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02 Dec 2019

BY AMA VICE PRESIDENR DR CHRIS ZAPPALA, CHAIR, OF THE AMA MEDICAL PRACTICE COMMITTEE  

The 2018-19  Budget announced important changes under the Electronic Prescribing Budget Initiative. This includes initiatives for Electronic Prescribing (ePrescribing) and Active Ingredient Prescribing (AIP). From October 31, ePrescribing and AIP were enabled under legislation. This is a positive move the AMA supports.

ePrescribing will allow patients to receive their prescriptions in an electronic format as an alternative to paper-based prescriptions. Generally, the prescribing process for doctors will not alter greatly – clinical software programs will still issue a prescription. Some decrease in administrative burden is anticipated as doctors will no longer be required to print and sign a prescription. The additional benefit to patients is how this might shorten the supply chain for medications and circumvent or reduce trips to the retail pharmacy.  As the healthcare sector (slowly) becomes more digital, hopefully there will be a concomitant increase in convenience and affordability for patients. Provided patient safety and evidence-based doctor-centered care is not fragmented or compromised, both parties (doctor and patient) should gain advantage.

ePrescribing is in its infancy.  Software providers are currently developing programs to conform with the technical framework set out by the Australian Digital Health Agency. ePrescribing software is being developed under a set of eight principles which aim to:

  • ensure patient information is safe and secure,
  • maintain patient choice in their prescriber/pharmacy, and
  • whether they opt for a paper-based or ePrescription, ensure that ePrescribing aligns with existing Commonwealth, State and Territory legislation, and other important frameworks, policies, and infrastructure.

ePrescribing is expected to be available from the first quarter of 2020, so please check with your software provider when this will be available for you and your patients.

AIP is the second project under the Electronic Prescribing Initiative aims to increase the uptake of generic and biosimilar medicines, with a view to making the system financially sustainable. As you know, many patients recognise their medication by the brand name (if they recognise the drugs they are on at all!), and there can be a risk of incorrect dosing if they take multiple medications that contain the same active ingredient, through brand substitution, or perhaps even omit doses due to confusion or lack of recognition. We are all familiar with the burden of medication errors in our healthcare system. Therefore, the AMA has taken a close and positive interest in the development of this initiative.

The National Health (Pharmaceutical Benefits) Regulations Amendment (Active Ingredient Prescribing) Regulations 2019 requires that active ingredients are included by default on all Pharmaceutical Benefits Scheme (PBS) and Repatriation (RPBS) prescriptions. This requires clinical software providers to update their software.  More than this, it would make sense for this active ingredient recognition to flow through to Webster Pack information and package labelling – but this latter step will hopefully occur by assimilation as patients become more confident with their medications and the changes outlined above become established.

There are some exceptions, however. Handwritten prescriptions, paper-based medication charts in residential aged care facilities, and medication with four or more active ingredients are excluded. Doctors will still be able to prescribe by brand (noting the active ingredient must still be on the script) if the doctor considers this necessary for the medical treatment of the patient. In addition, the ‘do not substitute box’ is still available to be ticked. Perhaps the slight tendency for this box to be ignored at dispensing will diminish as patients become more empowered and aware of the exact medications they are prescribed.

Although the legislation is already active, there is a transition period until October 31, 2020. There is still time to familiarise yourself with the changes. This is important to do as the prescriber is responsible for ensuring the prescription is written in accordance with the new legislative requirements. It is also important that you guide your patients through these changes to avoid any confusion regarding the name of their medication. The Australian Commission on Safety and Quality in Healthcare will be developing Australian Guidelines for AIP and clinical guidance on which medicines should be prescribed by brand and which medicines are excluded from AIP when it relates to patient safety or practicality.

The AMA has been engaging closely with the Department of Health and the Australian Digital Health Agency to develop these initiatives, including participation in technical working groups. AMA engagement has provided timely opportunities to raise concerns AMA members have regarding these initiatives, but also medicines more broadly.

For example, my colleagues report that too often their decision to prescribe a particular brand has been overridden by the pharmacist. There are good clinical reasons why generic or biosimilar medicines are not appropriate for some patients, and the AMA has called on the Government to uphold appropriate compliance measures to prevent pharmacists from not upholding the doctor’s direction. The AMA also sought assurances from the Government that there will be no additional administrative burden accompanying the changes, doctors will be appropriately engaged, and that active ingredient labelling on medication boxes should be larger than the brand name.

Overall, the AMA is pleased to see these innovative initiatives come to fruition which continue to progress the medical profession through a digital age. One of my next challenges for our association is to develop assistance tools and training that help practices becomes more efficient and digital. Our overarching aim should always be to make the working life of doctors a little bit easier. Please contact the AMA if you have any ideas to help us achieve this for you. Or I can be emailed at czappala@ama.com.au


Published: 02 Dec 2019