Restrictions to apply to fixed-dose combination medications for people with asthma

The Pharmaceutical Benefits Advisory Committee (PBAC) has recommended that all fixed-dose combination of inhaled corticosteroids and long-acting beta adrenoceptor agonist listings on the Pharmaceutical Benefits Scheme (PBS) be changed to ‘Authority Required (Streamlined)’.
 
The move is designed to ‘encourage prescribers to consider first line treatment with [inhaled corticosteroids] alone’, according to a letter the PBAC sent to the RACGP.
 
The PBAC became concerned about overuse of fixed-dose combination medications following a 2014 post-market review (PMR) of asthma medicine use in children.
 
National Asthma Council Australia’s guidelines recommend inhaled corticosteroids as the first line treatment, and do not recommend fixed-dose combination medications to children under five.  
 
In 2017, a new evaluation report of the PMR found some improvement in the numbers of children under five using a fixed-dose combination medication, but noted the proportion of use outside clinical guidelines ‘continued to be unacceptable’.
 
The PBAC letter states that a systematic review had found ‘no clinical benefit associated with the use of [inhaled corticosteroids]/[long-acting beta adrenoceptor agonist] versus inhaled corticosteroids alone in children’.
 
This recommendation follows an August 2017 PBAC recommendation to change all inhaled corticosteroids/long-acting beta adrenoceptor agonist fixed-dose combination medications that have dual listings for chronic obstructive pulmonary disease (COPD) and asthma to Authority Required (Streamlined).
 
The finalisation of the PBS restriction will take place over the next few months.
 
Australia has one of the highest rates of asthma in the world, according to a global 2014 report.
 
A March study by University of New South Wales and Sydney Children’s Hospital medical researchers found there was high prescribing of fixed-dose inhalers to children under five, despite this being outside the age recommended in national guidelines.

asthma fixed-dose-combination PBS restriction