Pharmacists in NSW can dispense a prescription for most medicines using an image of the prescription received by email or fax, rather than requiring a paper prescription. 

This temporary measure 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.

Image-based prescriptions for Schedule 4 medicines that are not in Appendix D, are legally valid up until 30 September 2022. However these are not eligible for PBS subsidy.

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How does it work?

Pharmacists can accept image-based prescriptions received by email or fax from a medical practitioner or nurse practitioner. Image-based prescriptions do not need to be followed up with a hard copy of the prescription, and can be issued with repeats.

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 the temporary arrangements due to risks associated with fraudulent prescription and supply.

The steps for image-based prescribing and dispensing are:

  1. Prescriber issues a prescription, including a physical handwritten signature
  2. Prescriber sends an image of the prescription to the patient’s pharmacy of choice by email or fax. The presciber must ensure transmission is appropriately secure to protect patient privacy and prevent fraudulent use of the image.
  3. Pharmacist dispenses the prescription, prints a copy and endorses it as per usual
  4. Pharmacist arranges delivery or pick up by the patient, carer or patient's agent
  5. Pharmacist keeps any repeats and all prescriptions for two years.

All repeats must be supplied and held in the same pharmacy as the original supply. 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.

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.

Medicines excluded from image-based prescribing

Image-based prescriptions cannot be used for Schedule 8 medicines and Schedule 4 Appendix D medicines:

Schedule 8 medicines and drug classes

  • opioids
  • selected benzodiazepines (alprazolam, flunitrazepam)
  • psychostimulants (dexamfetamine, lisdexamfetamine, methylphenidate)
  • cannabis-based medicines

Schedule 4 Appendix D medicines and drug classes

  • anabolic steroids
  • barbiturates
  • benzodiazepines (except alprazolam, flunitrazepam)
  • erythropoietins
  • growth hormones
  • quetiapine
  • peptides
  • pregabalin
  • selective androgen receptor modulators
  • tramadol
  • zolpidem
  • zopiclone

As with any Schedule 4 Appendix D medicine, prescriptions for these medicines can only be dispensed for up to six months from the date of issue.

A list of all Schedule 4 Appendix D medicines is available.

Frequently asked questions

The patient has a photo of their prescription. Can I dispense it?

No. Image-based prescriptions are only valid when sent directly to the pharmacy by the prescriber using email or fax.

Can I dispense repeats from an image-based prescription?

Yes. Print the repeat authorisation form as normal and attach it to the printed copy of the prescription. Keep the repeats at the pharmacy.

Which medicines are included?

Image-based prescriptions can be used for Schedule 4 medicines excluding those in Appendix D. Schedule 4 Appendix D and Schedule 8 medicines are not included in the temporary arrangements.

The prescriber has sent me an image of a prescription for a Schedule 8 medicine. Can I dispense it?

No. Arrangements for issuing and dispensing prescriptions for Schedule 8 medicines have not changed. The prescriber must still send you the paper prescription for a Schedule 8 medicine.

A prescriber has sent me an image of a prescription but I do not have stock of the S4 medicine – what do I do?

If a pharmacist cannot dispense a medicine on an image-based prescription, inform the prescriber so that the prescriber can send the image-based prescription to another pharmacist. A pharmacist cannot forward an image-based prescription to another pharmacist for dispensing. Ideally, the prescriber should liaise with the pharmacist to check stock for unusual medicines or medicines known to be in short supply, prior to sending the image-based prescription.

How long will image-based prescribing be permitted?

This temporary change is in place until 30 September 2022. Electronic prescribing through prescription exchange services is expected to be widely available by this time.

What do I need to do?

Ensure you have an email address or fax to receive image-based prescriptions and advise local prescribers.

I have questions. Who do I contact?

For more information contact the Duty Pharmaceutical Officer at the NSW Ministry of Health at​​​​​

Current as at: Friday 8 April 2022
Contact page owner: Pharmaceutical Services