Medicines Matters

Information for health professionals about prescribing and supplying medicines in the ACT during the COVID-19 outbreak is available on this page.

Telehealth Prescribing

The Australian Government is fast-tracking implementation of electronic prescribing (ePrescribing) as part of its COVID-19 National Health Plan.

The Australian Government aims to reach up to 80 per cent of general practices and community pharmacies by May 2020.

Electronic prescriptions are enabled by ACT legislation[1] .

As an interim measure, to support telehealth services, the Australian Government has enabled the dispensing and claiming of pharmaceutical benefits using a digital image (photo, scanned copy or pdf) of the prescription.

Under the Australian Government interim arrangements[2], the dispensing and claiming of pharmaceutical benefits using a digital image are allowed, including:

  • A digital image (photo, scanned copy or pdf) of the entire prescription sent to the patient’s pharmacy of choice directly from the prescriber via email or text message (Digital Image Prescriptions), or
  • A copy of the entire prescription sent to the patient’s pharmacy of choice directly from the prescriber via fax (Faxed Prescriptions).

Telephone (verbal) prescriptions are also enabled by ACT legislation[1]. An original written prescription must be sent to the pharmacy within 24 hours of being given verbally. Written includes in electronic form. Telephone prescriptions are not claimable under the Australian Government interim arrangements.

The supply of schedule 4 (prescription only) Appendix D and schedule 8 (controlled) medicines using electronic, digital image, fax or telephone prescriptions is enabled under ACT legislation[1].

It is critical that prescribers send prescriptions directly to the patient’s pharmacy and have the necessary ACT standing or Chief Health Officer approval in place in order to mitigate risk of diversion or duplicate dispensing of Appendix D or schedule 8 medicines that may be subject to abuse or misuse.

Prescribers and pharmacists are also reminded to use the DORA real time prescription monitoring website to support patient care for those requiring treatment with a controlled medicine. Further information about ACT DORA is available here.

Digital Image Prescriptions

Digital image prescriptions transmitted electronically are enabled by ACT legislation[1].

A digital image prescription must be sent from the prescriber directly to the patient’s pharmacy of choice. Digital image prescriptions should never be given directly to the patient.

You can search for your patient’s preferred pharmacy and their contact details using the Healthdirect Find a health service website.

Under ACT and Australian Government interim arrangements, prescribers are not required to send a printed paper prescription to the pharmacy. The Australian Government interim arrangements require a prescriber to retain the prescription for at least 2 years.

Prescribers should also obtain and record patient’s consent to send the prescriptions electronically.

Please note that the PBS and RPBS interim arrangements are only for prescriptions written as a result of telehealth attendance or phone attendance provided on or after 20 March 2020. The PBS and RPBS interim arrangements are temporary and will cease in accordance with the COVID-19 National Health Plan which is currently scheduled to cease on 30 September 2020.

Faxed Prescriptions

The PBS and RPBS interim arrangements and ordinary arrangements[3] allow pharmacists to supply pharmaceutical benefits from a copy of prescription sent via fax.

Faxed prescriptions are also enabled by ACT legislation[1]. ACT pharmacists may claim for pharmaceutical benefits supplied on a faxed prescription according to the PBS and RPBS interim arrangements.

ACT regulation requires ACT prescribers to send the original prescription to the pharmacy within 24 hours of sending it via fax[4].

Pharmacists are also required to notify the Pharmaceutical Services Section of the Health Protection Service (on behalf of the Chief Health Officer), in writing, if they fail to receive the original prescription of a faxed prescription within 7 days of dispensing of the prescription[5]. Notifications may be sent to pss@act.gov.au or via fax 02 5124 9309.

ACT Health Directorate has worked with key medical and pharmacy stakeholder and developed the following FAQs to assist with Telehealth Prescribing.

Further information about the Australian Government interim prescribing arrangements for prescribers and pharmacists are available via these links.

Further information on requirements for Digital image prescriptions and Faxed prescriptions in the ACT is available here.

Further information about prescribing via telehealth for your patients is available on the telehealth prescriptions FAQ page.

Contact details of community pharmacies are available at the Healthdirect Find a health service website.

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[1 Medicines, Poisons and Therapeutic Goods Act 2008]

[2 National Health (COVID-19 Supply of Pharmaceutical Benefits) Special Arrangement 2020 and National Health (COVID-19 Supply of Pharmaceutical Benefits) Amendment (Expansion of Telehealth and Telephone Attendances) Special Arrangement 2020)]

[3 National Health (Pharmaceutical Benefits) Regulations 2017]

[4 Section 31 of Medicines, Poisons and Therapeutic Goods Regulation 2008]

[5 Section 120(g) of Medicines, Poisons and Therapeutic Goods Regulation 2008]

Home Medicines Services

The Australian Government COVID-19 National Health Plan package enables vulnerable people and people in self-isolation to order their PBS and RPBS prescriptions remotely and have their medicines home delivered to reduce their potential exposure to COVID-19. All community pharmacies will be eligible to participate if they can support online dispensing of medicine and provide home delivery services.

Home medicines services are enabled by ACT legislation1

Further information about the Australian Government COVID-19 National Health Plan - Home Medicines Services package may be found here.

Opioid Maintenance Treatment

The continued safe delivery of opioid maintenance treatment (OMT) for ACT patients during the COVID-19 emergency is a key priority for ACT Government.

The Chief Health Officer approvals framework under ACT legislation1 provides options to support prescribers and their patients during the COVID-19 pandemic.

Patients who are required to self-isolate or quarantine will not need to leave their residence to receive their OMT and should contact their prescriber and pharmacy/clinic by phone to make appropriate arrangements. The ACT Health Directorate has prepared information for patients who need to self-isolate or quarantine due to suspected or confirmed COVID-19.

The ACT Health Directorate has developed contingency guidelines for the delivery of OMT medication to clients under quarantine. Additional information available includes:

If you are a prescriber or pharmacist and have any questions about managing OMT for your patient during the COVID-19 emergency, please contact the Health Protection Service 02 5124 9208 or hps@act.gov.au.

For general information on OMT contingency arrangements contact AODPolicy@act.gov.au.

Medicines Shortages

On 19 March 2020, the Australian Government announced national measures to assist pharmacists manage panic buying and prevent medicines shortages during COVID-19.

The measures include:

- Pharmacists are required to only dispense one month's worth of prescription medicines

- Pharmacists are required to limit supply of over-the-counter medicines like ventolin and paracetamol to one unit per purchase

- Some items, like children's paracetamol, will be moved behind the counter to ensure supply.

The measures have been introduced by the Australian Government and are supported by the Pharmaceutical Society of Australia (PSA) and Pharmacy Guild of Australia (PGA).

Further information about medicines availability and potential shortages may be found on the Therapeutic Goods Administration website.

The ACT Government supports these measures by pharmacists to help ensure the availability of essential medicines during the COVID-19 public health emergency.

ACT adoption of TGA Serious Shortages Medicine Substitution protocol

The Therapeutic Goods Administration (TGA), in consultation with state and territory health departments and national stakeholders, has developed a national protocol for enabling pharmacists to substitute medicines during serious medicines shortages.

In the event of a serious medicines shortage, the TGA will coordinate stakeholder advice on whether a pharmacy-level substitution is warranted. The decision to confirm a serious medicines shortage and allow substitution would be made by the TGA and will be published as a Serious Shortage Medicine Substitution notice (Notice) on the TGA website.

There is a range of situations where substitution by a pharmacist could be undertaken by a Notice, such as dispensing tablets of:

  • a lower or higher strength of a product,
  • another dose form of the same medicine,
  • a combination of individual medicines when a fixed dose combination is not available, or
  • an immediate release form in lieu of a sustained/ extended release version or vice versa.

Under the TGA protocol, substitution will not be permitted for another product containing a different active ingredient or for Schedule 8 (controlled) medicines, such as strong opioids.

A pharmacist is not required to check with the patient’s prescriber before substitution in accordance with a TGA Notice, however they should advise the prescriber as soon as practicable.

To enable pharmacist substitution under a TGA Notice in the ACT, on 1 May 2020, Dr Kerryn Coleman, ACT Chief Health Officer issued a temporary Standing Order for the supply of medicines during a public health emergency under the Medicines, Poisons and Therapeutic Goods Regulation 2008.

This decision has been made to reduce the impact of a serious medicines shortage in the ACT and prevent or mitigate any resulting public health harms.

The Standing Order automatically enables pharmacist substitution of any medicine in accordance with a TGA Notice in the ACT. The Standing Order is in force for the duration of the ACT declared public health emergency, unless revoked earlier. ACT Health Directorate will consider options to adopt the TGA scheme in the longer term.

More information about the TGA Serious Medicine Shortage Substitution protocol, including Questions and Answers, is available on the TGA website.

TGA scheduling changes

The Australian Government Therapeutic Goods Administration (TGA) has made updates to scheduling of some medicines during the COVID-19 emergency. The key changes include:

Salbutamol

The schedule 3 (pharmacist only medicine) entry for salbutamol has been changed to limit supply:

- to persons with evidence of a medically diagnosed lung condition; or

- to persons with a record of previous supply from the pharmacist; or

- to persons authorised under a law of a State or Territory to use or supply salbutamol in the practice of their profession; or

- for use in institutional first aid; and

Supply is also restricted to one primary pack of salbutamol per person (with evidence of a medically diagnosed lung condition or previous supply from the pharmacist).

The scheduling change for salbutamol is automatically adopted in ACT legislation1.

The Australian Government has made these changes to regulate inappropriate supply of salbutamol and to ensure ongoing access for people with diagnosed respiratory conditions.

Hydroxychloroquine

Hydroxychloroquine is approved for use as a treatment for malaria and certain autoimmune diseases, including rheumatoid arthritis.

Recently there has been considerable focus on hydroxychloroquine as a potential treatment for COVID-19, leading to increased off-label prescribing.  This has the potential to create a shortage of hydroxychloroquine for patients who need it for treatment of an auto-immune condition.

Given the limited evidence for effect against COVID-19, as well as the risk of significant adverse effects, the TGA strongly discourages the use of hydroxychloroquine outside of its current indications at this time other than in a clinical trial setting or in a controlled environment in the treatment of severely ill patients in hospital.

To regulate off-label prescribing and ensure continued access for patients who require this medicine, the Australian Government has listed hydroxychloroquine as an Appendix D medicine in the Poisons Standard. Appendix D medicines are those where additional controls apply on their possession or supply.

The Appendix D entry restricts the initial prescribing of hydroxychloroquine to the following specialists from 24 March 2020:

  1. dermatology;
  2. intensive care medicine;
  3. paediatrics and child health;
  4. physician;
  5. emergency medicine.

From 3 April 2020, the Appendix D entry also applies to Australian Dental Board registered oral medicine specialists.

Further information on the new restrictions on prescribing hydroxychloroquine can be found on the Therapeutic Goods Administration website.

The Appendix D entry for hydroxychloroquine is automatically adopted in ACT legislation1.

This means that from 24 March 2020 offences apply for prescribing of hydroxychloroquine by unauthorised prescribers in the ACT.

Appendix D medicines cannot be self-prescribed in the ACT.

Continued Dispensing and Emergency supply

The Australian Government has extended Continued Dispensing (Emergency Measures) arrangements for the COVID-19 outbreak until 30 June 2020. The arrangements enable a pharmacist to supply a Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) medicine to a patient when there is an immediate need and they can’t get a prescription.

A patient can only receive one supply of an eligible medicine every 12 months.

Further information about Continued Dispensing may be found here.

Continued Dispensing is fully enabled by ACT legislation1.

In addition, on 1 April 2020, Dr Kerryn Coleman, ACT Chief Health Officer issued a temporary Standing Order to enable the emergency supply of a standard pack size of private designated prescription only medicines by pharmacists without a prescription during the COVID‑19 emergency.

The emergency supply order is intended to be a supportive measure for continued medicines access as COVID-19 puts pressures on the health system. The emergency supply order extends the arrangements put in place during the recent bushfire season.

Continued Dispensing and emergency supply of medicines are intended to be supportive measures for continued medicines access as COVID-19 puts pressures on the health system. Patients are still encouraged to contact their doctor regarding options for remote medical consultations and prescriptions during the COVID-19 emergency.

Pharmacists are only able to supply medicines under Continued Dispensing or emergency supply arrangements where all other options for obtaining a prescription have been exhausted, including a telephone, faxed or electronic prescriptions.

A fact sheet for pharmacists about these arrangements is available here.

For further information about the ACT temporary Standing Order or medicines management during COVID-19 in the ACT please contact the Health Protection Service 02 5124 9208 or hps@act.gov.au.

Modification to the ACT Pharmacist Vaccination Standards

In the ACT, a suitably trained pharmacist is authorised to administer vaccines in accordance with the ACT Pharmacist Vaccination Standards (Vaccination Standards). The Vaccination Standards require pharmacists administering vaccines to hold current First Aid and Cardiopulmonary Resuscitation (CPR) qualifications.

Due to the COVID-19 emergency restrictions, some training providers are unable to deliver first aid or CPR training. This is creating challenges for pharmacists who are already qualified immunisation providers to meet the requirements for renewing mandatory first aid and CPR refresher training.

The current pandemic together with the onset of influenza season has created increased demand on pharmacist immunisation providers and a need to ensure pharmacists may continue to provide this valuable service to the community. Therefore, the ACT Chief Health Officer has temporarily modified the Vaccination Standards to enable already qualified pharmacists to continue providing immunisations until six months after the COVID-19 declared emergency is over, without the required first aid or CPR refresher training.

The modified Vaccination Standards do not permit pharmacists to administer immunisations if they have not previously met all the training requirements.

ACT Health Directorate is aware some first aid and CPR training organisations are still conducting limited training and encourages pharmacists to consider these options where it is possible for them to attend.

If you have further queries, please do not hesitate to contact the Pharmaceutical Services Section at the Health Protection Service on 02 5124 9208 or hps@act.gov.au.

Page last updated on: 25 May 2020