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.
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.
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.
For patients requiring urgent supply of most oral contraceptives or statins, pharmacists may dispense a single PBS quantity under Continued Dispensing arrangements.
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 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 pharmacist must record:
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.
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.
For patients treated with methadone or buprenorphine under the Opioid Treatment Program see Information for Community Pharmacy Opioid Treatment Program dosing points for guidance.
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:
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
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.
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.
The Commonwealth Government has set limits on dispensing and sales of medicines at pharmacies, see:
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.
It is recommended that all pharmacists consider this situation and develop a contingency plan. In preparing this plan you are reminded:
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.
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.
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.
