PBS authority process needs ‘serious revamp’: RACGP

The RACGP has called for an overhaul of the PBS authority approvals process in a new submission to the Australian National Audit Office (ANAO), which is evaluating oversight and governance of the scheme.
 
It is also recommending that decisions related to the listing of medications be focused on clinical efficacy, rather than cost-effectiveness, and that it ensures healthcare consumers are regularly sought out for feedback.
 
‘The RACGP has long called for an end to or, at [the] very least, a serious revamp of the PBS authorities system due to the unnecessary inefficiencies and complexities it creates,’ RACGP President Dr Nicole Higgins wrote.
 
‘This administrative and bureaucratic burden ultimately takes valuable time away from providing care to patients, limits GPs potential to work to their full scope of practice and contributes to GP burnout.’
 
According to data from the Australian Institute of Health and Welfare, GPs provide the vast majority of PBS prescriptions – accounting for 87% of those dispensed.
 
However, the process for obtaining authority approvals for certain medications has long been considered outdated and unnecessary by many GPs, who need to either phone the authority line, navigate an online portal that lacks basic functionality or send a written request by post.
 
To avoid these delays, the RACGP has said streamlined authority approvals – standardised codes GPs can already use when prescribing certain restricted medications via the PBS – should be sufficient for all authority prescriptions.
 
Dr Rob Hosking, Chair of the RACGP Expert Committee – Practice Technology, has been advocating for an overhaul of the authority approvals process and is working with Services Australia to make the process easier for GPs.
 
However, he believes that the authority system itself is no longer fit-for-purpose.
 
‘Making new computer systems to solve old paper problems, it just doesn’t make any sense in the digital age,’ he told newsGP.
 
‘We now have computerised records that people can audit and check whether we’re doing the right thing or not.
 
‘We know that [the authority process is] to try to limit the medications that we prescribe and to make us think twice about prescribing some of these more expensive drugs or … reduce the number or amounts that we’re prescribing.
 
‘I’m not sure that making it difficult is the appropriate way of dealing with [these issues]. To me, it’s like saying we’ve got a speeding problem on a major highway so let’s put speed humps in all the way down for everybody.’
 
The submission also calls for a greater focus on health equity alongside living clinical practice guidelines that include options for non-pharmacological interventions. It was noted that submissions from drug sponsors to the Pharmaceutical Benefits Advisory Committee (PBAC) tend to focus on cost-effectiveness rather than evidence-based clinical practice.
 
The RACGP also highlighted the importance of consumer consultation and recommended it be embedded throughout the review process to ensure decisions consider ‘on-the-ground’ experiences.
 
The controversy surrounding PBS eligibility changes for low-dose fluticasone propionate inhalers was cited as one example of poor stakeholder engagement. Earlier this year, GPs were advised they could no longer initiate the medication on the PBS without paediatrician input – a decision the PBAC reversed following widespread criticism.
 
Submissions to the audit are expected to close in mid-January.
 
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