fairly new.
 
‘So, we’re still looking for guidance in terms of how that transition is going to go for patients who have got scripts that overlap the initiation date.
 
‘But overall, I think it’s going to be much easier for GPs – and for our patients as well – rather than creating extra burden.’
 
In the meantime, Dr Wilson suggests GPs who are currently prescribing consider taking the following steps:

• Liaise with dosing pharmacies to ensure patients will have continued supply
• Liaise with local public AOD services to see how they can support patients if needed
• Prepare to move to PBS scripts if not already doing so 
• Ensure that patients have scripts to tide them over the transition period
• Talk to patients and let them know the change is ultimately a good thing that will decrease the financial burden on them

Dr Grinzi assures members that as information is provided to the college by the various health departments that it will be communicated through RACGP Specific Interests Addiction Medicine.
 
Meanwhile, in Victoria, where the college has been awarded the tender to deliver the state’s accredited AOD training program, the changes will be incorporated into the program.
 
‘Similarly, for other states where those training programs are often run by other organisations or health departments, these changes will be incorporated within that so that GPs going through accredited training will understand how to put it all together,’ Dr Grinzi said.
 
‘This is simplifying things, it’s reducing stigma and barriers, and it’s a very healthy move, but it just needs a bit more detail in terms of how it translates into practice, especially in this transition.’
 
Further information about the changes is available on the PBS website, and further insight on the Section 100 HSD Program (Community Access) is available on the Services Australia website.
 
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chronic illness funding ODT opioid dependency treatment program opioid use disorder PBS pharmacotherapy

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