Six monthly scripts proposal dropped in new regulations

13 July 2011 Virginia McMillan Officials have shut down alarm among some in the health sector who feared new regulations would see patients picking up six months worth of medicines. Prescriptions will not cover six months but remain at a three-month limit, after officials changed their stance on new regulations being gazetted tomorrow. [14 July] The Ministry of Health proposal to allow six-month prescriptions was widely, but incorrectly, interpreted to mean six-month dispensing, says Pharmacy Guild chief executive Annabel Young. Amended regulations under the Medicines Act 1981, confirmed yesterday by health minister Tony Ryall, state prescriptions will last three months (six months for contraceptives). This is contrary to the extended time periods referred to in a ministry document summarising submissions and final decisions last November. Proposal was alarming people Ms Young says the matter was alarming people and some DHBs believed their costs would rise. Six-month dispensing was not envisaged, Ms Young says. However, she adds it is good the proposal has been removed as it will calm people down. In a statement today, the ministry says: Extending the period of supply for prescription medicines has fiscal and software impacts. Further work is required to accurately quantify the impacts and determine how they can be best managed. The guild, meanwhile, is comfortable with six-month prescribing but wants discussions to take place and protocols to be developed. Six-month prescribing will be suitable for medicines for long-term conditions, as long as protocols guide pharmacists on what prescribers envisage will happen during the period, says Ms Young. The endgame has to be pharmacists managing the period of supply. Prescribing rights of various professionals aligned Mr Ryall also announced the Government has agreed to amend the

Medicines Act to align prescribing rights of all health professionals with independent prescribing rights (ie, medical practitioners, dentists, midwives, nurse practitioners and optometrists). A further change to the Medicines Act will create a new category of prescriber: a delegated prescriber. The new category will allow highly trained health professionals in a collaborative team environment, and under the supervision of an independent prescriber, to prescribe within their scope of practice, for a specific group of patients. It is expected pharmacist prescribers will fit into this category. The issue is under discussion between the Pharmacy Council and Health Workforce New Zealand. Further changes are to be made to prescribing rights. Prescribing by doctors, dentists and midwives will be aligned by restricting it to their respective scopes of practice and removing the 10-day limit on prescriptions by dentists. Pharmacists don't need to play pharma cop Some pharmacists questioned their ability to verify that midwives and dentists were prescribing within their scopes. The ministry said it would provide clarification. Pharmacists may dispense a prescription on its face provided he or she acts in good faith, it said in the final decisions document. In other changes, the amended regulations should ease pharmacists concerns around difficulties contacting prescribers, in particular, midwives with no business address. A physical or postal address and phone number must be provided with every prescription. The regulations allow pharmacists, as of right, to substitute a different brand from that on a script, unless the script instructs otherwise; certain conditions, such as having same dosage and ingredients, also apply. This helps pharmacists, many of whom spent a lot of time trying to obtain generic substitution agreements with individual prescribers, notes Ms Young. Various products are deemed by the new regulations no longer to be medicines or related products. As such they can be sold in supermarkets always a potential issue to the guild longer term, as it notes these are unregulated environments. The products are dentrifices, anti-dandruff products, anti-acne products, barrier creams, and anti-bacterial skin products (not for use in piercing or

injection). The products must not be accompanied by a medical therapeutic claim. Sale of certain drugs to be allowed through vending machines The regulations also pave the way for vending machine dispensing of general sale medicines. A list of those suitable for such machines will be developed by the DirectorGeneral of Health. Consultation is expected, as it is not clear where machines will be allowed (eg, on streets or in foyers) nor what type of products they will stock. The ministry has said it does not envisage vending machines outside pharmacies, says Ms Young. The ministrys statement further explains that a vending machine operator will have to apply for permission to sell particular medicines, with details about pack sizes, location of machine etc. In approving applications, the Director-General may specify conditions such as presence in public spaces, limiting pack size for medicines, requiring temperature control. The ministry says most of the amendments will come into force on 1 August 2011. Those that align prescribing rights and amend the form of the prescription will take effect on 1 December 2011.