Medical Forum
Concern over GPs losing PBS adrenaline prescribing exemption
Doctors are raising concerns about patient safety over a decision to remove an exemption for some GPs to prescribe adrenaline.
About the Author
Medical Forum
The exemption allowed certain GPs to initiate adrenaline for severe allergies and anaphylaxis under the Pharmaceutical Benefits Scheme (PBS) to broaden access to the medications.
Usually, the only way a patient can get a prescription for adrenaline is if they require an emergency prescription after presenting to an emergency department with anaphylaxis, or if their GP refers them to an allergy specialist.
But some GPs are classified as ‘non-specialist prescribers’ to allow them to prescribe adrenaline for their patients who may have to wait months, or years, for a specialist review. This is particularly common in rural areas.
But in an email to these GPs, the Pharmaceutical Benefits Advisory Committee (PBAC) advised that they could no longer initiate the PBS-subsidised treatment, newsGP reported.
The decision will mean those GPs can now only initiate PBS-subsidised adrenaline if a patient has undergone a specialist consultation or presented to emergency with an acute allergic reaction with anaphylaxis.
RACGP Expert Committee – Quality Care Deputy Chair Professor Rowena Ivers said the decision would hit people in rural and remote areas and those on low incomes the hardest.
She said the initial reasoning behind allowing some GPs to prescribe adrenaline was about broadening access to these life-saving medicines, but this decision would limit access.
“In lots of rural areas there won’t be an immunologist that they’ve got access to. It’s not realistic to think they are going to get to see a non-GP specialist in a timely manner,” she told Medical Forum.
“You preferably want to treat allergy before they get to an emergency department. To see a specialist, especially for low-income people in cities but also for people in rural areas, it can be a two- or three-year weight to see a paediatrician or specialist.”
Professor Ivers said there was also a monetary cost involved. Adrenaline is available at pharmacies but only on a private fee, which can be up to $220.
“It is quite prohibitive for many people on a low income who have got anaphylaxis, they can’t afford that,” she said.
“If you’re someone who needs them, they are critical.”
Earlier this year the Therapeutic Goods Administration (TGA) approved a needle-free alternative to the Epi-pen in an Australian first.
The product, called neffy, was listed on the PBS to treat children over four years of age (and 15kg+) and adults at significant risk of anaphylaxis from July 1.
It was heralded a gamechanger for allergy treatment when it was approved, but the changes to GP prescribing now mean it is only available for existing patients. All new patients will have to see a specialist to initiate a prescription for any emergency adrenaline device.
A spokesperson for the Department of Health, Ageing and Disability said exemptions were not supported under the National Health Act 1953.
“PBS listings, including any restriction criteria, are recommended by the independent PBAC, based on clinical and financial data from the pharmaceutical company supplying the medicine and input from health professionals and consumers.
“The PBS restrictions for adrenaline require prescribing by, or in consultation with a specialist.
“Under legislation, PBS-listed items cannot be subsidised outside the terms of their restrictions. This includes any medicines that are required to be prescribed by a specialist.”