This is the text extract for Review of Dispensing Frequency for Monthly Medicines approved; Contact: Notifications; Posted: 2012-05-21, browse documents here.

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21 May 2012

Review of Dispensing Frequency for Monthly Medicines approved

PHARMAC is pleased to announce the approval of a proposal to include a number of pharmaceuticals on the ‘stat’ dispensing list. This was the subject of a consultation letter dated 5 April 2012. In summary, the effect of the decision is that from 1 June 2012, 34 products will be added to the dispense ‘all-at-once’ or ‘stat’ list. Details of the proposal The following chemicals and presentation, as listed in the Pharmaceutical Schedule have been added to the stat dispensing list from 1 June 2012. This means that these chemicals and presentations will now be listed in the Pharmaceutical Schedule with an asterisk () next to them and must be dispensed all-at-once for the total quantity of the prescription. Please note that for current prescriptions where there are repeats owing, from 1 June 2012 any remaining repeats must be dispensed stat, or all-at-once. We sought clinical advice to ascertain the risks associated for patients where the dispensing frequency changes during the life of the prescription. There is low risk of harm for patients dispensed an increased quantity. Prescriptions for any of the 34 new stat medicines that are already being dispensed Close Control, should continue to be dispensed Close Control. These will most likely be weekly Close Control dispensings. Rest home and community residential care facility patients are eligible under the Close Control rules to have their medicines dispensed in monthly lots. Prescribers and pharmacists are both able to endorse/annotate Close Control for these patients. If the dispensing pharmacist believes the patient may benefit from monthly dispensing, then they should contact the prescriber to discuss. If the prescriber agrees that patient requires more frequent dispensing, then the prescription must be returned to the prescriber for the Close Control endorsement. It is not PHARMAC’s intention that the dispensing pharmacist find every original script to check if there was a Close Control endorsement or not. It is not technically possible to grandparent the repeats on existing prescriptions. In the May 2012 Clinician’s Newsletter there was an article about the proposed changes to the stat list. Clinician’s were informed that some monthly medicines may move to stat dispensing. They were told they did not need to do anything unless they were particularly concerned about specific patients being dispensed more than a month at a time.

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Therapeutic Group Alimentary Tract Metabolism - Vitamins Alimentary Tract Metabolism – Antacids Antiflatulants Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism - Vitamins Alimentary Tract Metabolism – hypoglycaemic agents Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism - Minerals Alimentary Tract Metabolism – Vitamins

and

Chemical Alfacalcidol

and and and and and and and and Oral and and and

Aluminium hydroxide

Presentations Cap 0.25 µg Cap 1 µg Oral drops 2 µg per ml Tab 600 mg

Ferrous fumarate Ferrous fumarate with folic acid Iron polymaltose Magnesium sulphate Multivitamins Pioglitazone

Tab 200 mg (65 mg elemental) Tab 310 mg (100 mg elemental) with folic acid 350 µg Inj 50 mg per ml, 2 ml Inj 49.3%, 5 ml Powder Tab 15 mg Tab 30 mg Tab 45 mg Tab 256 µg (150 µg elemental iodine) Tab 1.1 mg (0.5 mg elemental) Soln 1000 µ with Vitamin D 400 u and ascorbic acid 30 mg per 10 drops Presentations Tab 75 mg

Potassium iodate Sodium fluoride Vitamin A with Vitamins D and C Chemical Clopidogrel

Therapeutic Group Blood and Blood Forming Organs – Antithrombotic Agents Blood and Blood Forming Organs – lipid modifying agents Blood and Blood Forming Organs – lipid modifying agents Therapeutic Group Cardiovascular system – Beta adrenoceptor blockers Cardiovascular system Calcium channel blockers –

Gemfibrozil

Tab 600 mg

Pravastatin

Tab 20 mg Tab 40 mg

Chemical Carvedilol

Isradipine

Presentations Tab 6.25 mg Tab 12.5 mg Tab 25 mg Cap long-acting 2.5 mg Cap long-acting 5 mg Presentations Oint BP

Therapeutic Group Dermatologicals – Barrier creams and emollients Therapeutic Group Genito-Urinary System Urinary Agents Genito-Urinary System Urinary Agents

Chemical Zinc and Castor Oil

– –

Chemical Finasteride Tamsulosin hydrochloride

Presentations Tab 5 mg Cap 400 µg

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Therapeutic Group Infections – Antifungals Therapeutic Group Musculoskeletal System – Drugs Affecting Bone Metabolism Musculoskeletal System – Drugs Affecting Bone Metabolism Musculoskeletal System – Drugs Affecting Bone Metabolism Musculoskeletal System – NSAIDs other Therapeutic Group Nervous system – Antidepressants Nervous system – Antidepressants Nervous System – Antinausea and Vertigo Agents Nervous system Antidepressants Nervous system Antidepressants Nervous system Antidepressants Nervous system Antidepressants Therapeutic Group Oncology Agents Immunosuppressants Aromatase Inhibitors Oncology Agents Immunosuppressants Aromatase Inhibitors Oncology Agents Immunosuppressants Aromatase Inhibitors -

Chemical Terbinafine Chemical Alendronate sodium

Presentations Tab 250 mg Presentations Tab 40 mg Tab 70 mg with Tab 70 mg with cholecalciferol 5,600 iµ Tab 60 mg

Alendronate sodium cholecalciferol Raloxifene hydrochloride

Meloxicam

Tab 7.5 mg

Chemical Escitalopram Moclobemide Ondansetron

Paroxetine hydrochloride Phenelzine sulphate Sertraline Tranylcypromine sulphate

Presentations Tab 10 mg Tab 20 mg Tab 150 mg Tab 300 mg Tab 4 mg Tab disp 4 mg Tab 8 mg Tab disp 8 mg Tab 20 mg Tab 15 mg Tab 50 mg Tab 100 mg Tab 10 mg

and – and – and –

Chemical Anastrozole

Presentations Tab 1 mg

Exemestane

Tab 25 mg

Letrozole

Tab 2.5 mg

A further five chemicals and presentations were consulted on being added to the stat list but have been excluded at this time. These products are:  ezetimibe tab 10 mg  ezetimibe with simvastatin tab 10 mg with simvastatin 10 mg, 20 mg, 40 mg and 80 mg  Paraffin white soft  Gabapentin cap 100 mg, 300 mg and 400 mg  Gabapentin (Neurontin) cap 100 mg, 300 mg, 400 mg and tab 600 mg

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Feedback received We appreciate all of the feedback that we received and acknowledge the time people took to respond. All consultation responses received by 2 May 2012 were considered in their entirety in making a decision on the proposed changes. Most responses were supportive of the proposal, and the following issues were raised in relation to specific aspects of the proposal:

Theme Comment

Some responders commented on the timing of the proposal and the effective date not being in line with the changes under the proposed Pharmacy Services Agreement.

The review of the Stat list is independent to the other proposed changes that support the Pharmacy Services Agreement. The consultation letter for the Stat list stated the implementation date was proposed as 1 June 2012, and this is the date PHARMAC staff announced at the recent presentations to pharmacists. There is another proposal currently being reviewed by the PHARMAC Board on the issue of flexibility for dispensing periods. Prescribers would still be able to utilise the Close Control rule where appropriate to enable dispensing more frequently.

A responder would prefer a mechanism for the patient requesting a more frequent dispensing period other than Stat at their request. The NZMA supported this proposal dependent on the prescriber still being allowed to retain monthly dispensing (or indeed some other frequency) if it is felt to be clinically necessary. The consultation does not state if prescribers can utilise the Close Control rule for the aged population.

Prescribers could still initiate the Close Control rule for patients meeting the eligibility criteria so could stipulate the dispensing frequency for patients. The proposed Pharmacy Services Agreement would enable pharmacist to enroll patients into a Long Term Care programme where they could give close monitoring of at risk patients, resulting in the modification of dispensing periods where needed.

More information If you have any questions about this decision, you can call our toll free number (9 am to 5 pm, Monday to Friday) on 0800 66 00 50.

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