Aniello Iannuzzi: Sensible authority

THE AMA recently emailed members and publicly called on the federal government to scrap the Pharmaceutical Benefits Schedule authority system.

To refresh a few basic points, reasons for medicines requiring PBS Authorities include a drug is very expensive (eg, goserelin for prostate cancer); a drug has a clinical indication that needs to be restricted for clinical reasons (eg, norfloxacin for complicated urinary tract infections); a doctor wants to prescribe more than the PBS-approved quantity (eg, giving more than just a few days of narcotics to those in chronic pain); ora drug must be initiated by a particular specialist (eg, the dutasteride/tamsulosin combination, for prostatic hyperplasia).

Authority scripts can be authorised in three ways — by a preset authorisation number (eg, for clopidogrel), by telephone or by post.

As well as these restrictions, we sometimes also have to deal with hospital and state government restrictions on certain drugs (eg, addictive narcotic drugs, the amphetamine groups and the retinoids for acne).

Given our health system has to be rationed, most of us accept that health authorities cannot simply allow all drugs to be prescribed without some boundaries. It is actually the process required to gain authorisation that gets under everyone’s skin as it takes so long and is prone to mistakes at the other end.

There is something just not right about having to phone a call centre, be put on hold and have to wait to seek permission for a drug from a call centre worker who might not even know how to spell the drug let alone understand what it is.

At least at the Department of Veterans’ Affairs (DVA) call centre we get to talk to a pharmacist about the pros and cons of a drug, as well as possible alternatives. Over the years, I have learned some good tips from the DVA pharmacists at their call centre.

The postal authority system also leaves a lot to be desired, especially for those of us in rural and remote areas relying on “snail mail”, with common problems including delays of more than 2 weeks, scripts lost in the mail and mistakes regarding clinical indications and duration of scripts.

For a small number of drugs, in particular the Alzheimer treatments, authorities must go via mail. Given that memory is a problem for these patients, remembering what to do with a script posted to their homes or remembering to collect a script from the surgery is a big problem.

Some solutions and improvements are immediately apparent.

Postal authorities should be permitted by fax or email to save time (the originals can follow by slow mail if necessary). All authority drugs could be moved to the restricted PBS class, with better monitoring of this class by Medicare to ensure compliance.

Even more sensible would be for all authority drugs to be streamlined under the pre-approved authority numbers, saving much time for doctors.

Some commonsense solutions such as these would result in the only time-consuming authorisation requests being those for increased quantities beyond those of the PBS. This would save the vast majority of phone calls and save the department a lot of money on call centres.

Authorities on the PBS have been a great burden to doctors of all specialties for a long time. However, the AMA calling for the system to be scrapped altogether is a little over the top.

We need some boundaries and rationing … but they should be sensible and efficient.

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

Posted 26 November 2012