Sixty-day scripts slow to find favour: Study

Uptake of 60-day prescriptions has fallen well short of the 45% projected by the Federal Government by 2023–24.

That is according to an analysis released this week from the Grattan Institute, which found, one year after the program’s launch, there was a 30% uptake of 60-day prescribing for medications rolled out in its first stage.
 
The Department of Health and Aged Care predicted a 45% uptake by 2023–24, and 63% by 2026–27 once fully implemented.
 
When including all three stages, the Grattan Institute found the uptake rate was just 21%.
 
Amid much fanfare, the Federal Government introduced the change in 2023, following a long-fought push from the RACGP, and despite staunch opposition from the Pharmacy Guild of Australia.
 
So far, about 300 medications, including for cardiovascular disease, diabetes, anxiety disorders and asthma, have been added to the eligibility list across three tranches – September 2023, and March and September 2024.
 
In response to this staggered release of eligible medications and the significance of the change, the RACGP has provided several in-depth resources to help GPs navigate the new initiative.
 
These resources include information about patients needing new prescriptions, when prescribing software will be updated, whether GPs can still write a one month’s supply prescription, and how the changes can impact the PBS Safety Net.
 
Associate Professor Rashmi Sharma, Chair of the RACGP Expert Committee – Funding and Health System Reform, believes a range of reasons is behind the lag in uptake.
 
She told newsGP this could include GPs facing more pressing priorities, prescription software impediments, ‘complexity’ over what drugs were available in what tranches, and patient views on safety net benefits.
 
Associate Professor Sharma believes prescribing may have also slowed since the rush of publicity around the 2023 announcement of the first tranche, with ensuing tranche announcements not as visible on GPs’ radars.
 
‘GPs, we’re busy,’ Associate Professor Sharma said.
 
‘There’s a lot of things coming across our table that we have to think about, whether it be measles outbreaks or other infectious illnesses that we need to be on the lookout for.
 
‘So, if they then give an announcement that there’s another tranche of meds, it’s not necessarily the first thing that we think about.
 
‘Uptake is happening. It is going in the right direction, but sometimes there are other competing priorities in our clinical lives.’

Associate Professor Sharma said clinical decision-making by a GP can have an impact on a prescription quantity. Availability of a 60-day prescription did not automatically result in a script for that amount.
 
‘That might be one reason why the uptake has not been as high,’ she said.
 
‘You don’t just put a number in the repeats – you’re actually making a clinical decision and considering the situation and circumstances. Do I want the patient to come back in six months for a blood test? Do I want them to have a longer supply for a particular group of drugs, because it’s riskier if they cease that?’
 
Prescription software could also be playing a role in the slower than expected uptake. With 30 days being the default setting for prescriptions, any change to the default must be done manually by the GP, which takes time away from the consultation, Associate Professor Sharma said.
 
‘You might think that’s a fairly insignificant step, but we’re busy,’ she said.
 
‘We’ve got to deal with the authority system, which can take up half the consult, and then to actually go in and change that default, it’s just added time.’
 
Furthermore, the software default does not indicate which medications have been added since the first tranche, Associate Professor Sharma said. And with some patients on multiple medications, the addition of more drugs to each tranche added ‘complexity’ to the rollout.
 
‘[The system] doesn’t actually prompt us to think, “oh this is in the 60-day dispensing group now”,’ she said.
 
‘If I’m just clicking on the default, I’m not necessarily going to pick up the information that, with some medications, I can now get two months of antidepressants, I can now get two months’ supply of asthma drugs because they weren’t in the first tranche.’
 
Despite the slow uptake, the 60-day dispensing scheme has already shown to be saving both consumers and the Federal Government money.
 
The Grattan Institute study estimates that, from September 2023 to November 2024, Australian consumers saved $114 million, and the Federal Government saved $141 million.
 
Yet some patients have been reluctant to move away from 30-day scripts, believing it would ultimately cost them more money by preventing them reaching the safety net, said Associate Professor Sharma.
 
‘That’s certainly what I’ve seen in clinical practice,’ she said. ‘Patients come back from the pharmacy and say, “well I’ve been told I won’t reach the safety net now because I’ll be paying less for my scripts”.
 
‘That was some of the encounters that I experienced early on, people not wanting to move to 60-day scripts because they were concerned about how it might impact them reaching the safety net.
 
‘But then actually, when you did the maths, you’re better off [with 60-day scripts].’
 
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