COVID-19 update for Pharmacists -  17 April 2020

The Pharmacy Council of NSW is working with NSW Health to provide pharmacists with COVID-19 updates.

Supply on the Image of a Prescription and additions to Appendix D

Pharmacists in NSW can now dispense Schedule 4 medicines (other than those in Appendix D) based on the image of a prescription.

This temporary measure effective from 17 April 2020 to 4 April 2021 will better support patients, prescribers and pharmacists during the COVID-19 response, and allow better integration of the prescription and supply of medicines with the Commonwealth Government’s COVID-19 response telehealth reforms (PBS subsidy for supply on image-based prescriptions).

The NSW Health webpage Image-based prescriptions are now valid in NSW is now available, and includes answers to Frequently Asked Questions.

Note that pregabalin, quetiapine, tramadol, zolpidem and zopiclone have been included in Appendix D of the Poisons and Therapeutic Goods Regulation 2008.

Supply based on the image of a prescription

Community pharmacists can accept image-based prescriptions received by email or fax directly from a medical practitioner or nurse practitioner. Image-based prescriptions cannot be received from patients.

Image-based prescriptions do not need to be followed up with a hard copy of the prescription, and can be issued with repeats.

All repeats must be supplied and held in the same pharmacy as the original supply (under PBS requirements).

For a prescription issued with repeats, print the repeat authorisation form as normal and attach it to the printed copy of the image-based prescription and store them together at the pharmacy for future dispensing.

The steps for image-based prescribing and dispensing are:

• Prescriber issues a prescription, including a physical handwritten signature
• Prescriber sends an image-based prescription to the patient’s pharmacy of choice by email or fax
• Pharmacist dispenses the prescription, prints a copy and endorses it as per usual
• Pharmacist arranges delivery or pick up by the patient, carer or patient's agent
• Pharmacist keeps any repeats and all prescriptions for two years

Image-based prescriptions can only be issued and dispensed for Schedule 4 medicines, except those in Appendix D (S4D medicines). S4D medicines and Schedule 8 (S8) medicines are not included in these arrangements due to risks associated with fraudulent prescription and supply.

There are no changes to issuing and dispensing prescriptions for S4D and S8 medicines. A prescriber may still direct a pharmacist to dispense S8 and S4D medicines by telephone, email or fax, and the paper-based prescription must be sent to the pharmacist within 24 hours.

Addition to Appendix D

Additional substances identified as liable to abuse, misuse and trafficking have been included in Appendix D of the NSW Poisons and Therapeutic Goods Regulation 2008 (prescribed restricted substances), including:

• growth hormones as listed in Appendix D(5) of the Poisons Standard
• peptides as listed in Appendix D(5) of the Poisons Standard
• pregabalin
• quetiapine
• tramadol
• zolpidem
• zopiclone

This means the provisions for supply on image-based prescription and supply without prescription under the temporary special authority do not apply to the above substances, or to any other S4D, or to S8s.

As with any S4D medicine, prescriptions for these medicines can only be dispensed for up to six months from the date of issue.

Also as with any S4D medicine, loss must be reported to the Ministry of Health. For further information, visit the NSW Health webpage on Notifying the loss or theft of drugs under Poisons and Therapeutic Goods legislation.

Please note that the storage requirements for S4D medicines kept in a hospital ward will not apply to the newly added substances until 5 April 2021.

A list of all Schedule 4 Appendix D medicines is available on the NSW Health website.