Bring biologic prescribing into the 21st century

Calls by rheumatologists for a new electronic database and prescribing system to replace the ‘outdated’ process used to access subsidised biologics are gathering support.

Senior gastroenterologist Professor Jane Andrews, head of IBD Service and Education at the Royal Adelaide Hospital’s department of gastroenterology and hepatology, has added her voice to the debate, saying it is time to do away with written applications and replace them with online forms and electronic collection of data.

“It is important that the data that is entered is shared with us as clinicians,” she told the limbic. “We are in a position to understand the clinical implications of the data.”

Professor Andrews’ comments follow an MJA clinical focus this month that reflected on 10 years of publicly funded bDMARDs.

Co-author, rheumatologist Dr Susanna Proudman, said the current written documentation process used by clinicians to access subsidised biologics for their patients was ‘outdated’ and needed to be replaced.

She said a new electronic system could be set up to capture the data from the prescribing system, so that it could be studied and used to maximise patient care and help better predict government expenditure on subsidies.

“Ten years of documentation on clinical and laboratory finding indicating eligibility to initiate and continue on bDMARDs remain unused,” she and her co-authors wrote.

“These data represent an untapped opportunity to promote quality use of bDMARDs and biosimilars and to improve cost predictions for high cost drugs.”

Professor Andrews said she “wholeheartedly” endorsed Dr Proudman’s comments, and suggested the Federal Government’s commitment to invest $20 million over 2015-2018 to improve awareness and confidence in biosimilar medicines  could provide a funding source to at least get started on setting up a ‘well-overdue’ online database.

“If we ran health as a business we would know this data and this analysis,” she said.

She also said she would like to see a tightening of the criteria for the use of bDMARDs for IBS, excluding symptom-only based criteria in favour of demonstration of active disease. This could be achieved through the gathering of objective evidence by endoscopy or radiology.
“We would then be better able to target the drug therapy for people with active disease,” she said.

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