Coronavirus disease (COVID-19) information for pharmacists

This information was last updated Friday 27 March 2020

 

PSA is committed to keeping members informed throughout the rapidly evolving coronavirus disease (COVID-19) pandemic. Through this webpage, we’ll keep you informed with the latest information as it becomes available. It contains links to up-to-date information, guidance and resources from governments and other trusted sources for pharmacists and their patients.

Live webinar – COVID-19: Your Immunisation Questions Answered (Wed 1 April 2020, 7.30 pm)

 

PSA’s national president, Associate Professor Chris Freeman, and RACGP’s Chair, Associate Professor Charlotte Hespe will be discussing how you can safely immunise patients. They’ll deliver a quick update on COVID-19, discuss changes to immunisation guidelines and then you’ll have a chance to ask any questions you want.

 

Register here (PSA member only)

Latest updates

Webinar recording now availablewatch a replay of the COVID-19: your questions answered webinar.

 

Fee Increase for Home Medicines Service – The government has approved an increase in the fee for provision of the Home Medicine Service. Read more here.

 

Dispensing of hydroxychloroquine – Important information regarding legislative changes to the dispensing of hydroxychloroquine. Read more here.

 

Limits on dispensing and sale of medicines – There are new limits on the dispensing and sale of certain medicines. Find out more here. PSA has also created a poster to explain these changes to customers.

Federal government information advice

The Commonwealth Department of Health continue to publish and update a variety of information and resources for health professionals and patients on the evolving COVID-19 situation.

Minister Hunt has penned an open letter to the community pharmacy sector thanking them for their dedication and service to the Australian Community. Read the letter here.

 

The TGA is regularly publishing information about medicines and medical devices as they relate to COVID-19. Read the latest TGA advice here.

 

The following information relates to medicine supply and limits:

 

The following safety advisories have also been published by TGA:

Advice on the use of ibuprofen for treatment of COVID-19 symptoms

Advice on the use of high-dose vitamin C to manage COVID-19

State and territory government information and advice

Access ACT-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

Access NSW-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

NT-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

QLD-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

SA-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

TAS-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

VIC-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

WA-specific advice and information below

If you have any queries or are looking for the latest, up-to-date advice regarding COVID-19 in your state or territory, please contact your local PSA office.

General information and resources

Watch a replay of the COVID-19: your questions answered webinar recorded on 25 March 2020. PSA members are encouraged to self-record CPD to their CPD plan after viewing this webinar.

PSA has been fielding many member queries seeking practical advice about things like general hygiene precautions and infection control measures. Below are some valuable resources.

The Department of Health has developed this resource explaining the different symptoms you may experience if you have coronavirus (COVID-19), a cold, or the flu.

The Department of Health has developed this COVID-19 infection control training for health workers in all settings, which covers the fundamentals of infection control.

The Therapeutic Goods Administration has issued advice on the association between the use of ibuprofen and worse outcomes in patients with COVID-19.

The following practical, interim guidance for pharmacists has been developed by local health authorities:

PSA has developed the following posters that you can download and printed for use in your pharmacy, or share on social media:

Medicines limit poster

Health alert poster 1

Health alert poster 2

The Commonwealth Government Department of Health has produced the following posters which you may choose to display in your pharmacy, or share on social media:

 

(certain resources have also been translated in other languages. See the full range of translated resources here).

Keeping your distance

Simple steps to stop the spread

Keep that cough under cover

Recently travelled overseas?

Good hygiene in your hands

Temporary changes’

Change of business hours

PSA is aware of member concerns that patients are pressuring them to dispense unsafe amounts of medicines. This is unacceptable, and we are dedicated to protecting frontline pharmacists doing their best in these challenging times.

 

Together with the Government, the Pharmacy Guild of Australia and the National Pharmaceutical Services Association, the bold decision has been made to start putting a limit on the dispensing and sale of certain medicines.

 

From Thursday 19 March 2020:

  • Pharmacists will be required to limit dispensing of certain prescription products to 1 months’ supply at the prescribed dose, and sales of certain over-the-counter medicines to a maximum of one unit per purchase
  • In addition, pharmacists will be strongly encouraged to limit dispensing and sales of all other medicines to one months’ supply or one unit
  • pharmacists are required to place paracetamol paediatric formulations behind the counter to assist in allocating supply equitably
  • Supply of salbutamol inhalers are also subject to additional restrictions, assessment and recording requirements.

 

Full details of the decision can be found below.

 

To help explain these changes to customers, PSA has developed a sign that can be used in your pharmacy.

Further to the limits introduced on 19 March 2020 to the supply of S3 salbutamol inhalers, on 24 March 2020, a new legislative instrument came into force to specify that its supply is limited:

  • to persons with evidence of a medically diagnosed lung condition, or
  • to persons with a record of previous supply from the pharmacist, or
  • to persons authorised under State or Territory law to use or supply salbutamol in the practice of their profession (such as medical practitioners), or
  • for use in institutional first aid (e.g. schools and workplaces).

 

The new entry also specifies that supply is limited to one primary pack of salbutamol for each person with evidence of a medically diagnosed lung condition or previous supply from the pharmacist.

 

These changes to the Poisons Standard are designed to ensure availability of salbutamol inhalers for patients with a genuine need for their asthma condition.

 

To support pharmacists with this change, PSA has prepared the following Q&As.

What legislative changes have come into force for salbutamol?

On 24 March 2020, a new Commonwealth legislative instrument, the Poisons Standard Amendment (Hydroxychloroquine and Salbutamol) Instrument 2020, came into force.

What has changed?

The Schedule 3 entry for salbutamol was amended to require pharmacists to confirm that patients requesting salbutamol over-the-counter have evidence of a medically diagnosed lung condition or a record of previous supply from the pharmacist, and to limit the supply to a maximum of one pack per purchase. Salbutamol will continue to be allowed to be supplied by pharmacists for use in institutional first aid (e.g. schools, workplaces) or to persons who are authorised under state or territory law to possess it or supply it under lawful practice of their profession (e.g. medical practitioners) without the limit of one pack per person.

Why was such drastic action necessary?

Pharmaceutical companies reported to the Therapeutic Goods Administration that, in response to the COVID-19 pandemic, community demand for salbutamol had increased markedly. An unprecedented surge in demand for salbutamol inhalers was also experienced by pharmacists and reported to PSA in recent weeks. If these levels of excessive purchasing and stockpiling behaviour were to continue, a shortage of salbutamol inhalers Australia-wide was likely to occur, and this would have significant adverse health impacts for patients with chronic conditions such as asthma and chronic obstructive pulmonary disease (COPD).

How do I respond to patients and carers who ask why the supply of salbutamol inhalers is being limited even though they have been using this medicine for many years?

The Australian Government has made these changes to regulate inappropriate supply of salbutamol and to ensure ongoing access for people with diagnosed respiratory conditions. The peak bodies representing pharmacists worked with the government on these urgent measures to ensure people who need the medicines most can access them.

What can be used to confirm a clinical diagnosis?

There are a number of ways a pharmacist could check to ensure the supply of a salbutamol inhaler to a person as a Schedule 3 medicine meets the requirements stipulated. For example: previous supply is confirmed through the person’s dispensing history or My Health Record, confirmation that the person has a current asthma management plan, observing via photo or in person a physical inhaler or asthma medicine dispensed in their name.

A person says they have heard that they should now avoid using their corticosteroid inhaler, and want to just rely on using their Ventolin inhaler. What advice should I give?

If your doctor has prescribed inhaled corticosteroid controller medication for your asthma, you should continue to use it (as prescribed) during the COVID-19 pandemic.

PSA is aware that there is a significant and increasing demand for face masks and personal protective equipment (PPE) in response to the COVID-19 pandemic.

 

Face masks

 

The advice from the Chief Medical Officer is that, if you are well, you do not need to wear a face mask as there is little evidence supporting the widespread use of face masks in healthy people to prevent transmission in public.

 

For those who have returned from a country or region that is at high or moderate risk for COVID-19, or think they may have been in close contact with a confirmed case of coronavirus, they should use a face mask in the following circumstances:

  • need to leave your home for any reason and will be in public areas
  • are visiting a medical facility
  • have symptoms and other people are present in the same room as you.

 

Access the latest advice on the use of face masks from the Department of Health below.

Personal protective quipement (PPE)

 

Distribution of PPE from the National Medicines Stockpile (NMS) for community pharmacies is being coordinated through the Primary Health Networks (PHNs). The latest information can be found below.

Community pharmacies are eligible to access the supply for the use of their staff when there is no available commercial supply and they have significant contact with people presenting with fever or respiratory symptoms. Community pharmacies with demonstrated need should contact the relevant PHN in their region to request access to the supply.

 

Find the contact details for your local PHN below.

PSA has heard concern from members regarding arrangements for medication management programs (HMRs/RMMRs and MedsCheck services) during the COVID-19 pandemic.

 

PSA strongly believes patients urgently need capacity for pharmacists to deliver these services remotely via telehealth. This will limit the impact on the healthcare system from otherwise avoidable hospital admissions and ED presentations resulting from unnecessary medicine-related harm.

 

PSA has recommended measures to the Department of Health which ensure pharmacists and their patients remain safe while delivering these vital services. We will keep members updated on the outcome of this proposal both on this website and through our social media channels.

 

In the meantime, PSA has prepared the following FAQs related to conducting medication reviews in the context of COVID-19. These are recommendations only. Pharmacists have a duty of care and should exert their professional judgement at all times.

Should I continue to conduct HMRs/RMMRs?

At this stage, pharmacists are still able to visit patients to conduct HMRs/RMMRs. However, it is important to respect the wishes of some patients who may not want the HMR to occur at this time. Likewise, some aged care facilities are likely be introducing strict guidelines around contact with residents. This too should be respected.

 

Attention should be given to addressing high priority  HMRs/RMMRs (i.e. patients on high risk  medicines, recently discharged from hospital etc.). Pharmacists should weigh up the potential risks/benefits of conducting a HMR/RMMR, both for the patient and for themselves.

 

UPDATE: The government has approved an increase in the fee for provision of a Home Medicine Service to $7.77. This fee increase will be backdated to the start of the program (16 March 2020).

Should I continue to conduct MedsChecks?

At this stage, pharmacists are still able to conduct MedsChecks in the pharmacy. It is however important to consider the necessary changes to workflow that COVID-19 means for most pharmacies, and to ensure that conducting the service does not impact on other essential services (e.g. supply of medicines, influenza vaccinations etc.) the pharmacy will likely need prioritise.

 

Attention should be given to addressing high priority  MedsChecks (i.e. patients on high risk  medicines, recently discharged from hospital etc.). Pharmacists should weigh up the potential risks/benefits of conducting a MedsCheck, both for the patient, themselves and the pharmacy workflow.

What steps should I take if I choose to proceed with HMRs/RMMRs and MedsChecks?

If HMRs/RMMRs/MedsChecks proceed, it is vital that pharmacists consider standard precutions:

  • ensure both they and the patient are asymptomatic. For a HMR/RMMR, this should be established both when scheduling the visit and on the day of the review.
  • adhere to social distancing measures
  • maintain good hygiene practices throughout their interaction with the patient

 

It is important the person for whom the service is being conducted is also aware of the importance of these steps. This COVID-19 – what you need to know factsheet may be useful to send through to patients in advance or take along with you when conducting the review.

 

Should you or the patient develop symptoms (fever, a cough, sore throat, tiredness or shortness of breath) within 14 days of the contact with the patient, both parties should agree to inform the other.

What precautions should I take if I’m conducting HMRs/RMMRs and MedsChecks?

Prior to conducting the home or facility visit, or MedsCheck service, determine if the patient has:

  • returned from any overseas travel within the past 14 days
  • been in close contact with a confirmed case of coronavirus
  • symptoms of coronavirus (fever, a cough, sore throat, tiredness or shortness of breath).

 

If any of these apply, the HMR/RMMR/MedsCheck should not be conducted in person.

Can I conduct HMRs/RMMRs and MedsChecks via Skype/Facetime etc. to reduce contact with patients?

No, HMRs/RMMRs must be conducted face-to-face in the patient’s home or aged care facility and MedsChecks must be conducted face-to-face in the pharmacy as per the program rules. You may choose to conduct these services via alternate arrangements, however you will not be eligible for payments under the 6CPA programs. PSA is currently working with the Department of Health seeking approval for these services to be conducted via telehealth arrangements. We will update members when more information is available.

Effective 24 March 2020, a new legislative instrument has come into force with additional controls to be applied to the prescribing of hydroxychloroquine. Initial treatment of a patient with hydroxychloroquine is now restricted to specialists in any of the following specialties:

  • dermatology
  • intensive care medicine
  • paediatrics and child health
  • physician
  • emergency medicine.

 

PSA and the Guild advocated for this change in an open letter to prescribers on 21 March 2020. Read more about the new restrictions on the prescribing of hydroxychloroquine from the TGA here.

 

To support pharmacists with this change, PSA has prepared the following FAQs. Please be aware that these changes are intended to be short term to sensibly manage stock so that it is available for those who have a therapeutic need, and should clinical trials confirm that it is suitable for the treatment of COVID-19 in the future.

What legislative changes have come into force for hydroxychloroquine?

On 24 March 2020, a new Commonwealth legislative instrument, the Poisons Standard Amendment (Hydroxychloroquine and Salbutamol) Instrument 2020, came into force.

What has changed?

Additional Appendix D controls are now included in the Poisons Standard and apply to the prescribing of hydroxychloroquine. These specify that initial treatment of a patient with hydroxychloroquine must be authorised by a specialist in any of the following specialties: dermatology, intensive care medicine, paediatrics and child health, physician, and emergency medicine.

Does that mean general practitioners cannot prescribe hydroxychloroquine?

GPs cannot initiate treatment with hydroxychloroquine for a patient. However, GPs can authorise (prescribe) continuing supply of hydroxychloroquine for a patient (after specialist initiation).

A patient presents a new prescription for hydroxychloroquine. How do I know if I can dispense it?

Pharmacists should confirm whether the prescriber is a specialist. Calling the prescriber or using the AHPRA register are possible ways to verify that the prescriber is recognised in one of the listed specialties outlined in Appendix D.

What happens if a patient presents a new prescription for hydroxychloroquine from their GP?

Pharmacists should consider information from the patient’s dispensing history or My Health Record for prior dispensing of hydroxychloroquine. In the absence of any dispensing history, pharmacists should ascertain with the patient whether the medicine is for ongoing therapy.

What if a patient presents a repeat prescription for hydroxychloroquine?

A pharmacist can dispense a valid repeat prescription for hydroxychloroquine.

Does this change apply in every state and territory?

PSA understands these changes are being adopted by every jurisdiction.

Why were these changes necessary?

Hydroxychloroquine has been used for prevention and treatment of certain types of malaria, rheumatoid arthritis and other conditions. Recent studies indicated hydroxychloroquine may have potential in the treatment of COVID-19. Pharmacists also reported increased prescribing of hydroxychloroquine, and this raised concerns of a potential shortage of these medicines in Australia. This legislative outcome is to ensure availability of supply of hydroxychloroquine for those patients who need it and to prevent inappropriate use.

What specialties fall in the category of Physician?

The Medical Board of Australia refers to ‘Physician’ as any of the following specialties:

  • Cardiology
  • Clinical genetics
  • Clinical pharmacology
  • Endocrinology
  • Gastroenterology and hepatology
  • General medicine
  • Geriatric medicine
  • Haemotology
  • Immunology and allergy
  • infectious diseases
  • Medical oncology
  • Nephrology
  • Neurology
  • Nuclear medicine
  • Respiratory and sleep medicine
  • Rhuematology.

The Emergency Locum Service supports community pharmacies in rural and remote areas through direct access to pharmacist locums in emergency situations. The program rules have been updated with changes related to COVID-19.

 

In the event that a pharmacist is:

  • isolating themselves at home on the advice of a medical practitioner, for confirmed COVID-19; or
  • meeting the current national triage protocol criteria for suspected COVID-19 infection after consultation with either the national COVID-19 hotline, state COVID-19 hotlines, a registered medical or nursing practitioner or COVID-19 trained health clinic triage staff.

The maximum placement duration has also been extended to fourteen consecutive days. Find out more below.

Regarding self-isolation for interstate travel

 

LocumCo is currently seeking clarification regarding locums travelling between states and the need for isolation. PSA will provide further information here and on social media when it is available.

On Wednesday March 18 the Federal Government announced a range of restrictions to aged care with the following people unable to enter any aged care facility:

  • People who have returned from overseas in the last 14 days
  • Those who have been in contact with a confirmed cased of COVID-19 in the last 14 days
  • Those with fever or symptoms or acute respiratory infection and symptoms
  • Those who have not been vaccinated against influenza (from May 1).

 

Facilities must reduce the risk of transmission to residents, including limiting visits to short periods and a maximum of two visitors at one time per day.

 

Visits should be conducted in a resident’s room, outdoors or in a specific area designated by the facility, rather than communal areas where the risk of transmission to other residents is greater.

On Wednesday 11 March 2020 the World Health Organization made the assessment that COVID-19 can now be characterised as a pandemic.

 

Access the latest information and guidance from the World Health Organization (WHO).

PSA acknowledges the important work that pharmacists are doing on the frontline. It is important during events such as the current coronavirus situation that pharmacists take time to care for themselves and debrief with colleagues.

 

If you require additional support, contact the Pharmacists’ Support Service on 1300 244 910.

Ahpra and the National Boards are receiving a range of questions about how they will respond to requests for changes to the way that they register individuals in the context of managing the health sector impacts of COVID-19. They are in the process of considering how regulatory requirements can adapt to emergency health service needs and support continuity of health service delivery, and are planning for different scenarios which may occur. Keep up to date on developments at Ahpra’s COVID-19 updates web page.

 

More advice from Ahpra can be found below:

Information on Federal Government response to COVID-19

On Wednesday 11 March 2020, the Australian Government announced a $2.4 billion COVID-19 health package. As part of this package it was announced that the implementation of electronic prescribing (ePrescribing) will be fast-tracked to help protect people most at-risk in our community from exposure to COVID-19.

 

While the details are still being confirmed, the most current information specific to this initiative can be found here. More information on the Australian Government’s overall COVID-19 National Health Plan can be found here.

 

PSA is working closely with the Australian Government on the implementation of this measure and will keep pharmacists updated as this work is progressed.

On Wednesday 11 March 2020, the Australian Government announced a $2.4 billion COVID-19 health package. Included in this package was the COVID-19 Home Medicines Service that will enable vulnerable people and people in self isolation to order their PBS and RPBS prescriptions remotely and have their medicines home delivered to reduce their potential exposure to COVID-19.

 

The full details of this measure have now been released. The Australian Government will provide up to $25 million, over six months, to support and protect the most vulnerable members of our community from potential exposure to COVID-19 by way of a fee per delivery payable to pharmacies for the home delivery of PBS and RPBS medicines, thereby removing the need for a patient to visit a pharmacy.

 

More information about the COVID-19 Home Medicines Service, including the program rules, eligibility criteria and FAQs can be accessed here.

 

UPDATE: The government has approved an increase in the fee for provision of a Home Medicine Service to $7.77.  This fee increase will be backdated to the start of the program (16 March 2020).

On Thursday 12 March 2020, the Australian Government announced a $17.6 billion economic response to COVID-19. This package has been announced to address the potentially significant economic consequences of COVID-19 and, from a pharmacy perspective, will support vulnerable Australians and the health professionals and staff who support them. A full overview of the economic response can be accessed here.

 

CASH FLOW ASSISTANCE FOR BUSINESSES

The announcement includes grants of up to $25,000 with a minimum payment of $2,000 for small and medium businesses that employ staff with an annual turnover of up to $50 million and will be provided through the tax system, tax free. More information can be accessed here.

 

DELIVERING SUPPORT FOR BUSINESS INVESTMENT

As part of the announcement, the Government has also increased the instant asset write-off threshold from $30,000 to $150,000 and expanded access to include businesses with aggregated annual turnover of less than $500 million (up from $50 million) until 30 June 2020. Businesses with a turnover of less than $500 million will be able to deduct an additional 50 per cent of the asset cost in the year of purchase (through to 30 June 2021). More information can be accessed here.

 

ASSISTANCE FOR SEVERLY AFFECTED REGIONS

The Government has also set aside an initial $1 billion allocation to support those regions and communities that have been disproportionately affected by the economic impacts of the Coronavirus, including those heavily reliant on industries such as tourism, agriculture and education. More information can be accessed here.

Member enquiries

PSA will continue to provide updates as we receive information. To speak with one of our team please call PSA on 1300 369 772 or send us an email.

 

The Australian Government has established a Coronavirus Health Information Line on 1800 020 080 for anyone seeking information on coronavirus.