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Pharmaceutical Benefits for Palliative Care

PREPARATIONS WHICH MAY BE PRESCRIBED FOR PATIENTS RECEIVING PALLIATIVE CARE

The prescribing of medications listed in this section is in accordance with the requirements for General Pharmaceutical Benefits in the Schedule unless otherwise detailed in the listing for the item.

In addition, certain additional principles have been applied by the Pharmaceutical Benefits Advisory Committee (PBAC) in recommending the patients for whom these medications may be prescribed, and the number of repeats that may be approved by Services Australia. These principles have been encompassed in the listings for the items, and further details are provided below to assist doctors prescribing under this section.

For the purposes of this section a patient receiving palliative care is defined as:

• A patient with an active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is the quality of life.

Most palliative care listings are available as “Authority Required” (Streamlined) or Restricted Benefits, intended to provide up to four months therapy in total (as an original prescription with repeats). Subsequent continuing therapy can be prescribed on consecutive occasions under these listings if required.

Prior approval from Services Australia is not required to prescribe an ‘Authority Required’ (Streamlined) item where the quantity and number of repeats are not more than stated in the listing. “Authority Required” (Streamlined) items are written on an authority prescription form and must include a four-digit streamlined authority code.

Prior approval from Services Australia or the Department of Veterans’ Affairs (DVA) is required for each prescription to prescribe quantities and/or repeats above the number in the listing. (Refer to Prescribing Medicines — Information for PBS prescribers and Supplying Medicines — What Pharmacists Need to Know, for more information on authority prescriptions.) For prior DVA approval to prescribe certain palliative care medicines not included in the PBS Palliative Care Section please contact Veterans' Affairs Pharmaceutical Approvals Centre.

State and Territory requirements: Nurse practitioners may prescribe medicines as private prescriptions according to their State/Territory prescribing accreditation. The medicines which can be prescribed differ between states and territories. It is the responsibility of all prescribers to ensure adherence to State/Territory law for all prescriptions (PBS and private) and additionally to all PBS requirements for PBS prescriptions.

When a Palliative Care authority application is for an opioid, the following guidelines apply:

• the maximum quantity authorised is generally for 1 month’s therapy;
• where supply for a longer period is warranted, quantities for up to 3 months’ therapy may be approved via written applications.

Prescribers should state (on the prescription) the interval of repeat where repeats are called for, and ensure State/Territory health authorities are notified about ongoing treatment.

Prescribers may also prescribe PBS items included in the general Schedule for patients receiving palliative care. This includes opioid preparations, according to the restrictions that apply to individual items and the requirements that apply to the general Schedule.

Further information can be found in the factsheets.