GI tract

PBS introduces restrictions to curb PPI overprescribing  

Increased restriction levels for prescribing of proton pump inhibitors on the PBS take effect from 1 May 2019.

Prescriptions for esomeprazole 40mg with one repeat have changed from being a Restricted Benefit to Authority Required (Telephone).

And all standard dose PPIs (esomeprazole 20mg, lansoprazole 30mg, omeprazole 20mg, pantoprazole 40mg, rabeprazole 20mg) have changed from Restricted Benefit to Authority Required (STREAMLINED).

The restrictions were recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) after a 2018 drug utilisation review concluded that high dose PPIs were overprescribed in Australia, for excessively long periods of time and particularly amongst older people.

“The PBAC considered that this is not in the best interests of patients and is not without safety concerns,” its review stated.

The review also highlighted cost blowouts for the PBS budget relating to the large number of high and highest dose prescriptions dispensed (95%) relative to low dose PPIs (5%).

It made additional recommendations including:

  • All high dose indications for esomeprazole 40mg 1 and 5 repeat will require trial of standard dose PPI prior to initiation of a high dose PPI.
  • All standard dose PPIs with 5 repeats indicated for GORD will have clinical criteria included specifying they are to be used for long-term maintenance of GORD, in a patient inadequately controlled by a low dose PPI.
  • For all peptic ulcer indications to require negative H. Pylori testing or failure of eradication therapy before commencement of a standard dose PPI.
  • The addition of a new clinical indication – initial and short-term maintenance treatment of symptomatic GORD for standard dose PPIs with 1 repeat.

The PBS said the impact of the restrictions will be assessed after two years and if PPI overuse is still not curbed then further measures will be considered, including a requirement for high dose PPI treatment to be prescribed by a gastroenterologist or in consultation with a gastroenterologist, for all hypersecretory, scleroderma oesophagus and erosive oesophagitis indications.

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