During the COVID-19 pandemic Australians may be required to home-isolate. Everyone is urged to practice social distancing.
The following provides practical advice for community pharmacists to assist patients in home isolation and for social distancing, and advice for pharmacists in managing the supply of medicines during the pandemic.
On this page
- Minimising non-essential contacts with community pharmacies and general practices
- Patients in home isolation
- Home delivery service process
- Continued dispensing of selected PBS medicines
- Special temporary authority for emergency supply without a prescription
- Dispensing medicines under the usual 3-day emergency supply provisions without a prescription
- Opioid Treatment Program
- Over supply of medicines
- Information for consumers on medicines supply during the pandemic
- Supply and handling of dose administration aids (DAAs)
- Sending medicines via mail or courier
- Emergency temporary closure of a community pharmacy in NSW
- Image based prescribing
- Electronic prescribing
- More information
Minimising non-essential contacts with community pharmacies and general practices
- Co-ordinate prescriptions with the prescriber
Advise patients on options to obtain prescriptions from general practitioners (GPs) without presenting to the general practice, in consultation with local practices, if needed. For example, liaise with local general practices to determine where acceptable for patients to call the general practice and request ongoing prescriptions are written without consultation.
- Offer home delivery where feasible
Offer home delivery services so that the patient does not need to present in the pharmacy. Note the pharmacist will use professional judgement on what is appropriate in terms of consulting with the patient. The Pharmacy Board of Australia Guidelines for Dispensing of Medicines reminds pharmacists of obligations to provide information on use of medicines to the patient either face to face or via telephone or telehealth.
- Advise on options to keep prescriptions on file
Advise patients of the option to leave prescription repeats at the pharmacy in the event of home isolation. Note this may pose a risk in a pharmacy with a sole pharmacist.
- Recommend alternative pick up arrangements
For patients with flu-like symptoms or under isolation rules, arrange for prescriptions to be sent directly from the medical practice to the pharmacy where possible.
Patients in home isolation
Most people can manage to organise their prescription medicine supply by telephoning their usual GP and their usual pharmacy for arrangements to be made.
Where people hold their repeat prescriptions at home, a carer/friend not in isolation can present the repeat prescription to the pharmacy and deliver the medicines to the home.
If new prescriptions to continue therapy are needed, the patient can phone their GP for new prescriptions at the prescribers’ discretion. Repeats for those prescriptions could be temporarily held at the pharmacy until the patient comes out of isolation. A carer can collect the prescription for the person in home isolation and present it to a pharmacy.
The existing emergency provisions for a GP to phone/email/fax a copy of a prescription may be used if there is not time to have the GP mail a prescription to the pharmacy or have it collected by a carer or agent of the patient. Telephone orders can be made to a community pharmacist by a GP in such emergency situations, then followed with a prescription written immediately and sent to the pharmacy within 24 hours.
Offer a home delivery service. Note the pharmacist will use professional judgement on what is appropriate in terms of consulting with the patient.
Home delivery service process
- Medicines should be packed in plain packaging (i.e. not obviously from a pharmacy).
- The delivery person should be a responsible person delegated by the pharmacist, an adult in the case of Schedule 8 and Schedule 4 Appendix D medicines.
- Storage requirements for medicines should be considered.
- Where possible, notify the expected timing of the delivery.
- Facemasks, goggles and personal protective equipment is not required for home delivery services, as delivery should be achievable without contact.
- If the address is an apartment, the delivery person should be permitted through the common areas to the apartment door so that the isolated person remains in their apartment.
- If the isolated person is in a household with other people, someone who is not in isolation is preferred to receive the delivery.
- Delivery personnel should ring the doorbell or contact number and then stand back a minimum of 1.5 metres to check the delivery is received.
- Consider the risk if medicines are left unattended. For Schedule 8 and Schedule 4 Appendix D medicines, if the door is not answered and the medicine cannot be left in a secure place (eg. a locked letterbox), the medicine should not be left unattended, but returned to the pharmacy. If appropriate, items should be left outside the door for the recipient to collect.
- A receipt is required for delivery of Schedule 8 medicines. The pharmacist will need a mechanism to do this, and emailed acknowledgment of receipt would be reasonable.
- A pharmacist may dispense using telephone or email orders in an emergency
- The pharmacist can confirm the patient’s current medication details with the prescriber, or a prescriber may direct a pharmacist to supply a medicine to a patient in an emergency situation, by providing a telephone order, email or facsimile. The prescriber must forward a paper prescription to the pharmacy as soon as practicable and within 24 hours, endorsed as such. If not received within 7 days, the pharmacist must report this to the Pharmaceutical Regulatory Unit on telephone 02 9391 9944.
Pharmacists must take special care to verify a telephone order for a Schedule 4 Appendix D or Schedule 8 medicine is genuine, e.g. by calling back the prescriber using an independent source of telephone number. If the pharmacist is unable to verify the prescriber’s identity but has no other reason for suspecting the order is not genuine, then no more than two days’ supply should be made until the written signed hardcopy prescription is received.
Continued dispensing of selected PBS medicines
For patients requiring urgent supply of most oral contraceptives or statins, pharmacists may dispense a single PBS quantity under Continued Dispensing arrangements.
Special temporary authority for emergency supply without a prescription
A
patient can receive a supply of most Schedule 4 medication without a
prescription, where the pharmacist in his professional judgment is satisfied
that all the following conditions are met:
- the
medicine has been previously prescribed to the patient, and
- the
patient needs the medicine immediately for continuation of current
essential treatment, and
- it is
not practically possible for the patient, or the pharmacist, to obtain a
prescription from any appropriate prescriber, even via phone, fax or email
to the pharmacist.
The special temporary authority is published.
The pharmacist
should establish that the patient has not received any such emergency supply of
the medicine from any pharmacy in the previous 12 months, to ensure that
medical assessment has appropriately occurred, and a medical practitioner has
confirmed that ongoing treatment is required and to avoid over-supply
occurring.
Because a patient should be able to obtain a prescription
before he/she runs out of a supply made by a pharmacist under these
arrangements, the expectation is that only a single supply should be necessary
and then the patient should obtain a prescription (with repeats if appropriate)
for the next supply.
Schedule
4 Appendix D medicines and Schedule 8 medicines may not
be supplied under the special authority.
The
quantity to be supplied is no more than:
- the standard Pharmaceutical Benefits Scheme
maximum quantity for substances that are on the Pharmaceutical Benefits
Scheme
- the quantity that is contained in the
smallest standard pack in which substance is generally available, for
substances that are not on the Pharmaceutical Benefits Scheme.
The
pharmacist must record:
- name and address of the patient
- name, strength and quantity of the medicine
- directions for use of the substance as
determined by the pharmacist
- name and address of the authorised
practitioner who last prescribed that substance
- date of supply
- a unique reference number
- name of the pharmacist by whom the
substance was supplied. The medicine must be labelled as for a dispensed
medicine.
The
pharmacist should also make a record of how the conditions above are met.
If the supply
also meets the requirements of Continued Dispensing of PBS items
then the pharmacist may be able to pass on a PBS subsidy.
Supplying any
Schedule 4 medicine outside of the conditions of this and other provisions of
the NSW Poisons and Therapeutic Goods legislation is an offence.
Dispensing medicines under the usual 3-day emergency supply provisions without a prescription
A patient can receive a three (3) day supply of most Schedule 4 medication without a prescription, where the pharmacist is satisfied there is immediate need. The medicine must have been previously prescribed, be for continuation of current essential treatment and it is impracticable to obtain a prescription. In the case of a pre-packed liquid preparation, cream or ointment, pressurised aerosol container or an oral contraceptive, the smallest standard pack may be supplied. Schedule 4 Appendix D and Schedule 8 substances may not be supplied under these Emergency Supply arrangements.
Opioid Treatment Program
For patients treated with methadone or buprenorphine under the Opioid Treatment Program see Information for Community Pharmacy Opioid Treatment Program dosing points for guidance.
Over supply of medicines
Pharmacists have professional responsibilities when supplying prescription medicines for patients, and the Poisons and Therapeutic Goods Regulation 2008 (PTGR) must be complied with when dispensing multiple prescriptions or greater quantities of medicines. This means, the following must be observed:
The quantity and purpose for supply of all scheduled medicines accords with therapeutic standards of what is appropriate in the circumstances
Note the maximum number of times the substance may be supplied on the prescription
In the case of a prescription for a special restricted substance (S4B) e.g. anabolic androgenic steroids or a drug of addiction (S8), the intervals at which the substance may be supplied on the prescription.
Prescription medicines should be restricted to one month’s supply or one pack unless the pharmacist is satisfied there is an immediate therapeutic need to supply more. See also TGA - Limits on dispensing and sales of prescription and over-the-counter medicines.
Prescriptions presented for dispensing under Regulation 49 (formerly Regulation 24) should only be dispensed for one month’s supply unless the pharmacist is satisfied there is an immediate therapeutic need to supply more.
An amendment to the Poisons Standard on 24 March 2020 means it became illegal for a pharmacist to supply a Schedule 3 salbutamol inhaler, other than:
- to persons with evidence of a medically diagnosed lung condition
- to persons with a record of previous supply from the pharmacist
- supply must be limited to one primary pack of salbutamol per person.
The provisions for supply of salbutamol to a person holding an asthma certificate and to a responsible person for a residential care facility remain unchanged.
The pharmacist should restrict the supply of scheduled over the counter medicines such as certain analgesics or cold and flu products to one standard pack where appropriate
Risks of oversupply of medicines
There are patient safety risks and the risk of potential medicine misuse with stockpiling. Consider risks of self-harm and childhood poisonings.
There are unintended consequences of medication shortages being triggered due to some patients stocking up and others missing out.
The TGA cautions against over-buying medicines by pharmacies. For further information see the TGA response to Covid-19.
Information for consumers on medicines supply during the pandemic
Advise consumers to ensure they have enough medication to meet their immediate needs, particularly if they are required to undergo home-isolation unexpectedly.
For most people, a 30-day supply should be enough, but if patients consider whether they have other needs, they should speak with their general practitioner or pharmacist.
Reassure patients that there is no need to stockpile large quantities of medicines they or their family take.
Having much more than a 30-day supply of medicines is generally not necessary and comes with extra costs and medicine safety risks.
Encourage patients to speak to the pharmacist if they have concerns about their medicines and the amount needed.
More information for consumers
The Commonwealth Government has set limits on dispensing and sales of medicines at pharmacies, see:
Supply and handling of dose administration aids (DAAs)
Sending medicines via mail or courier
Medicines which have been prescribed, dispensed and labelled for a patient, and Schedule 2 or unscheduled medicines, can be sent to the patient by post or courier or other carrier (such as a bus driver in rural areas).
In the case of Schedule 8 medicines delivered by carrier, the sender should obtain a receipt from the carrier and require the carrier to obtain a receipt from the addressee and deliver it to the sender.
There should be nothing on the external packaging that identifies the contents as a Schedule 8 or Schedule 4 Appendix D medicine.
Australia Post regulations also apply, see Australia Post - Dangerous and prohibited goods and packaging guide. Sections 10.10, 10.13 and 10.14, require that the quantity sent “does not exceed the maximum quantity that may be dispensed at one time” and have special packaging requirements for tablets, liquids, pastes and powders.
Emergency temporary closure of a community pharmacy in NSW
It is recommended that all pharmacists consider this situation and develop a contingency plan. In preparing this plan you are reminded:
- Pharmacists must continue to comply with regulations with regards to supply and storage of medicines.
- Ensure you are familiar with your emergency locum options.
- Ensure any closure is communicated to customers with a sign on the pharmacy premises as a minimum.
- Although it is otherwise illegal for anyone to take or supply anything from a pharmacy in the absence of a pharmacist, a non-pharmacist staff member could, on the direction of the pharmacist:
- take possession of the prescriptions and repeats (other than S8 and S4B) which had been left at the pharmacy for safekeeping/convenience, then:
- take the prescriptions to a different pharmacy, advising patients to phone that other pharmacy if a medication is required, or
- deliver the prescriptions/repeats to the patient’s address for the patient to organise the dispensing at another pharmacy, or
- offer a courier/delivery service taking the prescription/repeats to another pharmacy (perhaps in the next town) to have the medication dispensed and then delivered to the customer.
Note, in the case of S8 and S4B (androgenic anabolic steroid) original and repeat prescriptions, these must remain on the premises of the pharmacy which first dispensed them. If a patient requires a further supply whilst the pharmacy is closed, another pharmacy will require a new prescription.
- take possession of dispensed (non-S8) medicines then deliver them directly to the patient.
Image based prescribing
Community pharmacists in NSW can now dispense a prescription for most medicines using an image of the prescription received by email or fax, rather than requiring a paper prescription. Further information is available about image-based prescriptions.
Electronic prescribing
Although electronic prescribing is not yet approved in NSW, more information will be provided on progress with approval of fast track electronic prescribing over the next two months.
More information
Pharmacists may seek advice on compliance with the Poisons and Therapeutic Goods legislation from the Pharmaceutical Regulatory Unit, Ministry of Health, contact the Duty Pharmaceutical Officer on telephone 02 9391 9944.
Pharmacists may seek advice on managing pharmacy closures from the Pharmacy Council of NSW on telephone 1300 197 177.
