2023 PBS changes

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.

Transitional prescription quantities – oral and sublingual ODT medicines

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.

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.

Table from PBS Fact Sheet for Prescribers

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.