“Mostly positive”: respiratory physician welcomes PBS review of COPD therapies


By Mardi Chapman

2 Feb 2018

A PBS review of COPD therapies has recommended a mix of prescribing restrictions to encourage spirometry and easing of criteria for starting some combination inhalers.

The final report from the Post-market Review of Chronic Obstructive Pulmonary Disease (COPD) Medicines was released on 30 January, comprising 11 recommendations.

As previously reported in the limbic, it includes the recommendation to remove the current PBS requirement to stabilise patients on both individual monotherapy inhalers before commencing a fixed dose combination LAMA/LABA.

The PBAC also recommended increasing the PBS restriction level to Authority Required (Streamlined) for ICS/LABA inhalers that have dual listings on the PBS for the treatment of COPD and asthma.

Professor Christine McDonald from the Austin Hospital and chair of the COPD National Program, Lung Foundation Australia told the limbic the final report was encouraging.

“The PBAC has taken on board the recommendation in our COPD-X Guidelines and I think as a consequence, the outcome of these deliberations is mostly very positive.”

“I really like the fact they haven’t just concentrated on pharmaceuticals. It’s terrific that we have managed to underline the importance of spirometry and to underline the importance of non-pharmacological management.”

The review recommended a PBS restriction note requiring prescribers of COPD medicines to confirm the diagnosis with spirometry. It also supported liaison with the MBS Review Taskforce regarding the possibility of changes to item numbers, which would encourage the use of spirometry in primary care.

“I think it’s actually admirable that they are coming to the party and saying we need spirometry to make a diagnosis because we don’t have a biomarker or a blood test, and you do need that evidence of a lack of complete reversibility.”

“It’s not as though they’re asking for a FEV1 before you can use this streamlined prescription but I think there is a clear nudge to try and educate people that they should be doing spirometry.”

The review also recommended advising the Medical Services Advisory Committee (MSAC) that the Reference Group supports reimbursement of pulmonary rehabilitation for COPD.

“Pulmonary rehabilitation, and physical activity for that matter, is key so hopefully we might be able to get the MBS item up for that. This was a review of COPD medicines and yet they have incorporated that.”

The other recommendations were:

  • The addition of a PBS restriction note regarding potentially unsafe medicine combinations to all LAMA, LABA and ICS/LABA products
  • The addition of a PBS restriction note to check inhaler device technique and adherence to all listed products for COPD
  • The health department write to manufacturers regarding device use and medicine packaging issues including the availability of placebo devices and instructional videos
  • The health department write to appropriate organisations and sponsors to improve awareness of current evidence-based educational materials
  • Liaison with the Practice Incentives Program (PIP) regarding quality use of medicines findings relevant to general practice
  • Liaison with the TGA re: developing guidelines for the naming, packaging and design of inhaler devices to reduce confusion, incorrect use and duplications.

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