National President’s Message: COVID-19 Update
19 May 2020
Two months ago when COVID-19 led to the rapid implementation of Stage 3 restrictions, it seemed impossible that by mid-May we would have seen cafes and restaurants reopening, boot camps recommencing and multiple jurisdictions achieving zero active known COVID-19 cases. For many in the community, there is a feeling that the worst of the pandemic is behind us, and there is agitation to return to our pre-pandemic lives.
I echo the sentiments of Professor Michael Kidd, Deputy Chief Medical Officer on Saturday that everyone must remain vigilant, and that the relaxation of restrictions is not a signal the pandemic is over and not a signal to return to life as it was pre-COVID-19. In the past few days, we have seen news headlines of new cases prompting workplace shutdowns, including multiple fast food stores, a furniture warehouse and a department store. We have also seen public criticism of people who attended workplaces providing health support when unwell.
We are moving into a ‘business as unusual’ environment where we reopen our community in a way which recognises and respects the ongoing presence of a virus to which we currently have no effective pharmacological treatment or community immunity.
In your practice, to your family and to your friends, promote and exhibit the modified norms: ongoing physical distancing, rigorous hand hygiene, staying home and being tested if sick and enhanced cleaning.
Serious Shortage Medicine Substitution system falls seriously short
You would likely be aware that the TGA last week published the first Serious Shortage Medicine Substitution Notice (SSSN) as part of its medicine shortages initiative. The initiative is meant to help patients continue to access medicines without delay during stock shortages, but the way it has been set up will make this difficult to achieve.
In this case, metformin XR 500mg is expected to be out of stock until at least early June. The TGA SSSN outlines three permitted substitutions based on total daily dose:
- 1500mg daily: substitute with metformin 1000mg XR and metformin 500mg IR
- 1000mg daily: metformin 1000mg XR
- 500mg daily: metformin 500mg IR
The permitted quantity to supply aligns to the equivalent doses to what was prescribed.
Does an SSSN make substitution by pharmacists legal?
As laws governing supply of medicines are state/territory-specific, whether you are allowed to make this substitution depends on where you practice – and each state and territory has incorporated it differently.
You are allowed to make the substitution unless you are practising in Victoria or South Australia – neither state has issued a public health order required to enable the substitution. For a more complete understanding of the regulation in your location, click here.
Is an SSSN recognised for PBS supply?
No. There is no provision to supply under the PBS when medicines are substituted under this approach. Even through metformin XR is a relatively low-cost medicine, this increase in out-of-pocket costs is a problem for some patients. For more expensive medicines, lack of PBS eligibility will render the SSSN impractical as patients will be better off delaying treatment to get an alternate prescription from their doctor.
When therapeutic substitution for medicine shortages was first tabled jointly by both the PSA and the Pharmacy Guild of Australia, this is not the model we put forward. In our view, the system is too complicated, too slow to respond to shortages, too inflexible to take into account local medicine shortages, and too bureaucratic to recognise pharmacists’ competence to make, what are largely, straightforward substitutions.
PSA will continue to work with state, territory and federal governments to improve patient access to medicines during shortages – with our first priority being to improve the workability of these arrangements. Together with the Guild, we will be following up with state and territories to modify state regulation to improve this system for pharmacists and the health and safety of patients.
Electronic prescriptions just a few weeks away
Electronic prescriptions remain a hot topic and one of strong interest to the profession, particularly as many of you are weighted down under a mountain of administratively complex digital image prescriptions.
Electronic prescriptions remain on target for implementation from the end of this month, with some prescribing and dispensing software providers expected to include its functionality in June software updates.
Last Wednesday night, I hosted an electronic prescriptions webinar in partnership with the Australian Digital Health Agency. We had more than 500 pharmacists join us for the live event, with a high level of engagement, interest and questions regarding how the initiative will work.
Webinars on electronic prescriptions will become a fortnightly event in coming months to ensure your questions and as you start to see them come through in your practice.
National Mental Health and Wellbeing Pandemic Response Plan
National Cabinet, last Friday, unanimously agreed to a nationally consistent approach to responding to mental health challenges which arise from the pandemic. The approach is described in the National Mental Health and Wellbeing Pandemic Response Plan, with suicide prevention a strong focus. The plan consists of:
- Data and modelling: including a focus on real-time data to identify emerging issues
- Outreach: focused on helping vulnerable communities, including older Australians, carers of people with mental illness, culturally and linguistically diverse communities and indigenous Australians
- Connectivity: including a public communications campaign titled: “It’s OK not to be OK”
The approach will work towards a ‘no-wrong-door’ approach to services, that wherever a person goes, they will be connected to part of the health system that can provide the services people need.
As I discussed last week, pharmacists are often a first point of contact for trauma-affected communities. Patients you interact with will present with signs and symptoms of mental health challenges, which can include reaching out to you in an indirect way. In supporting the ‘no-wrong-door’ approach outlined in the plan, I encourage you to know what options are available in your area and to connect patients to these services.
If you live in an eligible bushfire affected and have not already done so, I encourage you to sign up for the fully funded Mental Health First Aid training being run during May and June. Details the dates for these two-part workshops in your area are available here. If you don’t live in these areas, I encourage you to investigate other MHFA training in your area, such as those offered through PSA.
Webinar: MATOD in the time of COVID-19
As Australia cautiously eases restrictions, we are on a path towards ‘business as unusual’. So what will ‘business as unusual’ look like for your opioid substitution patients and services?
Join me on Wednesday night as Pene Wood, Lecturer of Clinical Pharmacy at LaTrobe University joins me to discuss the arrangements in place to support people living with opioid dependence on methadone or buprenorphine therapy.
7.30pm (EST) Wednesday 20 May
Our dedicated COVID-19 microsite has been updated with state-specific mapping of how the TGA SSSNs apply in each state and territory – as well as daily updates with information relevant to you.
Associate Professor Chris Freeman
Pharmaceutical Society of Australia