Positive change to opioid dependency treatment prescribing

01 August 2023

What do the changes mean for me and my patients?

The Australian Government is implementing positive change to Opioid Dependency Treatment (ODT) to make medicines for opioid dependency more equitable and affordable for Australians on the Pharmaceutical Benefits Schedule (PBS).

These changes are a win for patients, and are long needed.

Implementation is still progressing and there are logistical issues to work through.

SWSPHN will endeavour to keep GPs up-to-date as further information becomes available.

From 1 July 2023, ODT medicines have become part of the Section 100 Highly Specialised Drugs (HSD) Program.

At the Opioid Therapies Webinar on 30 June, David Laffan, Assistant Secretary, Pharmacy Branch – Department of Health and Aged Care, said:

“The Australian Government has agreed to continue to pay pharmaceutical companies directly for ODT medicines supplied to private clinic and non-other PBS dosing sites until 30 November 2023, and this includes GP clinics that order the long acting injectables directly.

“After 30 November, GP clinics will be able to administer long acting injectables by obtaining supplies from a PBS pharmacy, which is more in line with how the usual PBS operates.

“Transitional arrangements are in place for pharmacies to dispense existing private ODT medicine prescription written prior to 1 July. Patients will not require new prescriptions to be written from 1 July.

“From 1 July, ODT medicines scripts can be written as a streamline authority script for 28 days with two repeats.”

Prescribers will be able to:

prescribe ODT medicines for PBS-eligible patients, as per the prescription of other medicines under the Section 100 HSD Program
for Methadone oral liquid, prescribe up to a maximum quantity of 4,200 mg (840 mL) with two repeats (the maximum quantity is equivalent to up to a maximum dose of Methadone of 150 mg per day for 28 days)
for sublingual Buprenorphine and Buprenorphine with Naloxone, prescribe up to a maximum quantity equivalent to 32mg of Buprenorphine per day for 28 days, with two repeats
for injectable Buprenorphine, prescribe up to a maximum quantity equivalent to 28 days (four weeks) with two repeats.

Buprenorphine-containing ODT medicines will be prescribed and dispensed on a per pack basis, Methadone liquid will be prescribed and dispensed on a maximum mL basis per prescription.

Prescribers are encouraged to prescribe only the quantities and repeats which are suitable for the patient’s clinical needs, until their next review.

To prescribe any doses higher than outlined above, GPs will need to obtain PBS Authority Approval by calling Service Australia (1800 888 333) or by using the Online PBS Authority System to obtain an authority number.

Dispensing:

Under Section 100 HSD program, ODT medicines can be dispensed from a section 90 approved community pharmacy, a section 94 public or private hospital and a section 92 approved medical practitioners.

What does this mean for patients?

For patients, this change “rights an historical inequity for a group of people that have been marginalised and stigmatised” (Dr Hester Wilson, GP and chair of RACGP Specific Interest Group in Addiction Medicine, Opioid Therapies Webinar, 30 June).

Eligible patients will pay the PBS-copayment to access their treatment and the amount paid will contribute towards their PBS Safety Net threshold.

This means a patient will pay $7.30 or $30 (depending on concessional status) per 28 days rather than the current out of pocket costs of $30 to $75 per week for ODT scripts. Patients currently receiving free Buprenorphine injections, though, will now be charged a co-payment of $7.30 or $30 (depending on concessional status) per 28 days.

Additional private dispensing or dosing fees cannot be charged by section 90 community or section 94 hospital pharmacies under the PBS.

Note that Close the Gap (CTG) co-payment discount will NOT apply at this stage.

What does this mean for pharmacies?

To support in-pharmacy and take-away dosing, a community pharmacy program for ODT medicines will be established, including on-site pharmacist administration of injectable Buprenorphine.

Source: Australian Government, Department of Health and Aged Care, the Pharmaceutical Benefits Scheme – Updated 10 July 2023

Watch these webinars:

A SWSPHN Community of Practice – Changes to Opioid Dependence Treatment Prescribing – Online Meeting will be held on Thursday, 10 August at 7pm.

This is an opportunity to improve your understanding of the new requirements and discuss the changes with local ODT subject matter experts, including GPs.

This is an RACGP session for 1.5 CPD hours.