2023 PBS changes

This page summarises changes to how opioid dependence treatments will be provided from July 1, and provides brief guides to pharmacists and prescribers.

Note that doctors, nurse practitioners and pharmacists must continue to comply with all relevant State legislation regarding the prescribing, dispensing, recording and storage of drugs of dependence. The Victorian State Government DoH have published a fact sheet, Features of a Victorian Pharmacotherapy Prescription to assist with this.

For complete guides and rules about the changes, refer to the PBS and Pharmacy Programs websites.

On July 1, 2023, new PBS and Pharmacy Programs arrangements came into effect, changing the way pharmacies, doctors and nurse practitioners provide treatments for opioid dependence.

The new arrangements provide for listing of oral liquid methadone, sublingual buprenorphine and buprenorphine/naloxone, and long-acting injectable buprenorphine under the Highly Specialised Drugs, Community Access section of the PBS schedule.

From July 1, 2023:

  • Patients with a Medicare card are eligible to pay a single PBS co-payment for 28 days supply of the listed treatments. Multiple co-payments are payable if multiple strengths are supplied.
    No further fees are payable by the patient to access the treatment.
  • Transitional arrangements for existing, pre-July paper prescriptions and e-scripts are provided to enable continuum of treatment (see below).
  • For new prescriptions after July 1, doctors and nurse practitioners must provide their patients with a valid PBS prescription for up to 28 days supply, plus 2 repeats, if required.
  • Pharmacists will be remunerated for PBS supplies under the usual arrangements
  • A daily fee per patient, for activities associated with the staged supply of these medications (excl. LAIB) and an administration fee for LAIB, if applicable, will be claimable by participating pharmacies via the Pharmacy Programs portal,

Transition arrangements for existing prescriptions

Transition arrangements for pre-July paper prescriptions and e-scripts  are in place enabling the use of special prescription and streamlined authority numbers. We recommend pharmacists and prescribers liaise closely to facilitate new prescriptions as soon as possible after July 1.

Brief guides for pharmacists and prescribers on handling existing transition prescriptions is provided on this page (see above, next to “Overview), or refer to the prescriber and pharmacist fact sheets for full information on transition rules for prescriptions.

Fact sheets

The Federal government and pharmacy programs administrators have published fact sheets relating to the new PBS and Pharmacy Programs arrangements. Links to the fact sheets are provided below, or may be accessed via the PBS dedicated web page here – https://www.pbs.gov.au/browse/section100-md

Find guides and rules associated with the Opioid Dependence Treatment Pharmacy Program at the PPA website here – https://www.ppaonline.com.au/programs/medication-adherence-programs-2/odt

This is a brief guide for pharmacists handling existing, pre-July 1 paper prescriptions and e-scripts for oral liquid methadone and sublingual buprenorphine. For the full rules, including for long-acting buprenorphine injection,  refer to the PBS website.

From the PBS fact sheet for pharmacists, “for the purposes of dispensing and submitting a PBS claim, existing  prescriptions will be taken to be written on 1 July 2023.”

Annotating existing, pre-July prescriptions.

  1. Calculate days remaining on existing prescriptions according to table 1, and exact quantity and number of repeats to be supplied.
  2. Annotate a photocopy of the paper prescription, or a printout of the e-script with calculated days remaining, quantity and number of repeats. Include the endorsement “Per HSD transition arrangements”.
  3. Retain the copy or printout with the patient’s file.
  4. Advise the patient of the new, transitional expiry date of their prescription, if it has changed.

Table from PBS Fact Sheet for Pharmacists

Transition quantities table

Transitional prescription quantities – oral and sublingual ODT medicines

Existing script expiry dateQuantity and repeats for PBS claimNew script expiry date
1/7 -28/7supply exact quantity up to expiry datescript expires on current date on script
29/7 – 24/828 days supply, no repeats28/7
25/8 – 21/928 days supply, 1 repeat24/8
After 22/928 days supply, 2 repeats21/9

Claiming on existing paper prescriptions and e-scripts after July 1

For the purposes of claiming after July 1, in your pharmacy dispense software:

  1. Enter the first supply of the transition prescription as “original”, enter the calculated quantity for 28 days, or days remaining if less than 28 days, and the number of repeats, if applicable.
  2. When prompted, for authority numbers, enter the temporary PBS Authority Prescription Number (0000641) and the appropriate Streamline Authority Code from the table below.
  3. For doses of methadone greater than 150mg, or doses of buprenorphine greater than 32mg, where increased quantities are required, enter the PBS Authority Approval Number shown (P2023OD).
  4. Charge the patient the relevant general or concessional co-payment amount.
  5. Record the supply on the patients PBS Safety Net record if requested
  6. Retain the annotated copy or printout, and original prescription (if applicable) as per usual PBS rules and state drugs of dependence rules.

Table from PBS Fact Sheet for Pharmacists

Transition prescription approval numbers

New prescriptions written after July 1

New prescriptions for the PBS-listed opioid pharmacotherapy items should be PBS streamline authority prescriptions, with exact quantities for up to 28 days supply and two repeats OR for patients on methadone doses greater than 150mg, or sublingual buprenorphine doses greater than 32mg, a PBS authority prescription with telephone approval for an increased quantity.

Authorities for increased quantities of the long-acting buprenorphine injections are not provided for, but note that the usual rules for early supply are allowed, enabling more frequent injection for those patients that require it (typically between every 21 to 28 days).

Note that all state requirements and guidelines for the writing and dispensing of drugs of dependence prescriptions continue to apply or are recommended,

For prescribers, all prescriptions written prior to July 1, including e-scripts remain valid for a period determined by transition prescription rules, up to 84 days. Your pharmacist will advise your patient when a new prescription is required.

Patients presenting after July 1.

After July 1 you must provide PBS prescriptions for ODT treatments. Pharmacists will be unable to dispense prescriptions as PBS if not correctly written.

Refer to tables below for maximum quantities and streamline authority codes.

  1. Calculate the quantity of medication required for up to 28 days supply.
  2. For patients requiring less than or equal to the maximum quantity for up to 28 days’ supply, provide a streamline authority paper or e-script for the calculated quantity plus up to 2 repeats,

    OR

    For patients requiring greater than the maximum quantity for up to 28 days’ supply (patients taking more than 150mg methadone or 32mg SL buprenorphine daily), obtain a telephone authority for the increased calculated quantity plus up to 2 repeats.

  3. In the case of sublingual buprenorphine preparations, where more than one strength of buprenorphine is required, you must provide a prescription for each strength to be supplied.
Streamline authority codes

Table from PBS Fact Sheet for Prescribers

Maximum PBS quantities

Prescribing ‘monthly’ long-acting buprenorphine (LAIB) where the dose interval is less than 28 days

It should be noted that increased quantity authorities are not provided for LAIB, but this does not prevent prescribing a reduced dose interval for the ‘monthly’ injection (less than 28 days) when clinically appropriate. Prescribe a single injection and repeats and indicate the reduced interval clearly on the prescription. Your pharmacist is able to supply at the reduced interval under normal PBS rules.

Your patient having more frequent injections will also require more frequent new prescriptions, due to the reduced interval. e.g a patient having an injection supplied and administered every 21 days will need a new prescription at around every 63 days, presuming 1 injection and 2 repeats are prescribed.

Direct supplies of pharmacotherapy agents to doctors and nurse practitioners

Some doctors and nurse practitioners may obtain direct supply of pharmacotherapy agents, primarily LAIB. Transition arrangements allow for continued direct supply until November 30.

Clinicians currently receiving direct supply are encouraged to arrange alternative supply from a PBS accredited provider (a community pharmacy or approved hospital pharmacy) before the end of the transition period.

Key points for prescribers

  • Existing, pre-July 1 paper prescriptions and e-scripts remain valid after July 1.
  • From July 1,  new prescriptions must be PBS.
  • Up to 28 days supply, plus 2 repeats are allowed.
  • Prescribe precise quantities.
  • For sublingual buprenorphine, provide a prescription for each strength required.
  • All new PBS items are streamlined authority.
  • Doses greater than 150mg for methadone or 32mg for buprenorphine will require telephone authorities for increased quantity.
  • Increased quantity authorities are not allowed for LAIB, but early supply by pharmacists is allowed, enabling more frequent dosing when clinically appropriate

Key points for pharmacists

  • Existing, paper prescriptions e-scripts issued prior to July 1 remain valid after July 1, with allowed annotations.
  • A co-payment is payable by the patient for each 28 day supply, and for each strength supplied (for SL buprenorphine preparations).
  • A daily fee for staged supply activities is claimable in arrears via the PPA portal.
  • No further fees are payable by the patient.
  • Early supply is allowed under the same rules as other PBS medicines.