[Aus] Changes to Opioid Dependence Treatment (ODT) medicines & section-100 info

[Chip (OP)]

source: https://thephn.com.au/news/changes-for-opioid-dependence-treatment-odt-medicines

see also: https://www.pbs.gov.au/browse/section100-md (see the back of this page for an excerpt)

note: This means that clinics can no longer dispense Methadone or Bupe so you need to go to a pharmacy that does. The amount you can take-away may change and you may be able to change your prescriber. The cost of ODT medicines should come down as the clinics can no longer charge their higher prices.

Changes for Opioid Dependence Treatment (ODT) medicines

Posted June 22, 2023

From 1 July 2023, ODT medicines will become part of the Section 100 Highly Specialised Drugs (HSD) Program (Community Access) arrangements. This means ODT medicines will be dispensed in the same way as other community access Section 100 HSD Program medicines from section 90 approved community pharmacies, section 92 approved medical practitioners, and section 94 approved hospital authorities (public and private).

Under the Section 100 HSD Program, PBS-eligible patients will pay the PBS co-payment to access their treatment (for up to 28 days’ supply per pharmaceutical benefit prescribed) and the amount paid will contribute towards their PBS Safety Net threshold. Additional private dispensing or dosing fees cannot be charged by section 90 community or section 94 hospital pharmacies to patients for access to ODT medicines under the PBS.

Supplying patients with methadone liquid, buprenorphine sublingual tablets and buprenorphine + naloxone sublingual films often requires more frequent activities relating to in-pharmacy and take-away dosing. Therefore, from 1 July 2023, a community pharmacy program for ODT medicines will be established, including on-site pharmacist administration of injectable buprenorphine, that will introduce nationally consistent payment arrangements for ODT services provided by community pharmacists.

State and territory governments operate individual ODT programs in their respective jurisdictions. The operation of state and territory ODT programs are and will continue to be governed by the respective policies, guidelines and regulations within each of those jurisdictions.

The Commonwealth Government has published factsheets on the 1 July 2023 changes for opioid dependence treatment medicines under the Pharmaceutical Benefits Scheme on the ODT website.

The Pharmacy Programs Administrator (the PPA) has released Program Rules for the Opioid Dependence Treatment Community Pharmacy Program here.


an excerpt from https://www.pbs.gov.au/browse/section100-md

Patients

From 1 July 2023, patients may continue to be prescribed their ODT medicines from their current medical practitioner or nurse practitioner and access medicines for the treatment of opioid dependence from their current dosing site(s), however, the way in which these medicines are accessed under the PBS is changing.

From 1 July 2023, ODT medicines will be under the Section 100 HSD Program (Community Access)

These changes will mean that patients who are prescribed medicines listed on the PBS Schedule for the treatment of opioid dependence will pay a PBS co-payment (for up to 28 days’ supply per pharmaceutical benefit). Similar to other medicines on the PBS, if different strengths of an ODT medicines are prescribed, each strength will attract one PBS co-payment. PBS co-payment amounts paid for ODT medicines will count towards a patient’s PBS Safety Net threshold. It also means patients who access their ODT medicines from section 90 community pharmacies registered in the ODT Community Pharmacy Program will not pay additional out-of-pocket (private) dispensing or dosing fees and charges.

Patient Eligibility

To gain access to ODT medicines listed under the HSD Program Community Access arrangements, a patient must:

• be an Australian resident eligible for a Medicare card
• meet the specific medical criteria to receive ODT medicines (that is, for the treatment of opioid dependence).

As with other Section 100 HSD Program medicines, this includes patients who are a day-admitted or non-admitted hospital patient, or a patient on discharge from a participating hospital.

Prescriptions and dispensing

Patients may continue to obtain their prescriptions from an authorised medical or nurse practitioner.

PBS Approved Suppliers

PBS prescriptions may be dispensed by PBS Approved Suppliers participating in state and territory ODT programs. This includes section 90 approved community pharmacies, section 92 approved medical practitioners and section 94 approved hospital authorities (public and private).

From 1 July 2023, similar to other medicines listed on the PBS Schedule, eligible patients will be able to:

• have their ODT medicines dispensed from PBS Approved Suppliers (including community pharmacies) using a PBS prescription (further information will be made available here on how pharmacists transition existing prescriptions for ODT medicines written prior to 1 July 2023 onto the PBS)
• pay only the PBS co-payment to access their PBS medicine, at a level consistent with their Medicare status
• as with other PBS medicines, this can be for a quantity of up to 28 days’ supply with 2 repeats
• a PBS co-payment will be required in respect of each strength used to make up a dose (as prescribed by the patient’s medical or nurse practitioner)
• state and territory ODT program requirements regarding in-pharmacy and take-away dosing will still apply
• count their eligible PBS co-payment amounts towards their PBS Safety Net threshold.

Patients will not be required to pay additional out-of-pocket (private) dispensing or dosing fees or charges associated with access to ODT medicines under the PBS from section 90 community pharmacies. This means patients will not have to pay for activities associated with the preparation of in-pharmacy or take-away doses of methadone liquid, buprenorphine sublingual tablets or buprenorphine + naloxone sublingual films.

Other dosing sites

Patients may continue to receive their ODT medicines from other dosing sites and have their medicine supplied under the PBS, with the PBS co-payment amount contributing to their Safety Net threshold.

Further information available at What this means for: dosing sites participating in state and territory ODT programs.

State and territory ODT programs

Patients are advised that their individual state and territory government ODT programs remain the first point of contact for questions about participation and enrolment in ODT Programs, including, for example, access to take-away dosing and travel arrangements.