For people with chronic long-term health conditions needing treatment with certain PBS-subsidised medicines, staying on therapy just got a little easier.
Continuing treatment can require evidence of benefit
Some medicines require certain criteria to be met before a person can continue to be prescribed that medicine through the PBS. These medicines are often highly specialised and are used to treat chronic conditions such as Crohn disease, cystic fibrosis, severe rheumatoid arthritis or severe asthma.
Clinical criteria are used to confirm that a medicine is still of benefit, and that the person should continue to receive it as a PBS-subsidised therapy. Each time a prescription is prepared, the prescriber needs to provide documentation that these criteria are being met.
Clinical criteria can include many different types of measurements, from how well a person’s lungs are working through to the level of different disease markers in a blood test or the number of body joints showing active inflammation due to arthritis.
Exemptions now in place to 30 September 2020
The Australian Government recognises that attending appointments so certain clinical criteria information can be collected may not be appropriate for some people during the current COVID-19 pandemic. In response, an interim exemption measure has been implemented for some medicines.
During the exemption these medicines can continue to be prescribed without the supporting documentation of certain clinical criteria needing to be provided.
If a treating medical professional considers their patient may be at increased risk of COVID-19 infection or is impacted by quarantine, and that telehealth cannot provide the necessary information, they can now lodge a request for an exemption with Services Australia (Medicare).
People must have previously received a prescription for the eligible PBS medicine, and the prescriber is legally required to note the reasons for the proposed exemption as well as how it relates to the COVID-19 pandemic.
All other PBS restriction criteria that are not affected by the COVID-19 pandemic will still apply.
Learn more about this temporary measure including what medicines are eligible for exemption during this time.