By Suzanne Greenwood, Executive Director
The introduction of Active Ingredient Prescribing is generally a positive move, but at the Guild we are worried about how issues surrounding this initiative’s introduction may be affecting our patients.
Active Ingredient Prescribing became mandatory from 1 February 2021. What this actually means is most computer-generated PBS prescriptions have to be written by active ingredient, with prescribers still being able to indicate a brand or nominate not to substitute.
The intent of this measure is to increase a person’s awareness of the active ingredients of their medicines rather than the brand name and as such, to reduce the risks of medicine misadventure. It is also expected to optimise the uptake of generics and biosimilar medicines without compromising patient safety.
At the Guild we support the principles of this initiative and have provided input from the community pharmacy perspective to the Government agencies implementing the change. The Department of Health and the Safety Commission worked towards having prescribers and their prescribing systems ready for the 1 February change, including providing prescribers with information on which medicines for safety reasons are exempt from the new requirements (e.g. medicines with four or more active ingredients, a range of ophthalmologicals and food supplements) or recommended to include a brand (e.g. warfarin, insulins, clozapine).
Noting that a non-conformant PBS prescription could affect a patient’s subsidised access to their medicine, the Government agreed to the Guild’s request to introduce a six-month period of grace for dispensing and claiming non-conformant prescriptions. The Government was not expecting significant changes to pharmacy practice as the change was expected to be mostly with those who initiate the prescription – the prescribers. As prescriber software systems have been updated over the past weeks, we are seeing that this is not the case and more than ever pharmacists have been demonstrating the critical role they play as the ’safety-net’ for patients when they have their prescriptions filled.
What has been obvious over the past several weeks is that while prescribing systems have been updated, there remain flaws in the upgrades of some systems in which some active-ingredient prescriptions are being generated and are not consistent with the new requirements or the recommendations of the Safety Commission. Pharmacists are being presented with prescriptions in which the intention of the prescriber is unclear and are having to contact prescribers to clarify intentions. In addition, there are examples of pharmacists having to contact the prescriber to re-write prescriptions so that patients can get the correct medicine.
And of course, these interventions are predicated on pharmacists being able to easily contact the prescriber. The presentation of unclear prescriptions when the prescriber cannot be contacted means delays for the patient receiving their medicine, which in itself can be a safety problem.
I am very proud of the work done by the pharmacy profession which again is stepping up to manage the unintended consequences arising from these Government changes in the interests of their patients.
Members are advising us of problems they are seeing and in turn we are forwarding this information to the Department of Health and the Safety Commission to urgently address.
And it is not just us that are concerned. We are working with a wide range of stakeholders in the sector (including the PSA, SHPA, PDL and Pharmacy Board as well as the Medical Software Industry Association) to ensure that this initiative works properly and that the safety issues associated with its implementation are expediently resolved.
We are also alerting consumer groups so that they are aware of the problems and the potential safety risks for their members. We have shared our resources with stakeholders to ensure there is broad communication and understanding between health professionals to ensure maximum outcomes for patients.
Fortunately, the pharmacy profession is doing its job well to protect patients from prescription-related mishaps but how long can this safety net hold out before something serious happens? We have let Government know that while we continue to support this initiative, they must take the lead and work with the prescriber groups to iron out these safety-related problems as a matter of urgency.
In the meantime, we are confident that pharmacists will continue to do their job in managing any prescription-related problems they encounter. Please continue to keep us informed of any safety-related problems with active ingredient prescribing by sending an image of the prescribed medicine/s (without patient or prescriber details) and which prescribing software (if known) to AIP@guild.org.au.
We will continue to present these issues to the Government agencies for their urgent attention.
