Specialists demand end to ‘time sink’ PBS red tape


Australia’s specialists are collectively wasting hundreds of thousands of hours on paperwork with no clinical value simply to prescribe biologic medicines under the PBS, it is estimated.

A cross-speciality working party has launched a petition demanding urgent action on the issue, which they say is now impacting workforce issues because of the amount of time taken away from patient care by red tape.

“Clinicians across both public and private systems are overwhelmed by this ever expanding PBS administrative work,” say the group, based primarily in Western Australia.

“The pandemic has brought things to a head by exposing vulnerabilities in the health systems such as staff shortages and burnout.”

Launched just before Christmas, the Change.org campaign (link here) has already garnered more than 150 supporters and will be presented to the PBAC and specialist representative bodies in coming weeks.

The bulk of signatories have been gastroenterologists, rheumatologists, and dermatologists, each of whom regularly prescribe biologics for conditions like Crohn’s disease, rheumatoid arthritis, ankylosing spondylitis and psoriasis.

But while the pharmaceuticals have often revolutionised treatment, their high cost has been a growing headache for governments and they currently account for seven of the top 10 PBS medicines by expenditure.

Three years ago, the Federal Government issued a grant to the Australian Rheumatology Association and NPS MedicineWise to send PBS practice reports to 450 rheumatologists encouraging them to reconsider their prescribing of bDMARDs and consider down-titrating where possible.

“Unfortunately, these are lifelong diseases, which are generally increasing in prevalence in Australia’s ageing and co-morbid population,” the petition reads.

“The data shows that once patients are on a biologic medication to manage these conditions, they tend to remain on them for prolonged periods of time. Consequently, the current system generates ever increasing amounts of administrative work for clinicians.”

The authors propose the initial application process remains unchanged, including the requirement that biologics only be prescribed to patients who have failed first line therapies.

However, once a patient has qualified for one biologic, they should automatically qualify for all such medications listed for their disease on the PBS, with no requirement to reapply, the authors say.

As a result, specialist physicians would be able to continue to prescribe, cease, reinitiate or switch biologic as they see appropriate once a patient has initially qualified.

“This can be done using a streamline code with no further paperwork or phone calls to the PBS,” they write.

“This revised process should apply to the diseases and medications listed below as well as all new biologic medications that are approved by the PBS for the same conditions or indications in the future.”

Dr Oliver Waters, a gastroenterologist in Perth and one of the authors of the petition, said the current system was bad for both doctors and patients.

“We’re just being overwhelmed with administrative work. And it’s not just the PBS, we’re constantly being flooded with forms,” he told the limbic.

“Having discussed it with the nurses at the hospital where I work, they are spending at least 1000 hours per year on paperwork for biologics. It just isn’t sustainable.”

He said there was a general feeling that there no clinical purpose to the paperwork, despite the fact that applications had to be reviewed by Department of Health officials before scripts could be written.

And while biologics tended to be high cost drugs, reducing bureaucratic hurdles would likely save money for the health system by reducing hospital visits, Dr Waters argued.

“And even if you disagree, you have to ask yourself if getting health professionals to fill out endless paperwork is a good economic tool to reduce costs? I’d argue it clearly isn’t.”


The proposal covers:

Gastroenterology

Crohn’s Disease (both luminal and perianal)
Adalimumab, Infliximab, Ustekinumab, Vedolizumab
Ulcerative Colitis
Adalimumab, Infliximab, Vedolizumab, Tofacitinib, Golimumab

Paediatric Gastroenterology

Crohn’s Disease (both luminal and perianal)
Adalimumab, Infliximab
Ulcerative Colitis
Adalimumab, Infliximab

Rheumatology

Rheumatoid Arthritis
Abatacept, Adalimumab, Baricitinib, Certolizumab pegol, Etanercept, Golimumab, Infliximab, Tocilizumab, Tofacitinib, Upadacitinib
Psoriatic Arthritis
Adalimumab, Certolizumab pegol, Etanercept, Golimumab, Guselkumab, Infliximab, Secukinumab, Tofacitinib, Upadacitinib, Ustekinumab
Ankylosing Spondylitis
Adalimumab, Certolizumab pegol, Etanercept, Golimumab, Ixekizumab, Secukinumab, Upadacitinib
Non-Radiographic Axial Spondyloarthritis
Golimumab, Certolizumab pegol, Upadacitinib
Giant Cell Arteritis
Tocilizumab
  
Paediatric Rheumatology
Rheumatoid Arthritis
Infliximab
Juvenile Idiopathic Arthritis and Systemic Juvenile Idiopathic Arthritis
Etanercept, Adalimumab, Tocilizumab
Cryopyrin-associated periodic syndrome (CAPS)  
Anakinra

Dermatology

Chronic Plaque Psoriasis
Adalimumab, Etanercept, Infliximab, Ustekinumab, Secukinumab, Ixekizumab, Guselkumab, Tildrakizumab, Risankizumab, (Bimekizumab 2023)
Hidradenitis Suppurativa
Secukinumab, Adalimumab
Chronic Idiopathic Urticaria
Omalizumab
Basal Cell Carcinoma
Sonidegib, Vismodegib

Paediatric Dermatology

Psoriasis
Adalimumab, Etanercept, Ustekinumab
Hidradenitis Suppurativa
Adalimumab
Spontaneous Urticaria
Omalizumab
Atopic Dermatitis
Dupilumab


The petition is accepting signatures at https://www.change.org/PBSpaperwork

 

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