National President’s Message: COVID-19 Update
26 May 2020
As the pandemic grows by more than 100,000 new cases globally each day and the epicentre shifts to South America, in Australia, it feels like the worst is behind us with only 5-10 new cases reported nationally each day.
In the past week, Premiers and Chief Ministers around the country have announced and implemented a modest winding back of restrictions, which have included guidance on modifications needed to reopen business and the community in a modified ‘COVID-normal’ way. In doing so, they have emphasised these restrictions are likely to be our new normal for a long, long time – likely to be normal until a vaccine is developed.
There are positive signals on the vaccine development front with a US biotechnology company beginning human trials in Australia (Melbourne and Brisbane) of a coronavirus vaccine. The trial will focus on the safety aspects of the vaccine and will also look for early signs of effectiveness. There is now about a dozen experimental vaccines which are in early stages of testing or on the eve of commencing, mostly in the US, Europe, and China.
As the rest of Australia transitions from lockdown to COVID-normal, actively consider; what does your COVID-normal looks like? What semi-permanent changes do you need to make to your practice? How will you maintain increased infection control, physical distancing for staff/patients and supporting unwell people stay-at-home (staff and customers) until a vaccine is developed? What temporary signage and process workarounds need to become embedded as being more permanent?
Supporting you with electronic prescriptions: starting now
Temporary digital image prescriptions during COVID-19 have been critical to ensure the supply of medicines during the global pandemic – but it has put significant pressure on you with regulatory confusion and in some instances has put pharmacists in regulatory peril.
I welcome the imminent implementation of electronic prescribing in a staged and planned approach – which will see a safer, clearer and more secure prescribing model, supporting pharmacists and protect patient’s privacy and safety.
I am confident that the work PSA has done with the Australian Digital Health Agency will result in the reduction of many of the bugbears and regulatory issues of digital image prescribing and paper prescriptions.
As electronic prescriptions go live, it’s important you what to do when the first patient presents an electronic prescription to you in your practice.
To support you, PSA, in partnership with the Agency now offers a dedicated electronic prescribing support line for pharmacists. The support line is staffed by experienced pharmacists who have access to the latest workflow information on how to adopt electronic prescriptions.
You can contact the support line on 1300 955 162 (8:30am to 7:00pm AEST, Monday to Friday) or email email@example.com.
PSA has also created a dedicated electronic prescribing webpage which contains all the latest up to date information and resources for pharmacists: www.psa.org.au/ep.
Webinar: Electronic prescriptions
This Wednesday night, the agency’s Andrew Matthews MPS, Director of Medicine Safety Programs, and Kate Ellis Manager, Provider Adoption will join me to discuss everything you need to know about electronic prescriptions and answer your questions.
7.30pm (EST) Wednesday 27 May
PBS opioid changes from 1 June
The Australian Government, through the Department of Health, is implementing a range of changes to minimise the harms to Australians caused by opioid medicines. One of these measures is PBS changes which affect prescriptions written from 1 June.
These PBS changes include amendments to existing restriction requirements and arrangements for increased quantities and repeats. In addition, there are new Restricted Benefit listings for smaller maximum quantities of immediate release opioids, with no increased quantities or repeats, for patients requiring short-term relief of acute severe pain.
The 1 June PBS changes affect most opioid Controlled Drugs, as well as tramadol and paracetamol+codeine combination products.
I encourage you to start socialising these changes with your patients and medical colleagues to help transition as smoothly as possible to these new arrangements.
Supporting Australians to put their health first
On behalf of PSA, I am pleased to join with other peak bodies and consumer support groups in calling Australians to take action to avoid a second wave of health problems from reduced screening, management and monitoring of serious health conditions.
This call, in an open letter to Australians, encourages people to get the health care they need, whether that be screening, getting treatments from an allied health provider or having a telehealth consultation with their pharmacist.
Now is the time to reach out to patients who have disengaged from managing their chronic health conditions, particularly those who you may not have seen for a while. This can include undertaking medicine reviews, calling patients you haven’t seen for a while, discussing adherence during repeat dispensing or providing recommendations for screening services when non-prescription medicine requests warrant.
Provisions for medicine review services (e.g. Medschecks, HMRs) to be conducted via telehealth are available and I encourage you to promote them to your patients where they provide an avenue for people trying to avoid public contact to get the expert pharmacist care they need.
Medicine limits and restrictions remain
I am pleased to hear many of the medicine shortages which arose in March and April from increased patient demand for prescription and non-prescription medicines – in particularly salbutamol, paediatric analgesics, hydroxychloroquine – are well on their way to returning to more stable levels.
Back in March, PSA, together with the Government, the Pharmacy Guild of Australia and the National Pharmaceutical Services Association agreed to dispensing and supply limits for nominated medicines. Your hard work, the work of all pharmacists and the work of suppliers has been absolutely essential to restoring stability in the supply chain; helping medicines be available for everyone.
Limitations to the Schedule 3 listing of salbutamol are a permanent regulatory change; meaning the single inhaler limit and requirement for the patient to provide evidence of medical diagnosis of a respiratory condition or dispensing history at the supplying pharmacy remain.
As we move to a COVID-normal environment, it is essential adherence to these limits continue to maintain ongoing stability of the supply change. As many of you are aware, a large number of medicines remain out-of-stock or on constrained supply. Continuing to play our part helps ensure essential medicines will be available to as many Australians as possible when they need them. Something more important than ever as we focus on consumers with management of their chronic health conditions.
The non-COVID19 curves likely to rebound
Social distancing hasn’t just flattened and squashed the COVID-19 curve, it has also limited the transmission of other infectious diseases. Confirmed cases of other notifiable infectious diseases such as influenza, chlamydia and norovirus have been significantly lower in recent months. While some of this may be attributed to people not seeking usual medical care and pathology testing, limited social interaction and increased infection control measures has seen dramatic drops in community prevalence of these conditions.
The graduated return to workplaces, schools and social gatherings in a COVID-normal community will likely see increased rates of non-COVID infectious diseases, with health authorities renewing calls for influenza vaccination this week.
When responding to queries about respiratory conditions, the messages we have become accustomed to during COVID-19 remain the same: Stay at home if sick. Get tested if you have unexplained fever or any respiratory symptoms. Maintain physical distancing. Limit social interaction if vulnerable. Download the COVIDSafe App.
Your voice to parliament: highlighting the lessons of COVID-19
This week PSA will be submitting its response to the Senate Inquiry into the health response to COVID-19, which will highlight the challenges faced with medicines shortages, digital image prescribing and regulatory confusion. It will outline important lessons learnt as well as examine the extraordinary strength and purpose pharmacists demonstrated in supporting Australians under unparalleled pressure and community panic.
In the submission we will be highlighting the challenges faced with medicine shortages, digital image prescribing, regulatory confusion between the Commonwealth and state jurisdictions and the challenges with the TGA’s Serious Shortage Medicine Substitution Notices.
I will share the submission with you once it has been published on the Senate’s website.
Providing further clarity on emergency supply options
How well do you know your state/territory legal requirements for phoned/faxed prescriptions?
What conditions need to be met to use the emergency supply ‘3-day rule’ if someone doesn’t meet the requirements for Expanded Continued Dispensing (or one month emergency non-PBS supply during where allowed)?
The application of these requirements has been a point of tension with prescribers during COVID-19 where they need to be followed when prescriptions aren’t eligible to be supplied under temporary COVID-19 provisions (digital image prescriptions and Expanded Continued Dispensing).
Our dedicated COVID-19 microsite has been updated with state-specific mapping these requirements to help clarify requirements for prescriptions unable to be supplied as digital image prescriptions or under Expanded Continued Dispensing arrangements.
The microsite also continues to be updated daily with information relevant to your practice.
Associate Professor Chris Freeman
Pharmaceutical Society of Australia