Nurse practitioner PBS prescribing

MEDICINES WHICH MAY BE PRESCRIBED BY AUTHORISED NURSE PRACTITIONERS

From 1 September 2010, nurse practitioners endorsed to prescribe under state or territory legislation can apply for approval as PBS prescribers (authorised nurse practitioners).  Information for nurse practitioners to become authorised PBS prescribers is available from Medicare Australia.

The medicines listed for prescribing by authorised nurse practitioners are identified by ‘NP’ in the PBS Schedule. Nurse practitioners must not write PBS prescriptions for other medicines.

PBS prescribing is limited by a nurse practitioner’s scope of practice, and state and territory prescribing rights. Prescribing of PBS medicines is also contingent on a prescriber being an authorised nurse practitioner and having collaborative arrangements in place, as required by amendments to the National Health Act 1953.

The Pharmaceutical Benefits Advisory Committee (PBAC) is responsible for making recommendations to the Minister for Health and Ageing regarding medicines for prescribing by authorised nurse practitioners.

Further to prescribing within collaborative arrangements, certain medicines also have additional conditions for prescribing by nurse practitioners, as recommended by the PBAC. These medicines are identified by the codes ‘CTO’ for continuation therapy only or ‘SCM’ for prescribing within a shared care model, as outlined below:

• Continuing therapy only model

Where the patient’s treatment and prescribing of a medicine has been initiated by a medical practitioner, but prescribing is continued by a nurse practitioner. (This is similar to existing arrangements between specialists and medical practitioners for prescribing certain medicines.)

• Shared care model

Where care is shared between a nurse practitioner and medical practitioner in a formalised arrangement with an agreed plan to manage the patient, in a patientcentred model of care. The details surrounding shared care arrangements will depend on the practitioners involved, patient needs and the healthcare context.

Some medicines are included in more than one section of the Schedule, and for more than one prescriber type. For a prescription to be eligible for subsidy, prescribers must ensure that they prescribe under the PBS only those medicines, and in accordance with the restrictions, listed for their prescriber type. Listing details for the same product may differ between sections and different PBS item codes apply for each prescriber type.

Nurse practitioner PBS prescriptions are identifiable by colour, and include the indicator ‘NP’ on personalised forms and a tick box on non-personalised (blank) forms.

Prescriptions must include the nurse practitioner’s PBS prescriber number. For unrestricted and restricted PBS medicines, midwives/nurse practitioners can use the personalised or non-personalised PBS prescriber forms.  For authority required and authority required (streamlined) PBS medicines, midwives/nurse practitioners can use the authority personalised or non-personalised PBS prescriber forms.  Nurse practitioner PBS prescriptions may include repeats. 

Regulation 24 applies for nurse practitioner prescribing. A nurse practitioner can direct that original and repeat supplies of pharmaceutical benefits be supplied at the one time, if certain conditions are satisfied.

Authority prescriptions: Authority prescriptions for authority required items, or for increased quantities or repeats, require prior approval from Medicare Australia for each prescription. (Refer to Prescribing Medicines — Information for PBS prescribers and Supplying medicines — What Pharmacists Need to Know, for more information on authority prescriptions.)

State and territory requirements: Nurse practitioners may prescribe medicines as private prescriptions according to their state/territory prescribing accreditation. The medicines which can be prescribed differ between states and territories. It is the nurse practitioner’s responsibility to ensure adherence to State/Territory law for all prescriptions (PBS and private) and additionally to all PBS requirements for PBS prescriptions.