Prescription rule changes to support telehealth

Industry
By
Ann Winkle MPS
-

Australia’s Chief Health Officer has approved an amendment to PBS prescription requirements for telehealth consultations as an emergency measure during the COVID-19 response.1,2

Key points:

  • Pharmacists in Victoria and WA can supply Schedule 4 medicines from a digital image of a prescription delivered via fax, email or text message
  • From 17 April, NSW pharmacists can also dispense Schedule 4 medicines using a digital image of a prescription delivered by fax or email (but not by text message)
  • Telehealth changes apply to all prescription medicines with the exception of Controlled Drugs
  • Under the amended rules, the original prescription has to be kept by the prescriber for two years

Pharmacists in Victoria and Western Australia (WA) can now supply Schedule 4 medicines on the authorisation of a digital image of a prescription delivered via fax, email or text message.1,2 

From 17 April, pharmacists in New South Wales (NSW) can also dispense Schedule 4 medicines using a digital image of a prescription delivered by fax or email (but not by text message).3

President of the Pharmaceutical Society of Australia (PSA) Associate Professor Chris Freeman has urged all other states and territories to follow suit as a matter of urgency. 

‘PSA is working with the state and territory governments to accelerate this as quickly as possible in a way to minimise the additional burden this has caused,’ he said.

The aim of the temporary changes is to allow at-risk members of the community to avoid exposure to COVID-19 by staying home. It enables people to have a consultation with their general practitioner (GP) via telehealth, have a prescription sent to a pharmacy by fax, email or text and then have the dispensed medicines delivered to their home.

But adding telehealth prescriptions to an already heightened workload has been challenging for busy pharmacies, and some pharmacists see a need for improvement.

Pharmacists on the frontlines

Linda Keane MPS from Dunsborough Pharmacy in WA told Australian Pharmacist that, when a patient presents for their dispensed medicines saying ‘the doctor sent the prescription,’ it would be useful for the pharmacist to know that it is a telehealth prescription they are searching for in their faxes, emails and text messages. 

‘The search can be quite time consuming,’ she said.

Stacey Storey MPS from Wyndhamvale Pharmacy in outer Melbourne agreed that searching through multiple faxes and emails can be challenging, although her pharmacy is only seeing a few telehealth prescriptions daily at this stage, so it is manageable.

Ms Keane explained that telehealth prescriptions are just one type of prescription received by fax or email. ‘Owing’ scripts sent this way would need to be followed up for the original, unlike telehealth prescriptions.

For this reason, the Victorian Public Health Emergency Order requires Victorian pharmacists to record the medicines were supplied under the order. One of the easiest ways of doing this is through annotating ‘PHEO#4’ on the dispensing label.

Record keeping

Under the amended rules for telehealth prescriptions, the original prescription has to be kept by the prescriber for two years when supplying under this arrangement.

At Dunsborough Pharmacy, the volume of digital prescriptions arriving from GP telehealth consults has been high – most commonly by fax, followed by email, and then text message. 

To facilitate the process, Ms Keane suggests a GP include the word ‘Telehealth’ and the patient’s name in the subject line of the email or fax.

The Royal Australian College of General Practitioners (RACGP) has advised GPs to inform patients of the small, yet possible privacy risk with this prescription delivery method. It is also important that GPs check they have the correct address for patients during the consultation, as once dispensed, medicines will only be delivered to the address printed on the prescription.4 See the RACGP information for GPs on the process. 

Pharmacists could double-check the dispensed medicines are going to the correct person by contacting them before delivery.

Telehealth changes apply to all prescription medicines with the exception of Controlled Drugs, for example opioids and fentanyl. For these medicines, changes have been made to provide doctors with more time to get the hard-copy prescription to the pharmacy.1

Both the prescriber and pharmacist need to keep full records. 

Ms Keane in WA prints out the prescriptions and repeats in A4 format, churning through reams of paper and toner cartridges. As these represent the only copies of the prescription, they stay with the pharmacy. Patients must return for repeats, which may not suit people living elsewhere.

The need to print and store paper copies in the pharmacy should be alleviated when electronic prescriptions are enabled. Accuracy and privacy issues should also be addressed.

Electronic prescriptions coming soon

The Australian Digital Health Agency has been contracted by the Commonwealth Department of Health to work with software providers to fast-track the upgrade of clinical software so that it supports electronic prescribing. It is anticipated that this will be ready for 80% of general practices and community pharmacies by May 2020.5,6

Electronic prescribing will generate a QR code that is sent to a patient’s device and able to be shared with their preferred pharmacy. 

The rule changes for telehealth prescriptions are temporary, remaining in place until 30 September 2020 in accordance with the COVID-19 National Health Plan telehealth measure.4

References

  1. Changes to prescription rules to support telehealth during COVID-19. 2020. Government of Western Australia Department of Health. At: ww2.health.wa.gov.au/Media-releases/2020/Changes-to-prescription-rules-to-support-telehealth-during-COVID19
  2. Advice to pharmacists supplying medicines during the COVID-19 pandemic. Department of Health and Human Services Victoria State Government. 2020. At: www2.health.vic.gov.au/about/publications/policiesandguidelines/advice-pharmacists-covid19
  3. Doctors to send digital scripts to pharmacists. NSW Government. 2020. At: https://preview.nsw.gov.au/news/doctors-to-send-digital-scripts-to-pharmacists
  4. What does electronic prescribing mean for GPs in the fight against coronavirus? News GP. RACGP. 2020. At: www1.racgp.org.au/newsgp/professional/what-does-electronic-prescribing-mean-for-gps-in-t
  5. COVID-19 National Health Plan – Primary Care – Fast Track Electronic Prescribing. Australian Government Department of Health. 2020. At: www.health.gov.au/resources/publications/covid-19-national-health-plan-primary-care-fast-track-electronic-prescribing 
  6. Coronavirus disease (COVID-19) information for pharmacists: Digital image prescriptions and ePrescribing. Pharmaceutical Society of Australia. At: www.psa.org.au/coronavirus/#1584418401988-1d9fcf39-80f0