PBAC reverses plan to cut GP eye-drop prescribing rights

The Pharmaceutical Benefits Advisory Committee (PBAC) has reversed a decision to remove GP prescribing rights for preservative-free eye drops, which are increasingly being used to treat patients with severe dry eye disease.
 
The committee made the call in its March meeting, prompted by RACGP correspondence.
 
After the original PBAC decision in November to cut GP prescribing rights on the Pharmaceutical Benefits Scheme (PBS), which followed an analysis of usage and costs, the college wrote to the Department of Health, Disability and Ageing expressing its opposition.
 
‘The PBAC noted the RACGP’s advice that GPs often provide care for patients with severe dry eye disease, particularly in regional, rural and remote areas where access to specialists may be limited,’ the committee’s latest recommendations said.
 
It also noted the college’s advice that restricting prescribing rights ‘could negatively impact’ access for those patients.
 
The PBAC said while its original recommendation was ‘consistent with previous clinical advice,’ it would rescind it, and advised the Government to re-negotiate prices with companies supplying the preservative-free medications.
 
Professor Mark Morgan, RACGP Expert Committee – Quality Care Chair, welcomes the decision.
 
‘This is good news for patient care,’ he told newsGP.
 
‘It also shows that RACGP advocacy can have very direct impacts.
 
‘The RACGP letter made clear that specialist-only prescribing restrictions have the unintended consequence of making items available only to those who can afford to have an appointment with non-GP specialists.
 
‘GPs are the most accessible part of the health system. Non-GP specialist waiting times, out-of-pocket costs and urban locations are barriers that patients face.’
 
The November decision has not been put in place by the Government, which means there is currently no difference to the way GPs can prescribe the eye drops.
 
Changes stemming from the March decision are also yet to progress.
 
The PBAC report says that if there is an acceptable price reduction, it would recommend easing prescribing rights for preservative-free ocular lubricants to ‘restricted’, in line with those containing preservatives, removing the need for Services Australia approval on the PBS.
 
If a suitable price agreement is not reached, the PBAC warned it is likely to recommend changing to the authority requirements from streamlined to telephone/online ‘to support management of PBS utilisation and expenditure’.
 
Detail published from the PBAC’s November meeting shows a rise in ocular lubricant eye-drop prescribing, with a reported total of 2.3 million prescriptions in 2023 at a cost of $52.3 million for the Government. This represents an increase of around 400,000 prescriptions and a doubling of costs when compared to 2015.
 
The PBAC said this growth was driven by an increase in the preservative-free medication prescriptions, which accounted for $42 million of spending in 2023 – more than 80% of the total.
 
This is despite the preservative-free option originally being intended for ‘cost minimisation’, according to the PBAC.
 
The committee ‘acknowledged the steady increase in patient numbers alongside a clinical preference to keep patients on the same products once treatment is established’.
 
Analysis cited in November showed Government PBS spending on preservative-containing eye drops had declined from $12 million to $10 million, with that trajectory expected to continue in the next few years.
 
Overall Government spending was projected to rise to $93.2 million during the same time, driven by demand for preservative-free medications.
 
If put in place, the March PBAC decision will remove the requirement for patients to be sensitive to preservatives in multi-dose eye drops for a prescription to take place.
 
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dry eye disease PBAC PBS Pharmaceutical Benefits Advisory Committee