Nurse practitioner Jardiance prescribing greenlit

Nurse practitioners can now self-initiate prescriptions for SGLT-2 inhibitor therapy, empagliflozin (sold as Jardiance), via the Pharmaceutical Benefits Scheme (PBS).
 
The change has already drawn the ire of some GPs, who say it could put patient safety at risk if done in the community and could be setting a concerning trend.
 
However, others are more hopeful, seeing the main goal as getting patients on the right medications as soon as possible.
 
From 1 August, nurse practitioners can make the prescription as an initial or continuing therapy for chronic heart failure in eligible adults, regardless of ejection fraction as an adjunct to standard of care therapy.

The change in nurse practitioner prescribing applies to the Jardiance Heart Failure with Reduced Ejection Fraction (HFrEF) and Heart Failure with preserved Ejection Fraction (HFpEF) PBS listings, as well as the 60-day dispensing PBS listing for HFrEF patients.
 
RACGP President Dr Nicole Higgins raised Scope of Practice concerns with the change and the precedent it sets for those who can prescribe it now, and any changes into the future.
 
‘These are complex medications,’ she told newsGP.
 
‘If we’ve got a nurse practitioner working in diabetes or in heart disease who’s working in a narrow scope, and at the top of it, it would be acceptable for that to be done with in conjunction with guidelines,’ she said.
 
‘But if it is being done in the community, it must be done as part of team-based care in general practice.’
 
Last year, the RACGP raised concerns about a plan from the Nursing and Midwifery Board of Australia (NMBA) to allow registered nurses (RNs) to prescribe a range of medications.

The college instead endorsing a plan to ‘retain the status quo prescribing practice’, citing fears of fragmented care, lack of training, rising costs, and risks to patient safety.
 
GP and Melbourne University academic Associate Professor Ralph Audehm, who advised on national heart disease guidelines, told newsGP the change does bring with it concerns about care fragmentation, but could save lives if there is proper communication back to GPs.
 
‘If general practice was best supported, or if there was a mechanism by which you could employ nurse practitioners within general practice to make it viable, I think that would be a solution because I’m worried about fragmentation of care,’ he said.
 
‘Evidence says that there are many patients with heart failure who leave the hospital who fall between the cracks just to get on the right medication at the right time, so I think there has to be multiple solutions.
 
‘We know that starting those medications really early on post discharge will actually save lives.’
 
Chronic heart failure has reached ‘epidemic proportions’, with around 480,000 Australians living with the disease and more than 60,000 new diagnoses every year.
 
The decision follows the March 2024 Pharmaceutical Benefits Advisory Committee (PBAC) meeting, which found the amendment ‘could potentially lead to an increase in the treated population due to improved access’.
 
Associate Professor Audehm said one of the biggest barriers in treatment of heart failure is getting people on the right medication.
 
‘After someone’s been admitted to hospital for heart failure, because hospitals are so overburdened, often people can’t get back in quick enough and we’re now starting to see a similar problem with access to GPs,’ he said.
 
‘The system that we have at the moment between hospitals and general practice, is not as smooth as it could be.
 
‘With these nurse practitioner clinics, people will be booked in within two weeks.’
 
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ACNP chronic heart failure heart disease heart failure nurse practitioners PBS scope of practice SGLT-2 inhibitor therapy