Surge in hardship provisions risks shortages during pandemic

Doug Hendrie

2/04/2020 12:03:09 PM

GPs using hardship provisions to help patients self-isolate with supplies of medication may need to use new alternatives, the DoH warns.

Pharmacist getting pills
GPs have been prescribing to help patients avoid running out during isolation.

Tens of thousands more scripts are being filled each week under the Pharmaceutical Benefits Scheme’s (PBS) Regulation 49 hardship measures, a ‘concerning’ rate of increase that has led to calls for restraint from the Department of Health (DoH). 
The surge is due to GPs wanting to help vulnerable patients to self-isolate, the RACGP believes. But President Dr Harry Nespolon told newsGP that while GPs understandably want to help their patients only go to the pharmacy when necessary, it could lead to a shortage of medication. 
‘The increased use of Regulation 49 [previously known as Regulation 24] may cause shortages of medications. This means that patients who need vital medications may miss out,’ he said.
To ward off potential shortages the DoH recently launched new alternatives, such as medication delivery services and allowing pharmacies to accept digital images of prescriptions.
The issue comes after the Federal Government last year backed away from plans to allow two-month prescriptions after pressure from the Pharmacy Guild.
GPs are currently able to prescribe a regular script of one month’s supply, or use a Regulation 49 prescription for up to 12 months’ supply, with no middle ground.
A recent DoH letter states that the current surge in Regulation 49 scripts could see an additional 300,000 scripts dispensed over the next three months.
While there is no suggestion that GPs are doing the wrong thing, the surge could place further pressure on the supply chain, ‘potentially posing a serious risk’ to medication stocks, the DoH notes in a letter sent last week to the RACGP and Australian Medical Association (AMA).
The number of scripts prescribed under Regulation 49 has surged dramatically in recent weeks, with a 47% increase in the first week of March compared to the same week in 2019, representing almost 29,000 more scripts. 
And the trend is continuing, with tens of thousands of extra scripts now being prescribed weekly under the provisions, leading the DoH to warn of potential shortages at local pharmacies.
The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine has warned the trend could cause temporary shortages of HIV medication.
Under PBS rules, Regulation 49 allows GPs to direct pharmacists to prescribe the original and repeats of a script at the same time.
The regulation can be used if three conditions are met:

  • The maximum quantity of the script is not enough for treatment
  • The patient needs treatment for a chronic illness, or lives far from a pharmacist
  • Obtaining the supplies on separate occasions would cause great hardship
In the letter, the DoH notes that Regulation 49 is an important way to address patient hardships.
‘However, it is critically important that this use is balanced with the need to ensure continued supply of medicines,’ the letter states.
The DoH has recently put in place special arrangements during the coronavirus pandemic to make it easier for patients to access their medication while self-isolating.
These include:
  • image-based supply of medicines, meaning prescribers or patients can use a digital image of their script via fax, email or text message for all medications except Schedule 8 or Schedule 4 (D) medications. Under this rule, patients or prescribers must then provide the paper script to the pharmacy within 15 days
  • waiving the requirement to acknowledge receipt of supply, meaning PBS medicines can be supplied without a signature from the patient if they are self-isolating. Pharmacists are still expected to ask the patient where practical
  • introducing the COVID-19 Home Medicines Service to allow patients considered vulnerable to have their PBS and Repatriation PBS medication home delivered to reduce potential exposure to the virus and reduce stockpiling.
The RACGP will continue to push for the standing ability to prescribe two months’ supply of medications for chronic disease patients.
If the trend continues, the DoH states it will put new restrictions in place to stop ‘unsustainable demand’ for medicines.
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