Continued Dispensing

Owned by Colin.Campbell
May 15, 2023
8 min read

[Adapted from Help Files March 2020]

5CPA Fact sheet: Under Continued Dispensing, pharmacists may supply the standard PBS quantity of eligible medicine as a PBS item and claim any relevant Government subsidy as part of their routine PBS claim. Consumers pay the relevant PBS co-payment. Only one Continued Dispensing supply is allowed per year for each eligible PBS medicine.

5CPA FAQ: How much do consumers have to pay? A consumer’s concessional entitlement, if relevant, does not change – consumers pay their usual PBS co-payment under the Continued Dispensing arrangements

 Continued dispensing is one of the measures facilitated by the National Health Amendments (Fifth Community Pharmacy Agreement Initiatives) Bill was intended that continued dispensing be implemented from 1 July 2012. However this was deferred to commence 1 September 2013 when legislative changes were enacted in all jurisdictions except Northern Territory and Queensland .  

From September 2013, in accordance with professional guidelines and protocols, pharmacists are permitted, in particular circumstances, to supply a defined range of PBS benefits where a prescription is not available.

Continued Dispensing will be allowed in the following states:

  • South Australia

  • Victoria

  • Tasmania

  • Western Australia

In the following jurisdictions, until legislation is changed, Continued Dispensing is not an urgent supply option for pharmacists:

  • Australian Capital Territory

  • New South Wales

  • Northern Territory

  • Queensland

Continued dispensing will provide an additional mechanism for patients to gain access to certain Pharmaceutical Benefits Scheme (PBS) medicines where a valid prescription is unavailable.  This could apply, for example, in cases where a prescription has been lost and a doctor consultation is not readily available.  Professional protocols will apply, so that quality and patient safety will not be compromised.

Initially, the measure will apply only to:

  • oral hormonal contraceptives and

  • Lipid Modifying Agents used in the treatment of high cholesterol.

These two therapeutic groups have been chosen on the basis that they are relatively well tolerated medicines with a very good safety profile.

Importantly, this initiative will make it easier for certain consumers taking medication for the treatment of chronic conditions to continue their treatment without interruption. As then, Minister Roxon told Parliament in December 2011, the continued dispensing initiative will also introduce efficiencies for pharmacists and prescribers.

The prescribing of the medication will continue to be the sole domain of the patient’s doctor. The legislation provides for a mandatory feedback loop to the prescriber that continued dispensing has occurred.

The Pharmacy Guild says it is confident this initiative will ensure optimal outcomes for patients without jeopardising relationships between pharmacists and doctors.

A review of the measure will be conducted in two years.

Continued Dispensing in RxOne

As of 1st September 2013 patients whose prescriptions have run out are able to obtain some drugs from a pharmacist without a script from their GP.

Initially the Continued Dispensing supply will be limited to two therapeutic categories:

  •  Oral Hormonal Contraceptives (OHC)

  •  Lipid Modifying Agents, (specifically the HMG CoA reductase inhibitors as listed in the Schedule of Pharmaceutical Benefits).

 To Dispense

  • Tick the 'Continued Dispensing Script' box on the Options Tab.  *Please note that as no repeats are able to be dispensed on this script. The Repeat field will be disabled.

  • Enter the Pharmacist name in the ‘Doctor’ field or create new ‘Doctor’ if needed. (Click ‘Edit’ then ‘Edit Doctor’ and enter your AHPRA Number and choose 'Pharmacist 'in the ‘Doctor Type’.)

  • When selecting the drug, check the selected drug is eligible for Continued Dispensing ('Y' in the 'Continued Dispensing' column on the drug lookup). Choose the one with the fewest repeats (e.g. choose the one with 5 repeats instead of 11 repeats).

  • Note the check column for Continued Dispensing 'Y/N' on the drug lookup screen.

  • Finish entering the details and select finish script.

  • After the dispensing is completed, one repeat form will be printed with CONTINUED DISPENSING printed in the Original Prescription Details box.  This is a standard repeat authorisation form to be kept by the pharmacy. This allows the consumer’s acknowledgement of receipt, and will support the DHS-Medicare claim process.  Repeats remaining will always be 0 and the number of times dispensed will always be 1.

  • Two prescriber notification forms will be printed; one copy for the pharmacist, one copy for the patient. This supports the consumer declaration that they understand and consent to the supply. The form will also be used for written notification to the prescriber.

To successfully claim a script as “Continued Dispensing”, the following rules apply:

  • The pharmacist dispensing the script needs to have an AHPRA (Australian Health Practitioner Registration Agency) on their staff record. This can be done in the Staff Utility, or the pharmacist will be prompted to enter it the first time they do a 'Continued Dispensing' script.

  • The drug being dispensed needs to be eligible for continued dispensing (there’s a “Cont. Disp” column on the drug lookup screen, showing either a “Y” or a “N”).

  • A valid doctor does not need to be entered on the script.

  • When the script is completed, two continued dispensing forms will be printed to your reports printer

  • Total repeats and repeats left are not required to be entered (these boxes won’t be available on the script screen when the script is marked as continued dispensing).

  • The script will be submitted to DHR Medicare Australia with a form category of 2 (which is a repeat form category).

Guidelines for the Continued Dispensing of eligible prescribed medicines by pharmacists

Dispensing Recording Requirements

  • The supply of the medicine by Continued Dispensing must be recorded in the dispensing system in a manner consistent with the recording of dispensing with a valid prescription.

  • Two forms will be generated by the pharmacy dispensing system.

  • The first form is a standard repeat authorisation form which allows the consumer’s acknowledgement of receipt and will support the DHS-Medicare claim process.

  • The second form supports the consumer declaration that they understand and consent to the supply and may also be used for written notification to the prescriber (see Section 3.10).

  • The pharmacist should document any information used to support the decision to supply the medicine by Continued Dispensing. This includes the:

  • details of any dispensing history obtained from other pharmacies

  • consumer history (clinical) notes obtained during consultation with the consumer

  • details of any communication with other health professionals/ providers and the prescriber

  • directions for use.

  • Consistent with the standard dispensing process, information will be required to support the pharmacy claim to DHS-Medicare for PBS medicines. This includes the:

  • consumer’s name, address,

  • DHS-Medicare number and any entitlement numbers,

  • medicine name, strength and quantity supplied, and

  • date of supply.

Communication with the consumer

  • Counselling and the provision of Consumer Medicine Information (CMI) should be performed to the same standards expected for all services in pharmacy.

  • When multiple medicines have been requested in an urgent or emergency situation and different supply arrangements apply, pharmacists should attempt to minimise potential confusion about the different supply arrangements in their counselling.

  • The pharmacist should discuss with the consumer the importance of regular review of therapy with the PBS prescriber.

  • They should advise the consumer to organise an appointment with the PBS prescriber immediately, highlighting that a subsequent supply of the medicine by continued dispensing by any pharmacy will not be possible within the next 12 months.

Communication with the prescriber

  • Pharmacists must provide written communication to, but not limited to, the most recent prescriber advising of the supply of the medicine to the consumer by continued dispensing. This should occur without delay (and within 24 hours). The information that should be provided to the prescriber includes the:

  1. consumer details (name and address)

  2. date the medicine was supplied without a valid prescription

  3. details of any medicine dispensed (including strength, form and instructions for use)

  4. reason for continued dispensing

  5. declaration co-signed by the consumer indicating their understanding of, and consent to, the supply.

As an active participant in the health care team, pharmacist communication to the prescriber supports continuity in medication management of the consumer.

Fact Sheet from Department of Health and Ageing (June 2012)

The Continued Dispensing of PBS Medicines in Defined Circumstances (Continued Dispensing) initiative

Background

The Continued Dispensing initiative, as funded under the Fifth Community Pharmacy Agreement, refers to the supply of an eligible medicine under the Pharmaceutical Benefits Scheme (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS) when there is an immediate need for that medicine but it is not practicable to obtain a prescription. The pharmacist must be satisfied that:

  • the medicine has been previously prescribed, therapy is stable and there has been prior clinical review by the prescriber that supports continuation of the medicine; and

  • the medicine is safe and appropriate for the consumer.

The aim of the initiative is to maintain patient adherence to therapy by preventing treatment interruption due to the inability to obtain a timely prescription renewal. Current arrangements permit pharmacists to supply Prescription Only (Schedule 4) Medicines without a prescription in urgent or emergency situations. Continued Dispensing will complement these current provisions and allows pharmacists to process a PBS/RPBS claim without the need for a follow-up prescription.

When the arrangements commence, a Continued Dispensing supply will be limited to two therapeutic categories:

  • Oral Hormonal Contraceptives for systemic use.

  • Lipid Modifying Agents, specifically the HMG CoA reductase inhibitors (‘statins’) as listed in the Schedule of Pharmaceutical Benefits.

Medicines in these therapeutic categories which are not listed in the Schedule of Pharmaceutical Benefits will be out of scope for this initiative. A review of the initiative will take place within two years and will measure the extent to which the initiative has met the objectives identified within the Fifth Agreement, including the appropriateness of the eligible therapeutic categories.

Current status and timeframe for implementation

The Australian Government has introduced changes to PBS legislation to enable Continued Dispensing supplies to be claimed under the PBS/RPBS. However, to enable successful national implementation, legislation in each state and territory must also be amended. Advice from the states indicates that this is not likely to occur until 2013. The necessary jurisdictional amendments may also be developed at differing times and implementation may therefore be staggered across the states and territories during 2013.

While pharmacy dispensing software will incorporate new functionality for Continued Dispensing events, pharmacists cannot supply and claim medicines under Continued Dispensing until legislation in their state has been amended in 2013.

What are the ‘defined circumstances’?

Continued dispensing may only occur in defined circumstances which are:

  • The medicine requested is identified in the relevant legislation as eligible for supply by Continued Dispensing.

  • There is an immediate need for supply of the medicine to facilitate continuity of therapy, and it is not practicable for the person to obtain a prescription for the medicine from an authorised prescriber.

  • The medicine has been previously prescribed for the person, the consumer’s therapy is stable, and there has been prior clinical review by the prescriber that supports continuation of the medicine.

  • There is a need for ongoing supply, and the medicine is safe and appropriate for that consumer.

Professional Guidelines

Legislation will require pharmacists to comply with the Guidelines for the Continued Dispensing of eligible prescribed medicines by pharmacists, developed by the Pharmaceutical Society of Australia.

The Guidelines will be released publicly prior to implementation of the initiative.

Key components of the Guidelines include:

  • Continued Dispensing is not intended to replace existing emergency supply arrangements, but will complement them. Therefore, pharmacists will have the following four options when receiving a request for supply without a prescription:

    • dispense the medicine on receipt of an order from the prescriber by telephone or other means (with a written prescription to follow);

    • provide an emergency supply of the medicine (usually 3 days with no need for a follow-up prescription);

    • provide the medicine by Continued Dispensing allowing a PBS claim to be made without the need for a follow-up prescription; or

    • referral to a prescriber without supply of the medicine.

  • Continued Dispensing may only be utilised on one occasion during a 12 month period (per medicine);

  • The prescribing of the medicine will continue to be the responsibility of the patient’s doctor or alternative authorised prescriber;

  • The pharmacist must inform the most recent prescriber in writing within 24 hours that supply has occurred under Continued Dispensing; and

  • Pharmacies will implement an internal policy and procedure which must include adequate record keeping.

Unlike Fifth Community Pharmacy Agreement (5CPA) programs, pharmacies do not need to register for these new arrangements.

Further information will be available to pharmacists following passage of legislation permitting Continued Dispensing to operate in their state or territory.

This project is funded by the Australian Government Department of Health and Ageing as part of the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild of Australia.