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PBS authorities: Pain points and upcoming improvements


Dr Rob Hosking


2/10/2023 4:49:13 PM

Dr Rob Hosking provides an update on RACGP efforts to revamp the much-maligned system.

Close-up image of blister packs.
The RACGP has consistently called for changes to the PBS Authorities system.

The Pharmaceutical Benefits Scheme (PBS) Authorities system and its restrictions on GPs’ abilities to prescribe certain medications has long been a concern to many in the profession.
 
And while I’m pleased to relay that we’ve recently made headway with Services Australia regarding the improvement of these processes, there is plenty more work to be done.
 
The intention of the current PBS Authorities system is, essentially, to ensure certain PBS medications are prescribed appropriately and with special consideration.
 
This can be achieved via a restriction being placed on a medication (eg, celecoxib is restricted for use in osteoarthritis or rheumatoid arthritis to obtain a PBS benefit), or through an Authority Restriction.
 
Where there is a restriction placed on a medication, the doctor simply needs to consider and internally acknowledge the reason behind why they are prescribing the medication.
 
However, stricter criteria must be met for PBS Authorities and a declaration must be made confirming that both the doctor and patient’s condition meets the PBS Authority descriptor (noting certain medications can only be prescribed by specialists in particular fields).
 
All types of restrictions to prescribing under the PBS can be audited by Services Australia and prescribers may be required to justify their prescribing.
 
The RACGP has long called for an end to or, at very least, a serious revamp of the PBS Authorities system due to its notoriously hindering inefficiencies and complexities.
 
Although requests can be generated online through the HPOS Online PBS Authorities (OPA) system, more than 70% of prescribers still prefer to pick up their telephone to obtain an Authority approval.
 
Typically, digital solutions aim to simplify and streamline processes, but we are yet to see such benefits from the HPOS OPA system.
 
Instead, it is outdated, complex and lacks some basic functionality, such as being able to copy and paste certain information or save patient details when they require more than one authority request.
 
An alternative method of applying for PBS Authority Approval numbers is to print out a paper prescription, post it to the PBS or Repatriation PBS, wait for authorisation and then wait once again for the prescription and authority number to be mailed back to yourself, the prescriber, or the patient.
 
The typical timeframe for this full process is 2–3 weeks. This was actually the predominant method of obtaining an Authority approval in the 1980s when I started practice.
 
The good news is the RACGP has been working with Services Australia to improve the HPOS OPA system, and progress is being made.
 
As part of our advocacy, we recently developed an OPA user journey map detailing the steps prescribers must take in order to use the OPA system. The map highlights a range of frustrations, including that there are over 30 mouse clicks required to obtain an authority number, and it can take more than five minutes to navigate through an unnecessarily complex system as our patients wait.
 
Representatives from the Department of Health and Aged Care and the Australian Digital Health Agency visited my practice to observe this onerous process in action, each leaving aware of the issues at hand.
 
Ideally, the OPA system would be integrated with our clinical information software (CIS). This would mitigate the need to visit a separate website, complete two factor authentication to log in, manually transcribe information from one system to another and search again for patients and medications already open on our system in situations each time a PBS Authority is required.
 
While the current OPA system provides an option for integration into CIS (including Medical Director, Best Practice, Zedmed and others), and integration is our ultimate goal, it has been made clear by CIS developers that this integration process is highly complex.
 
It should be noted the Medical Software Industry Association has developed a project proposal for OPA system integration into CIS, but it has not yet seen approval from Services Australia or the Government.
 
Instead, what we have been working towards in the short term is improving the usability of the current, non-integrated system.
 
As a result of RACGP advocacy, Services Australia has officially launched a project which aims to address some of the primary ‘pain points’ of the existing PBS Authorities system. While further and more specific plans for this project will be released by Services Australia in the near future, we can expect the project to make changes including (but not limited to):

  • an updated search function designed to help prescribers locate certain forms and medicine strengths
  • the ability to save patient details when prescribing more than one authority medicine for the same patient
  • a new pop-up HPOS timeout reminder
  • more intuitive patient eligibility questionnaires
  • improvements to the system’s structure to allow continued updates and changes as required
  • an improved screen design.
As raised persistently, including in the RACGP’s response to the Health Technology Assessment Policy and Methods Review terms of reference, ongoing GP consultation will be key to the success of this project, ensuring future solutions are practical, beneficial and sustainable.
 
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Dr Annabel Kain   3/10/2023 9:11:40 AM

Thanks Rob for your work on this. I love that you had someone come in and watch you try to do the process - there never seems to be enough "user experience" work done on the many IT things that come out of Canberra. Just a note though - on your list is "the ability to save patient details when prescribing more than one authority medicine for the same patient" - this is already possible, there is a button at the end of first process that says "new authority, same patient"


Dr Brenda Greenall   4/10/2023 6:28:19 PM

Thanks for your work Rob. One other glaring ridiculousness with authorities is the ongoing need to seek one for inc supply in order to prescribe perfectly normal antidepressant doses. EG : if pt on 200mg sertraline daily we should just be able to prescribe 60 tabs. It makes the patient question the normality of their dose, and thus adds stress to mental health management. I've tried to write letters to PBS about this in the past and got the run around and given up...but every time I do one it makes me so frustrated.