Major changes to opioid PBS listings effective 1 June

Pharma News: Commencing 1 June 2020, the Pharmaceutical Benefits Scheme (PBS) listings for opioid medicines will change including Tramal (tramadol) and Panadeine Forte (paracetamol/codeine).

In response to concerns regarding the high number of deaths and hospitalisations due to prescription opioids, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended changes to PBS opioid listings.

These changes form part of a broader suite of measures intended to support appropriate use of opioids, including education and awareness campaigns, changes to clinical guidelines and ongoing prescription and compliance
monitoring.

The 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.

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What do these changes involve?

Opioid medications will now be available in smaller quantities with no repeats for the treatment of non-chronic pain. To be eligible for treatment with opioids, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, to maximum tolerated doses of non-opioid treatments.

Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.

For chronic pain, increased quantities and/or repeats may be authorised by Services Australia where the patient meets the restriction requirements. Increased quantities to extend treatment up to one month may be requested via telephone/electronic authority request, and up to 3 months’ supply (up to 1-month quantity and up to 2 repeats) may be requested via an electronic/written authority request.

To be eligible for treatment with high strength opioids such as morphine and fentanyl, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.

These new arrangements apply to all PBS listings for opioid medications and therefore there will also be amendments to the tramadol and paracetamol/codeine restriction requirements.

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What does this change mean for prescribers?

The new opioid listings for reduced pack sizes will provide a simplified way for prescribers to prescribe smaller quantities of immediate release opioids for acute, short-term treatment.

Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. The ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website.

To ensure appropriate use of opioid medicines for the management of pain, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.

What does this change mean for pharmacists?

From 1 June 2020, some opioid listings will become Authority Required (STREAMLINED). Pharmacists will therefore be required to ensure any relevant dispensed scripts have a valid streamlined authority code, which needs to be valid at the date of prescribing. Pharmacists are also required to ensure prescribers have correctly requested increased quantities or repeats for chronic pain through telephone/electronic authority for up to 1 month’s
treatment or electronic/written authority for up to 3 months treatment.