This is the text extract for Close Control flow chart for health professionals, browse documents here.

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Close Control FAQs

Change of dose/medication

With the change in medicine/dose can the balance of the prescription be dispensed monthly? (e.g.10 days + 20 days + 30 days + 30 days)? No. After the initial dispensing of e.g. 10 days, the balance has to be dispensed stat (e.g. 80 days) if it is a stat medicine. If a patient needs a further change in dose or medicine, can this be dispensed for the shorter period? Yes. It would be considered a new change in dose or medicine, and can be prescribed and dispensed in accordance with the change dose/medication rules.

Rest home and residential care

If a patient in a rest home requires a change of dose or medicine, are they eligible to have the initial period dispensed for a shorter period than 28 days? No. Dispensings for patients in rest homes cannot be for periods of less than 28 days. Does each item need annotating? No. The script only needs to be initialled once. If a computer generated prescription has ‘cc’ next to each item does each item need to be initialled? No. The script only needs to be initialled once. Is weekly dispensing allowed for rest home prescriptions? No. The rule states that dispensings cannot be for periods less than 28 days . Does each prescription require the rest home to be named in the address field? Yes . Where a prescription is written for multiple rest home patients, does the prescription need to be initialled for each patient, or can it be initialled once for the bulk prescription? The prescription can be initialled once for the bulk prescription.

Changes to the

Close Control Rules

from 1 June 2008

Pharmaceutical Management Agency Level 14, Cigna House, 40 Mercer Street, Wellington 6143, New Zealand Phone: 64 4 460 4990 - Fax: 64 4 460 4995 www.pharmac.govt.nz Freephone Information line (9am-5pm weekdays) 0800 66 00 50

Other

Controlled Drug prescriptions require Close Control if they are to be dispensed more frequently than every 10 days.

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3. Pharmacist endorsed Close Control.

1. Initiating new medicines or changing doses.

Improvements to the Close Control rules

Changing the Close Control rules to allow a monitoring period when a new medication is initiated or the dose is changed to reduce wastage of medicines.

In certain circumstances when advised by PHARMAC, pharmacists will be able to endorse prescriptions Close Control. This mechanism could be utilised when there is a potential out-of-stock of a certain medication.

We have also enclosed a patient information leaflet explaining Close Control when initiating new medicines or changing doses.

2. Extending Close Control to rest home and residential disability care institution residents.

This will mean that these patients will be permitted to have their prescriptions dispensed Close Control in monthly lots allowing prescribers to write a three month script (rather than new scripts on a monthly basis).

Subsidised medicine Rest home or Residential care

Patient resident in a rest home or residential disability care institution

Specific Medications

The pharmaceutical is either: • a tricyclic antidepressant; or • an antipsychotic; or • a benzodiazepine; or • a class B Controlled Drug

Stock Issue YES

PHARMAC has notified pharmacists to implement Close Control for a specified pharmaceutical for a specified time

Penal Institution

Patient resident in a penal institution

Requires monitoring

The prescriber determines the patient: • Frail, or infirm, or unable to manage their medication without additional support, or intellectually impaired, or requiring close monitoring due to recent initiation or dose adjustment of a pharmaceutical • Needs the pharmaceutical to be dispensed in smaller quantities than that for which it is currently funded

These changes have been made following feedback from the pharmacy sector and other stakeholders. If you have further questions regarding these changes or would like to order additional resources, call PHARMAC on 0800 66 00 50 or visit www.pharmac.govt.nz.

Close Control is a mechanism to permit any subsidised medicine to be dispensed more frequently than its default (i.e. stat or monthly). The prescriber endorses the prescription with the words “Close Control” or “CC” and states the period of supply e.g. dispense monthly for 3 months. Following feedback on Close Control rules PHARMAC conducted a review of the rules and will be implementing the following improvements from 1 June 2008:

YES YES

Changes to the Close Control Rules from 1 June 2008

Close Control dispensing funded if: • The supply to be dispensed at any one time is not less than 28 days; and • If prescriber or pharmacist: o Endorses the prescription form “CC” and initials the endorsement/annotation; and

NO

o Specifies maximum quantity/period of supply to be dispensed at any one time; and o Writes name of residential care facility on the prescription

YES

Close Control dispensing funded if the prescriber: • Endorses each item to be dispensed Close Control with “Close Control” or “CC”; and • Initials each endorsement in their own handwriting; and

NO

• Specifies maximum quantity/period of supply to be dispensed at any one time

Close Control dispensing funded if: • The dispensing pharmacist has: o Clearly annotated each of the specified pharmaceuticals on the prescription with “close control” or “CC”; and o Initialled the annotation in their own handwriting; and

NO

o Specified the maximum quantity/period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification

YES

Close Control dispensing not funded

Close Control dispensing funded if the prescriber:

YES

• Endorses each item to be dispensed Close Control with “close control” or “CC”; and • Initials each endorsement in their own handwriting; and

NO

• Specifies maximum quantity/period of supply to be dispensed at any one time Close Control dispensing not funded