Enoxaparin for haemodialysis – authority indications

Patients on haemodialysis are able to receive double the normal quantity of enoxaparin (Clexane) solution for injection per prescription – that is, 20 ampoules and 3 repeats versus the usual 10 ampoules. However, the restricted benefit listing for haemodialysis only covers the 20, 40 and 60 mg strengths. Clinicians are unable to prescribe double the quantity for the 80 and 100 mg strength for patients on haemodialysis. This seems a strange restriction. The recommended dose for haemodialysis is 1 mg/kg body weight for dialysis – so this restricts additional supply of medication to patients weighing 60 kg or less. It also creates additional cost for those patients above 60 kg, who choose to perform haemodialysis at home and have to purchase their own medication. Could this be reviewed?

Margaret Morris
Nurse practitioner – renal care, and anaemia co-ordinator
Dialysis Unit
St Vincent's Hospital
Melbourne

At its December 2002 meeting, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended a differential listing for the 40 mg and 60 mg enoxaparin injections for patients undergoing long-term haemodialysis, whereby a maximum quantity of 20 and three repeats would be available. This recommendation was made following a request from a specialist physician who had asked that these two strengths be made available under a differential listing for haemodialysis patients with an increased quantity.

In December 2003, the PBAC further recommended the inclusion of the 20 mg injection under the haemodialysis listing, with a maximum quantity of 20 ampoules and three repeats. The PBAC did not extend the recommendation to the higher strengths (80 mg and 100 mg enoxaparin injections) as it held concerns about the risk of bleeding if they were made available. However, taking into account that the recommended dosage of enoxaparin is 1 mg/kg for haemodialysis patients and that more patients may receive treatment in the home than previously, this matter will be reviewed by the PBAC at its March 2011 meeting after seeking expert advice.

Do you have a question for the PBAC?

Australian Prescriberreaders are invited to write in with their questions about decisions of the Pharmaceutical Benefits Advisory Committee (PBAC). The journal publishes selected questions from readers, together with answers from the PBAC. Questions may address issues such as regulatory decisions, pharmaceutical benefits listings and withdrawals.

This exclusive arrangement helpsAustralian Prescriberreaders understand how the contents of the Schedule of Pharmaceutical Benefits(www.pbs.gov.au)are determined.

Letters and responses are reviewed by our Editorial Executive Committee and may be edited before publication. It may not be possible to reply to all individual questions.