Active Ingredient Prescribing is coming: here’s what you need to know
Active Ingredient Prescribing was announced in the 2018-19 budget as part of the general ePrescribing initiative. While we’ve all heard a lot about ePrescribing and how it works, many of the GPs we’ve spoken to have heard very little, if anything, about Active Ingredient Prescribing.
What is Active Ingredient Prescribing?
When Active Ingredient Prescribing comes into effect over the next few months, active ingredients will be included by default on all PBS and RPBS prescriptions. This means that prescriptions will now only list the active ingredient in the medication, unless a GP specifies that the brand name should be included as well.
Under the new changes, when a patient takes a prescription to the pharmacy to be dispensed, they may be given a generic version of their medication instead of the brand they are used to. This is not compulsory and patients can still request a specific brand from their pharmacist if they have a preference.
While it’s still a way off, it’s not too early to start educating yourself about Active Ingredient Prescribing and talking to your patients about the active ingredients in their medications. The better prepared we all are for Active Ingredient Prescribing, the easier the transition will be.
Why are we changing to Active Ingredient Prescribing?
Active Ingredient Prescribing has been brought in for two main reasons;
- To increase the uptake of generic and biosimilar medicines to help make the healthcare system more financially viable in the long term.
- To ensure prescribers and patients are more cognisant of active ingredients in their medications, with a view to reducing medication-related harm.
What do GPs need to do?
Under this new change, the prescribing workflow in MedicalDirector software will remain unchanged, unless GPs want to ensure that brand names continue to be displayed on prescriptions. It may be useful for GPs to educate themselves on the active ingredients in the most common medications they prescribe. GPs will also need to identify situations where patients should remain on their branded medication and ensure this is specified on their prescription.
The most important thing for practitioners to do is to educate their patients about the change and talk through any concerns or questions they have, particularly those who are on long-term medication or who are taking multiple medications – or ensure that brand names are included on prescriptions where appropriate.
How will these changes affect pharmacists?
The new changes will allow pharmacists to dispense a generic medication when the prescriber has not opted out of substitutions. This means pharmacists will have to take an active role in educating patients and making sure they understand that while their medication might look different and have a different brand name, it’s still the same active ingredient.
Many patients have been on the same medication for a long time and know it only by the brand name and packaging, so they will be understandably worried about taking a medication that appears different or that has a different name. It’s important that communication is clear and consistent, and any patient questions and concerns are addressed. Failure to do this could lead to confusion and stress, or in a worst-case scenario, dosage errors and/or missed medications.
Are there any exceptions to Active Ingredient Prescribing?
Yes. Handwritten prescriptions, medications with four or more active ingredients and in cases where doctors specify a particular brand with no substitution will be exempt although the active ingredient will still need to be listed on the prescription. LEMI drugs have also been exempt from Active Ingredient Prescribing, and RLDBI (soon to be LMBC) drugs have been recommended for brand inclusion on prescriptions.
Benefits of Active Ingredient Prescribing
The most obvious benefit will be that patients will save money on branded medicines by switching to the generic. Also, by educating patients on the active ingredient in their medication, they will be more informed as to what they are taking and potentially be able to identify if they are doubling up on medications with the same active ingredient.
Another benefit of switching to Active Ingredient Prescribing is that in the event of medication shortages, it is easier for patients to switch to an alternative if they understand what their active ingredient is. This is very timely when we consider that COVID-19 has already led to a number of medication shortages which are likely to be ongoing.
On a wider community level, it’s expected that Active Ingredient Prescribing will encourage competition and lower the price of medications across the board, freeing up funds for the government to invest in new innovations and discoveries and helping the system become more sustainable as a whole.
Are there any disadvantages?
There is the potential for confusion, especially for patients who may only be familiar with the brand name of their medication.
Some patients may feel loyal to their particular brand and be anxious about changing or using a generic branded medication. It’s important that patients are made aware they don’t have to change, they can still request their particular brand when they go to their pharmacist or doctor. Likewise, doctors are still able to tick a ‘do not substitute’ box in their software if they wish to prescribe a specific brand of medication.
There are cases when patients may have an adverse reaction to a generic medication or a brand that’s different to their regular brand. This could be due to a particular filler that one company may use rather than an issue with the active ingredient. Small variations in active ingredient could also potentially cause a problem as some might be very similar but not interchangeable. It’s important that practitioners and pharmacists communicate closely with each other and with their patients to make sure these risks are minimised.
As always, MedicalDirector is here to support you through ePrescribing and Active Ingredient Prescribing. We’ll be updating our software to reflect the updated legislation and providing you with resources to help you educate yourself and your patients on the changes.