The Federal Government has been accused of dragging its heels reducing PBS authority requirements for adult rheumatology biologic indications, something recommended by PBAC over a year ago.

The delay comes amid a welcomed move to streamlined scripts for three biologic molecules in juvenile idiopathic arthritis, with paediatric rheumatologists declaring the change is already saving time and benefiting patients.

A PBS amendment enacted last month covered adalimumab, etanercept and tocilizumab, all of which had a reduction in authority level for the treatment of severe active JIA and sJIA.

Authority applications for initial treatments can now be made either in real time using the Online PBS Authorities system or by telephone. Prescriptions for continuing treatment are Authority Required (STREAMLINED).

But the ARA is arguing the reforms are incomplete, pointing out the PBAC also formally recommended an end to written authorities with biologics and biosimilars for various adult rheumatic diseases at its March 2022 meeting (link here).

These included:

• Biosimilars of adalimumab, etanercept and infliximab for initial and continuing  treatment of AS
• Biosimilars of adalimumab, etanercept and infliximab for initial treatment of RA, plus originator medicines for continuing treatment
• Abatacept, baricitinib, certolizumab, golimumab, tocilizumab and tofacitinib for subsequent continuing treatment of RA
• Etanercept used in dermatology for severe chronic plaque psoriasis (juvenile)

ARA president Dr Claire Barrett said the upshot was that rheumatologists were wasting multiple hours every week on pointless red tape to satisfy the bureaucratic requirements of the PBS.

“I see patients face-to-face 32 hours per week and that creates four hours of biologic-related administration work,” she told the limbic.

“If they were to change the system, that would probably be reduced to a minute per patient.”

Dr Claire Barrett

She said in addition to the burden on rheumatologists and staff of filling out paper forms, the current system had other flaws such as the long wait time for patients while the application for their authority prescription is processed.

This was currently at least 28 days in the case of written authorities and up to 10 days for electronic submissions, Dr Barrett said.

Beyond that was a risk of forms and approved prescriptions getting lost in the mail, an issue that had arisen more than once in Dr Barrett’s own practice.

“Even when you apply electronically, it can be more than a week for the approval number to be provided unless you write ‘urgent’ on the application form and even then you often have to chase them up over the phone.”

She added there was a strong sentiment within the ARA that the system of written PBS authorities should be abandoned altogether.

As evidence of the benefits of reform, she pointed to feedback received by the ARA over the past month from paediatric rheumatologists, saying this had been overwhelmingly positive.

Here is the 1st biologic medication streamlined script I’ve done since the new process started 1/7 as away.
Holy moly it took 1 click rather than a 3 page form, admin time & waiting days to weeks for approval.
INCREDIBLE!
Amazing advocacy everyone@AusRheum⁩ #juvenilearthritis pic.twitter.com/cYJohrBWuB

— Jane Munro (@DrJaneMunro) July 17, 2023

“For example, a neurologist is allowed to start a patient on multiple sclerosis medication by just writing a script with a streamline authority number on it, even though that medicine is more expensive than one of our targeted therapies,” she said.

“So why can’t I as a rheumatologist do the same for one of my patients?”

“When we have a growing shortage of rheumatologists in Australia, I cannot think of any reason why this is a good use of anyone’s time.”

The Department of Health has been approached for comment.