Are you prepared for 60-day dispensing?

Industry
By
Chloe Hava
-
60-day dispensing

As DD day inches closer, pharmacists can expect to start receiving new scripts with 60-days’ supply of medicines from this Friday (1 September 2023).

So what will pharmacists need to know? Australian Pharmacist addresses the most burning 60-day dispensing practice updates.

1. The 20-day rule will become 50-day rule for 60-day prescriptions

The PBS Safety Net interval between 60-day prescriptions will increase from 20 days to 50 days. However, this change will not be ready for clinical software on Friday when 60-day dispensing first launches. 

‘We have not been able to effect that technical change in the Services Australia software vendor packages from 1 September, but we are working to effect it as quickly as possible,’ said Adriana Platona, First Assistant Secretary, Technology Assessment and Access Division of the Department of Health and Aged Care in a webinar yesterday (29 August).

2. The discretion to withhold 60-day supply rests solely with prescribers

Pharmacists may form the view that a 60-day prescription is not in the patient’s interest, for example if the patient is not stable on the medicine or their condition is not stable.

However, the decision and discretion to prescribe 2 months’ worth of medicine is a clinical decision that sits solely with prescribers.

Should patients request their medicines be supplied on a 30-day basis, a discussion should take place between the patient and their prescriber, said Penny Shakespeare, the Deputy Secretary of the Department of Health and Aged Care.

‘If a patient prefers to get 30 days’ worth of medicine, I’m sure their prescriber will take that preference into account,’ she told the webinar.

Any concerns about the clinical appropriateness of a 60-day dispensing script should be communicated to the prescriber.

‘That would be how pharmacists approach any issue of this nature and we encourage that to apply here,’ said Ms Shakespeare. ‘In terms of refusing to fill scripts, [pharmacists] would need to make sure this wasn’t done in a way that affects clinical treatment of a patient.’

3. Will there be new counselling obligations?

Counselling obligations will not change when the 60-day dispensing policy launches, with pharmacists expected to uphold the same professional practice standards, said a spokesperson from the Department of Health and Aged Care.

However, understanding when patients next plan to visit their doctor may be relevant in informing tailored advice provision, for example in relation to monitoring or investigating a drug-related problem.

4. Regulation 49 (previously Regulation 24) will still apply

PBS Regulation 49 allows entire PBS prescriptions (original and repeats) to be dispensed at the same time under certain circumstances.

Pharmacists can still provide all repeats in a single dispensing event under this regulation, if the prescriber deems it appropriate, said Ms Platona.

‘We are not making any changes to regulation [49],’ she said. ‘For individuals taking medicines overseas, the Regulation [49] rules remain unchanged.’

5. Existing prescriptions can’t be retrospectively amended to 60-day scripts

Prescriptions issued prior to the launch of 60-day dispensing cannot be changed to allow for double supply of a medicine. A new script will need to be provided if the prescriber assesses that 60 days’ supply is appropriate. Prescribers will also need to update their clinical software so they can access 60-day dispensing PBS item codes when issuing the new scripts.

Ms Platona said while a new script with 60 days’ supply can technically be written prior to 1 September, it cannot be dispensed. It is also unlikely the prescriber would be able to access the correct PBS codes to do this.

6. What if I get a 60-day script with no repeats?

Although five repeats on a script will remain the standard, there will be flexibility in terms of the number of repeats issued, said Ms Shakespeare.

‘[The number of repeats] is at the discretion of the GP or nurse practitioner, taking into account the clinical characteristics of their individual patient, [and] their financial circumstances,’ added Ms Platona.

As the new policy is designed to reduce cost-of-living pressures on patients, this includes avoiding unnecessary GP visits. 

Should pharmacists receive a 60-day dispensing script with no repeats, and they are concerned this means the patient would not meet the criteria for 60-day dispensing, departmental staff advise communicating with prescribers – who have a legal and professional obligation to act in the patient’s best interests in accordance with Medical Board of Australia guidelines.

7. What do I do if I don’t have enough stock?

When stock of a medicine in tranche one of the 60-day dispensing list is running low, Ms Shakespeare said current approaches – such as contacting wholesalers and ringing other pharmacies to source supply – will still apply.

This includes:

  • contacting prescribers, who could prescribe a different form of the same active ingredient or a similar medicine with a different active ingredient, or recommend a new treatment option which suits the individual circumstances
  • substituting the 60-day quantity with another brand of the same medicine at the time of dispensing (provided the prescriber has not indicated that brand substitution is not permitted)
  • dispensing the full quantity but supplying one box of the medicine initially, and the remaining box/es later at no additional cost to the patient.

‘Our advice is that you dispense if you have one pack, and [have] the second pack available as quickly as possible,’ said Ms Platona. 

‘The policy is that … the patient cannot bear the consequence of [insufficient] stock. So individual patients should not pay two co-payments because a pharmacy does not have two packs to dispense in one go.’

Need further advice?

For additional information, pharmacists can refer to: