Adapted from Help Notes - 2011
Chemotherapy Vial / Claiming
To commence 1 December 2011 revised arrangements for the efficient funding of chemotherapy drugs will take effect. These revised arrangements cover both infusible and injectable chemotherapy medicines. Prescribing and dispensing arrangements for oral chemotherapy medicines remain unchanged.
The Revised Arrangements will change the way that prescriptions are written and how pharmacies are remunerated. Pharmacies will be paid for the most cost efficient combination of vials which makes up a patient dose. Pharmacists will still be able to choose how they prepare each injection or infusion.
The changes will:
require prescribers to write dose specific prescriptions using milligrams (in most situations) without specific reference to forms and strengths;
pay approved suppliers/pharmacists for the most cost-efficient combination of vials that makes up the required patient dose; and
result in changes to the way that chemotherapy drugs are listed in the PBS Schedule.
In addition, pharmacies may claim new dispensing fees per injection/infusion that recognise the specialist nature of preparing chemotherapy medicines. These are in addition to the Ready Prepared Dispensing Fee of $6.42, and include:
Preparation fee ($40);
Distribution fee ($24), which replaces the wholesale mark-up; and
Diluent fee ($4.75).
Patients will pay only one PBS co-payment for each original prescription dispensed.
Chemotherapy drugs included in the Revised Arrangements*
ARSENIC TRIOXIDE
DOXORUBICIN HYDROCHLORIDE, PEGYLATED LIPOSOMAL METHOTREXATE
BEVACIZUMAB EPIRUBICIN HYDROCHLORIDE MITOZANTRONE HYDROCHLORIDE
BLEOMYCIN SULFATE ETOPOSIDE NAB PACLITAXEL
BORTEZOMIB FLUDARABINE PHOSPHATE OXALIPLATIN
CARBOPLATIN FLUOROURACIL PACLITAXEL
CETUXIMAB FOTEMUSTINE PEMETREXED DISODIUM
CISPLATIN GEMCITABINE HYDROCHLORIDE RALTITREXED
CLADRIBINE IDARUBICIN HYDROCHLORIDE RITUXIMAB
CYCLOPHOSPHAMIDE IFOSFAMIDE TOPOTECAN HYDROCHLORIDE
CYTARABINE IRINOTECAN HYDROCHLORIDE TRIHYDRATE TRASTUZUMAB (for early stage breast cancer)
DOCETAXEL VINORELBINE TARTRATE VINBLASTINE SULFATE
DOXORUBICIN HYDROCHLORIDE VINCRISTINE SULFATE
Revised Arrangements do not yet include antiemetics, antinauseants, immunostimulants and detoxifying agents for antineoplastic treatment. These drugs are still available to public hospitals under the current CPAP arrangements. If a prescriber in a public hospital, which operates under the Revised Arrangements, wishes to prescribe these drugs, they should refer to the current CPAP Schedule.
From 1 April 2012, antiemetics, antinauseants, immunostimulants and detoxifying agents for antineoplastic treatment will be incorporated into the Revised Arrangements, and the CPAP will cease.
Claiming prescriptions prescribed prior to 1 December 2011
Prescriptions (originals and repeats) written prior to 1 December 2011 can continue to be dispensed and claimed from 1 December 2011 until 31 March 2012, under the PBS arrangements in place prior to 1 December 2011.
Prescribers cannot however continue to prescribe Section 85 General Schedule chemotherapy medicines as these will be removed on 1 December 2011.
In community pharmacies, these prescriptions can continue to be claimed under the pre-existing General Schedule item numbers.
From 1 April 2012 the Revised Arrangements will apply to all prescriptions. New prescriptions will need to be obtained if a prescription written prior to 1 December 2011 is presented for supply after 31 March 2012.
How the Revised Arrangements change the way that chemotherapy drugs are listed in the Schedule
From 1 December 2011, chemotherapy items will be removed from the General Schedule and listed in a special Supplement to the Schedule (under Section 100 of the National Health Act 1953).
The listings will be updated to include:
one item code per medicine (in most circumstances) with brands, forms and strengths listed underneath
the maximum amount, replacing maximum quantity, which refers to the upper limit in milligrams or other relevant unit of measure that can be prescribed, and
more items available as Authority Required (STREAMLINED) for participating public and private hospitals.
In RxOne Dispense
When the pharmacist selects a chemotherapy drug, a window automatically pops up that allows the pharmacist to enter ingredients for chemotherapy infusion. The lower half of the box shows the options for vial amounts, allowing the pharmacist to choose the correct size/vial combination for the prescribed quantity and ingredients in order to get the cheapest ingredients paid for by Medicare.
If the script is to be prepared externally then tick the box 'Prepare Externally' , add any comments and go OK.
If the infusion is to be prepared in the pharmacy, then you have the option to choose whichever vials you wish. However Medicare will only pay for the cheapest combination of vials. These are displayed in the bottom of the window. The top window shows the actual ingredients dispensed (which you should alter to reflect exactly what has been dispensed).