PBS restrictions on COPD meds a nudge towards best practice


By Mardi Chapman

19 Oct 2017

The PBAC has recommended increasing the PBS restriction level to Authority Required (Streamlined) for ICS/LABA inhalers in COPD and removing the current restrictions to stabilise patients on individual monotherapy inhalers before commencing a LAMA/LABA combination.

The recommendations follow the yet to be published Post-market Review of Chronic Obstructive Pulmonary Disease (COPD) Medicines, reinforce COPD-X guidelines and are consistent with the recently updated Stepwise Management of Stable COPD.

The PBAC noted that there appeared to be a high rate of initiation to ICS/LABA inhalers, which was inconsistent with clinical guidelines.

Respiratory physician Professor Christine McDonald told the limbic that while not onerous, having to use a Streamlined Authority should make prescribers stop and think.

“It’s to give people pause before they automatically write the combination ICS/LABA prescription for everybody,” she said.

“It does mean that you think more carefully about the diagnosis and whether the patient fulfills the criteria for corticosteroids.”

Inhaled corticosteroids were appropriate for some COPD patients including those with co-existing asthma or those with an FEV1 <50% and repeated exacerbations.

Professor McDonald, from the Austin Hospital, said the smoother path to a fixed-dose combination LAMA/LABA, without having to stabilise patients on both monotherapies, was also sensible.

“It was an unnecessary step and cost to have to make patients get two separate inhalers,” she said.


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