RACGP joins fight against asthma med change

Matt Woodley

21/04/2023 3:47:15 PM

The college has written to the PBAC Chair about potential grave consequences for families due to new restrictions on fluticasone propionate 50 mcg.

Child taking asthma puffer
GPs can no longer initiate PBS-subsidised prescriptions of fluticasone propionate 50 microgram and are instead required to refer patients to either a respiratory physician or paediatrician.

New restrictions imposed on the prescription of fluticasone propionate 50 microgram (FP 50 mcg) have drawn a sharp rebuke from the RACGP, which has raised concerns about health equity and the potential impact on vulnerable patients.
Following a Pharmaceutical Benefits Advisory Committee (PBAC) decision, GPs can no longer initiate PBS prescriptions of the medication and are instead required to refer patients to either a respiratory physician or paediatrician, creating a potential cost and access barrier for many families.
In response, RACGP President Dr Nicole Higgins has written to PBAC Chair Professor Andrew Wilson to explain the likely impact on young patients, as well as query the clinical justification behind the move.
‘These changes have implications in equity of access, clinical risk in delaying initiation of this medication, significant health and/or mortality risk from substitution with other medicines and broader costs to the health system of otherwise unnecessary consultations with paediatric respiratory physicians and paediatricians,’ the letter states.
‘The RACGP is unaware of any inappropriate prescribing of fluticasone propionate in young children, and in the absence of reasonable alternatives that are equally as effective, safe and accessible, the clinical need for this change is unclear.’
According to the letter, FP 50 mcg has been ‘the mainstay of asthma management for children and adolescents for decades’ and the RACGP was not aware of any open consultation on this issue before the changes were announced.
It also points out that the Australian Asthma (AA) Handbook recommends that an inhaled corticosteroid should be considered as ‘the first-choice preventer’ for children with frequent symptoms or whose asthma restricts activity or sleep, as well as those with a history of severe flare-ups.
But even though GPs see most children under five years of age with wheeze/asthma and AA guidelines do not require children to be diagnosed with asthma by a respiratory physician or a paediatrician, the letter indicates that treatment options will nonetheless be limited by the PBAC decision.
‘As a result of the PBAC changes, when a GP determines a child with asthma aged between 1–5 years should be initiated on inhaled corticosteroids, the GP has three options available,’ the letter states.
‘Refer to a paediatrician or respiratory physician; prescribe FP 50 mcg on a private script; prescribe other medicines “off label” which will often involve higher-dose steroids.’
And with more than 85% of paediatricians and nearly 90% of clinician physicians located in a major metropolitan area, the college points out that access will be ‘challenging’ for patients in rural and remote locations.
‘Access to affordable medication is very important for socioeconomically vulnerable populations such as Aboriginal and Torres Strait Islander peoples and other populations in need of more asthma care,’ the letter continues.
Poverty has been associated with increased risk of asthma exacerbation in children, [while] there are also families who have multiple children and parents with asthma and other conditions.
‘Inability to access PBS subsidies plus the cost of the script being ineligible to count towards the safety net, places these groups at a significant disadvantage.’
The letter concludes by highlighting that families will essentially have to choose between incurring paediatrician or respiratory physician appointment fees, or the $11–28 cost per inhaler of a private script, and makes the following requests to the PBAC: 

  • Remove the requirement for a paediatrician or respiratory physician to initiate FP 50 mcg for children 1–5 years and reinstate GP PBS prescribing rights
  • Continue access to PBS-subsidised FP 50 mcg for children six years and older
  • Remove the Authority Required, or if it cannot be removed entirely, change to Authority Streamlined
When contacted after newsGP first reported on the issue, the Department of Health and Aged Care declined to answer specific questions related to the rationale behind the decision, noting that that the Federal Government ‘relies on the advice of the PBAC’ to make changes to the PBS.
‘The PBAC considered that patients aged six years and above would be able to switch to other PBS listed alternatives,’ the spokesperson said.
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Dr Vishal Kohli   22/04/2023 8:24:06 AM

I recently got hit with this! I was told by pbs authority line, that because my patient was >5yrs old they weren't allowed to use this puffer. I explained the whole concept of minimal effective dose and they refused to allow me to use this puffer in my patient. This is complete madness.

Dr Graham James Lovell   22/04/2023 9:01:47 AM

It’s shameful that a bureaucracy in our country is able to cause harm to our children.Through this undisclosed rationale for inevitability restricting their rights to access Medical treatment we will see increased harm. When data shows increased hospitalisation and deaths from childhood Asthma will Professor Andrew Wilson be charged ?

Dr David Murray Reid   22/04/2023 4:53:50 PM

Quite odd.

Dr David Zhi Qiang Yu   22/04/2023 7:17:00 PM

It is very important to allow GPs to initiate the prescription of fluticasone propionate 50 microgram (FP 50 mcg) and save life for the Children with asthma.

Dr David Wai Shen Cheang   23/04/2023 7:34:54 PM

I work in Coffs Harbour. We have 3 private paeds and 1 public hospital paed. It takes months to see a paeds for non urgent appointments. How long are kids supposed to wait before we can start flixotide! The decision makers at PBAC need to come and work outside of a metropolitan centre before they make impractical suggestions.

Dr Timothy Yong-Fei Foong   24/04/2023 5:10:09 PM

Agreed with the comments: to reinstate GP subsidised FP, changed to Authority streamlined and continue access to PBS subsidised FD 50 mcg for children 6 years and older

Dr Timothy Yong-Fei Foong   24/04/2023 5:12:29 PM

Reinstate GP PBS subsidied FP