Simplified prescribing arrangements for chemotherapy patients during the COVID-19 pandemic
Page last updated: 21 August 2020
Amendments to the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011 and the establishment of a standalone instrument National Health (Chemotherapy Prescribing) Special Arrangement 2020 commence on 20 August 2020.
The Efficient Funding of Chemotherapy (EFC) Special Arrangement relates to the supply under the Pharmaceutical Benefits Scheme (PBS) of infusible chemotherapy medicines to eligible patients being treated in, at or from approved public and private hospitals. The EFC Special Arrangement also deals with the supply of PBS medicines associated with the side-effects of cancer and cancer treatment (‘related pharmaceutical benefits’) at certain public hospitals.
The original requirements for prescribing chemotherapy PBS medicines in the hospital setting included:
- EFC Schedule 1 medicines prescribed using an “infusion prescription” or an “infusion medication chart prescription”,
- Schedule 2 (related benefits) medicines prescribed using the standard PBS prescription or a PBS Hospital Medication Chart. If a non-PBS medication chart was to be used for prescribing, then this needed to be duplicated as a standard prescription to enable claiming, and
- Pharmacists were required to dispense chemotherapy medicines from an original script.
Chemotherapy Compounders raised concerns that, due to the COVID-19 pandemic, some prescribers will have limited capacity to physically see their patients and write a separate paper prescription in a timely manner. The physical handling of multiple paper prescriptions (instead of a single medication chart) may also be considered a potential health risk for pharmacists, technicians and medical staff.
Simplified Prescribing Arrangements
To improve the efficient dispensing of PBS chemotherapy medicines to patients, a two-stage approach is in place:
- Stage 1 consists of amendments to the EFC instrument and the establishment of a temporary new stand-alone legislative instrument (National Health (Chemotherapy Prescribing) Special Arrangement 2020) which authorises the use of a paper or electronic Chemotherapy Medication Chart. This will enable pharmacists to dispense directly from any prescriber-authorised medication chart (paper or electronic) during the COVID-19 pandemic (without the need for a duplicate paper PBS prescription).
- Stage 2 is a longer-term development of a national approved PBS chemotherapy medication chart (PBS CMC), as an approved medication chart under Regulation 41 of the National Health (Pharmaceutical Benefits Scheme) Regulations 2017. The new legislative instrument created under Stage 1 will then be ceased, after a period of transition to ensure vendors and hospitals have sufficient time to adopt the PBS CMC. Through these amendments, the supply of PBS chemotherapy pharmaceutical benefits to vulnerable patients will be more efficient as it will allow pharmacists to dispense from a chemotherapy medication chart (a chart that is also used to prescribe an infusion and/or related benefit) without the need for duplication or a paper-script.
Amendments to the National Health (Efficient Funding of Chemotherapy) Special Arrangement 2011
Amendments have been made to the EFC instrument:
- to enable eligible public hospitals to use a ‘chemotherapy medication chart’ to write prescriptions for infusions and related pharmaceutical benefits;
- to enable private hospitals to use a chemotherapy medication chart to write prescriptions for infusions, without the need for the original paper prescriptions; and
- minor updates have been made to the Special Arrangement to ensure consistency with current practices and protocols and up-to-date terminology.
Establishment of the National Health (Chemotherapy Prescribing) Special Arrangement 2020
This new arrangement:
- allows prescriptions for both infused chemotherapy medicines and related pharmaceutical benefits to be written using a 'chemotherapy medication chart';
- enables prescriptions for pharmaceutical benefits available for general supply to be written on a chemotherapy medication chart that is also being used to prescribe a chemotherapy infusion or related pharmaceutical benefit; and
- enables these prescriptions to be written via an electronic chemotherapy medication chart, without the requirement for the original paper prescription, to reduce contact with vulnerable patients.
Impacts on Prescribing
The amended chemotherapy dispensing arrangements will simplify the prescribing requirements for EFC and ultimately improve the efficient supply of certain chemotherapy medicines for patients. These amendments apply on a national basis, enabling pharmacists to operate under a uniform, consistently applied framework regardless of their jurisdiction.
Impacts on Dispensing
The amended chemotherapy dispensing arrangements do not affect the current dispensing and PBS online claiming processes for chemotherapy items.
The provisions commence on 20 August 2020.
The Explanatory Statements to the amendments can be accessed via the Federal Register of Legislation.