Avoiding wastage with insulin prescribing

The Pharmaceutical Benefits Scheme (PBS) provides affordable medicines to all Australians. However, increasing costs of medications are threatening it.

New means of cost-effective and cost-minimising interventions are always needed to ensure sustainability and viability of the scheme.¹ A practical and simple approach of saving is to change the PBS listing of insulin prescribed for gestational diabetes and users of low-dose insulin who will not necessarily go through the normal quantity of insulin provided to them. The standard quantity of insulin supplied by the PBS is five boxes of five individually packed units. This amount is usually excessive for patients using small doses of insulin who are prescribed other antidiabetic medicines.

A new listing of a single box of five individually packed units made available to these groups of patients will significantly save costs to the PBS and promote the quality use of medicines to the consumer as well as the prescribers.

By avoiding wastage of medications and educating prescribers about the need to restrict supply of excess unnecessary medications, resources could be freed up for other government-funded health expenditures.²

Hanan Khalil
Senior Lecturer/Pharmacist Academic
Department of Rural and Indigenous Health
Monash University, Melbourne

Thank you to Dr Khalil for the suggestion to add a differential PBS listing for insulin. The maximum quantity and number of repeats allowed for items subsidised on the PBS are recommended by the Pharmaceutical Benefits Advisory Committee (PBAC). In general, for drugs which are usually taken on a long-term basis – such as for the management of diabetes – the PBAC recommends a maximum quantity sufficing for about one month's therapy at average doses. The PBAC believes that this requirement is equitable since it is applied across most therapeutic classes of drugs intended for long-term use.

Although a maximum quantity is set out in the PBS listing, there is flexibility to vary the quantity prescribed for patients taking doses that are higher or lower than usual. It is the responsibility of the doctor to ensure that individual patients are prescribed the appropriate quantity. If a prescriber feels the maximum quantity (or number of repeats) should be increased for a particular patient, he or she has the option of completing an Authority PBS Prescription Form with Medicare Australia either by telephone or in writing. This situation usually arises where higher than normal dosages are required. If, as in the case raised by Dr Khalil, a lesser quantity is sufficient for the patient's needs, then this lower quantity may be prescribed. It is not necessary to prescribe the stated maximum quantity as PBS prescriptions and repeats can be for any amount up to the maximum quantity.