This is the text extract for Changed Close Control rules from 1 June 2008 , browse documents here.

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7 March 2008

Notification of changes to the Pharmaceutical Schedule

Changed Close Control rules from 1 June 2008

Outline of the changes

Close Control is a mechanism to permit subsidised medicines to be dispensed more frequently than the default period permits. From 1 June 2008 the Close Control rule will be widened to allow:

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pharmacists to annotate prescriptions with Close Control when PHARMAC has approved and notified pharmacists to endorse prescriptions Close Control for out-ofstock items; and patients in Rest Homes and Residential Disability Care Institutions to receive their subsidised prescriptions dispensed in monthly lots; and smaller quantities to be dispensed to patients who are initiated on a new treatment or to assist with dose changes.

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More information

More detailed information on these changes can be found on the following pages. If you have any queries about these changes, you can call our toll free number (9 am to 5 pm) on 0800 66 00 50. Resources will be sent to prescribers and pharmacist closer to the time of implementation.

What the changes will mean

Pharmacist annotation of Close Control dispensing during situations of short supply There has been an existing practice of pharmacists being able to annotate prescriptions Close Control in certain situations to assist with managing short-supply issues with medicines. This change formalises the practice within the Pharmaceutical Schedule on occasions where PHARMAC has approved and notified pharmacists to endorse prescriptions Close Control for these items. This does not allow pharmacists to annotate prescriptions Close Control for an out-of-stock item at any other time. However we do appreciate receiving feedback from pharmacists if a subsidised medicine is difficult to obtain to enable us to consider the options for managing the specific circumstance. Patients in Rest Homes and Residential Disability Care Institutions These patients will be able to have their prescriptions dispensed Close Control monthly from 1 June 2008.

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Prescriptions can be written for up to three months for these patients, and dispensed monthly to avoid the need for monthly prescriptions that is currently required by Ministry of Health guidelines. This allowance applies provided that:

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the name of the institution is written (or printed) on the prescription by the prescriber or pharmacist. Close Control is endorsed/annotated and initialled on these prescriptions by either the prescriber or the pharmacist. no less than 28 days supply is provided per repeat.

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Rest Home and Residential Disability Care Institution patients are not eligible for Close Control under any other circumstance. Initiation of new treatment and dose changes Three-month prescriptions written for patients who are initiated on a new treatment or have their dose changed on an existing treatment will be eligible for Close Control from 1 June 2008. This will enable the first month to be dispensed Close Control and facilitate monitoring during the change. If the new treatment or new dose is tolerated then the patient can collect the remainder of their medication all-atonce.

Why the changes are happening

The Close Control rule has been amended to assist prescribers and pharmacists to help patients manage their medication better. We had been contacted by a number of different organisations requesting a review the rule. We sought public feedback on a proposal to modify the rules in August 2007, and PHARMAC’s Board has now approved a modified proposal as a result.

What feedback was received?

We appreciate all the feedback we received and acknowledge the time people took to respond. All consultation responses were considered in their entirety in making a decision on the proposed changes. Some key themes raised during consultation and our response to the feedback are outlined below.

Theme The need to individually annotate each prescription item for patients in Rest Homes and Residential Disability Care Institutions was considered unnecessary if the patient clearly resides in such a facility Response The wording has been amended so that this group of patients only needs Close Control endorsed once on the prescription Legally the street address of the patient must be written on the prescription. However, for audit purposes this information is required on the prescription for the purpose of receiving a subsidy and can be added by the prescriber or pharmacist.

Whether the name of the Rest Home or Residential Disability Care Institution was legally required on a prescription.

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Theme For pharmacist annotated out-of-stock Close Control the possibility of having the computer software automatically recognise “CC” claims during certain dates was raised.

Response Unfortunately the HealthPAC payment system can not be modified to implement such a change. Pharmacists will be able to annotate prescriptions “CC” for patients in Rest Homes and Residential Disability Care Institutions. We did not propose a blanket use by pharmacists for Close Control in our consultation and we are not progressing this request at this at this time.

Requests for pharmacists to be permitted to endorse any prescription Close Control.

Request for the minimum period of supply for Rest Homes and Residential Disability Care Institutions be changed from 30 days to 28 days. This is because most compliance packaging is in 28-day blister packs.

This is reflected in the new wording.

What will the amended rule look like?

The Close Control rule as listed in Section A of the Pharmaceutical Schedule will be amended from 1 June 2008 as follows. Changes from the existing wording is shown in bold (additions) and strikethrough (deletions): “Close Control” means the dispensing of a Community Pharmaceutical, in accordance with a Prescription, in quantities less than one 90 Day Lot (or, in the case of for oral contraceptives, less than one 180 Day Lot) for a Community Pharmaceutical referred to in Section F Part I, or in quantities less than a Monthly Lot for any other Community Pharmaceutical, where any of a), b) or c) apply. as applicable, where a) All of the following conditions are met: i) the Community Pharmaceutical is a tri-cyclic antidepressant, antipsychotic, benzodiazepine, a Class B Controlled Drug, or any other Community Pharmaceutical that has been prescribed for a patient who: 1A) is not a resident in a Penal Institution, Rest Home or Residential Disability Care Institution; and 2B) either of the following: i) in the opinion of the prescribing Practitioner Doctor, Midwife or Nurse Prescriber is: a. frail; or b. infirm; or c. unable to manage their medication without additional support; or d. intellectually impaired; or and e. requires close monitoring due to recent initiation onto, or dose change for, the Community Pharmaceutical (applicable to the patient’s first changed Prescription only); and f. requires that Community Pharmaceutical to be dispensed in a smaller quantity than that for which it is currently funded, or ii) the Community Pharmaceutical is any of the following: a. a tri-cyclic antidepressant; or b. an antipsychotic; or c. a benzodiazepine; or d. a Class B Controlled Drug; and ii) the prescribing Practitioner Doctor, Midwife or Nurse Prescriber has:

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b)

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A) endorsed each Community Pharmaceutical on the Prescription clearly with the words “close control” or “CC”; and B) initialled the endorsement in their the prescribers own handwriting; and C) specified the maximum quantity or period of supply to be dispensed at any one time. All of the following conditions are met: i) The Community Pharmaceutical is prescribed for a patient who is a resident in a Rest Home or Residential Disability Care Institution; and A) the quantity or period of supply to be dispensed at any one time is not less than 28 days’ supply; and B) the prescriber or pharmacist has written the name of the Rest Home or Residential Disability Care Institution on the prescription; and C) the prescribing Practitioner or pharmacist has: 1) written on the Prescription the words “close control” or “CC” (this applies to all medicines prescribed on the prescription), and 2) initialled the endorsement/annotation in their own handwriting; and 3) specified the maximum quantity or period of supply to be dispensed at any one time. All of the following conditions are met: i) where PHARMAC has approved and notified pharmacists to annotate prescriptions for a specified Community Pharmaceutical(s) “Close Control” without prescriber endorsement for a specified time; and ii) the dispensing pharmacist has: A) clearly annotated each of the approved Community Pharmaceuticals that appear on the prescription with the words “close control” or “CC”; and B) initialled the annotation in their own handwriting; and C) specified the maximum quantity or period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification.

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