Patient safety the clear winner in Active Ingredient Prescribing initiative
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Patient safety the clear winner in Active Ingredient Prescribing initiative

Active Ingredient Prescribing (AIP) will help reduce the cost of medicines, mitigate risk of medication errors and increase health literacy among patients. However, education is essential for both patients and healthcare professionals to ensure a smooth transition and avoid potential risks to patient safety.

This was the consensus of four leading health professionals speaking on a panel led by MedicalDirector’s Acting Chief Medical Officer, Dr Charlotte Middleton. The panel explored the AIP changes through multiple lenses, discussing what the changes will mean for patients as well as healthcare professionals.

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View transcript

Meet Our Panellists

  • Dr Charlotte Middleton (Moderator), GP and Chief Medical Officer, MedicalDirector
  • Dr Shane Jackson, Pharmacist, Interim CEO and Former President, Pharmaceutical Society of Australia
  • Elizabeth de Somer, Chief Executive Officer, Medicines Australia
  • Gloria Antonio, Deputy Chief Executive Officer, NPS MedicineWise
  • Dr Jill Gamberg, GP and Media Personality

 

Key Insights

The Active Ingredient Prescribing initiative is part of a $1.8 billion investment in measures announced to reduce the drugs bill over five years. The proposed changes will help reduce the cost of medicines for consumers as well as reduce PBS spend on medicines. These changes will also have some positive knock-on effects for medications development.

“The savings that are generated through competition in this multi brand market will free up some head room for the government to develop new breakthrough medicines and for discoveries to be made available for Australian patients, which is critical for our health care system,” said Elizabeth de Somer, Chief Executive Officer at Medicines Australia.

While the cost-related benefits are clear, the overwhelming positive of the Active Ingredient Prescribing changes will be the reduction in medication errors and associated deaths.

“Unfortunately there’s a lot of medication related death in Australia. And if prescribing generically is a step towards reducing error, reducing death, and reducing disability from medication error then that’s an excellent benefit in my book,” said panellist Jill Gamerg, GP and media personality.

Pharmacist, Interim CEO and former President of the Pharmaceutical Society of Australia, Dr Shane Jackson backed up this point, highlighting the fact that more than 250,000 people are admitted to hospital each year because of medication related harm, costing the healthcare system $1.4 billion annually.

Jackson added that Active Ingredient Prescribing will also help address the medicine shortage we experienced recently during COVID-19. He points out that if someone’s familiar with their active ingredient then the change in brand is going to be less of an issue because they’re familiar with their drug.

Guiding patients through change

With any change of this magnitude, a robust education and health literacy program is key, the panellists agreed.

“Health literacy is critical because the more patients understand their medicine, the better and safer it will be. It really highlights the importance of the relationship between the patient, their prescriber, and their pharmacist to provide this education,” de Somer said.

Dr Jackson agreed it’s the duty of healthcare professionals to transition the conversation with patients to active ingredient prescribing, and ensure GPs and pharmacists are keeping lines of communication open.

“It’s incumbent on us all to make sure that we’re adequately communicating, that we’re going above and beyond. If COVID-19 has taught us anything, it’s to make sure that we pick up the phone and talk to our fellow healthcare professionals if we have any concerns.”

Framing is everything

Along with many positives there are also risks in making a change of this scale, and that could come at the cost to patients’ safety.

“It’s going to take some time before we can make it a very safe system and we need to be very wary while we transition that we don’t make more errors,” Dr Gamberg warned.

However, the way we frame the change will have a direct effect on patient engagement, said Gloria Antonio, Deputy CEO, NPS MedicineWise.

“It’s important that we as health care professionals reinforce this as a positive change rather than a risk. We need constant and ongoing reinforcement of the message, being mindful of the level of knowledge the patient has, to ensure the message is heard.”

Greater education around our healthcare system in general and the way the PBS works will also help consumers get on board with the Active Ingredient Prescribing changes, de Somer believes.

“It’s a complex system and our general community has very little awareness of how the PBS operates, where generic medicines sit in that, and how much they cost the taxpayer. I think that we could benefit from teaching Australians how the PBS works, and why it’s important for us to make efficiencies and create savings in the generic market.”

Active Ingredient Prescribing won’t preclude choice

It’s important to note that prescribers and patients will still have freedom of choice when it comes to the medicines they want to prescribe and consume. Dr Jackson stressed the fact that AIP changes will not invalidate brand substitution preferences, and that GPs will continue to have the final word in which medication is prescribed.

“If the box on the prescription is ticked or crossed that says brand substitution not permitted, it means brand substitution not permitted. Active ingredient prescribing doesn’t override that specification.”

Likewise, consumers will be free to choose a generic or branded medication, provided the active ingredient is specified on the prescription.

A multi-faceted approach to GP education

To support GPs in transitioning to this change, Dr Gamberg suggests a “multi-faceted” approach to ensure all GPs are well educated about the upcoming changes.

“Offer webinars, send emails, send letters. Provide lots of different ways to make sure that we’re all on board and well-educated about the changes about to happen.” She added that giving GPs the opportunity to provide feedback about any fears or concerns they may have will be crucial for engagement and support of the changes.

de Somer agreed with the importance of communication and education, pointing out that timeframes have been pushed back to ensure the government has the building blocks in place before Active Ingredient Prescribing changes come into effect. She said she’s “optimistic” that there’s time for the right level of communication and engagement to occur before the changes are rolled out.

Just the start of the journey

The panel agrees that Active Ingredient Prescribing will result in an overall positive change for Australians. However, it’s not going to be a “magic switch” that makes all our problems go away, de Somer concluded.

“Doctors, pharmacists and manufacturers of medicines will all play an important role in navigating our way through this new way of working.”

Transcript

Charlotte Middleton (00:00)
From 2021, it will be mandated that medications are prescribed using their active ingredient, instead of their brand name. This legislation is part of the National Health Strategy which aims to provide paper-free medication management by 2022. And while it’s hoped that it will minimise errors, increase safety and reduce costs, there are some concerns about enforcing this type of prescribing, as well as a call for greater awareness and education for doctors and patients alike. Today’s panel will be a multi-faceted view of the changes, what it means for different areas of the health sector, and what needs to happen before it comes into effect. Joining us today is Dr Jill Gamberg, GP and media personality, Gloria Antonio, Deputy CEO of NPS MedicineWise, Elizabeth de Somer, CEO of Medicines Australia, and Dr Shane Jackson, Pharmacist, Interim CEO and former President of the Pharmaceutical Society of Australia. Active Ingredient Prescribing, or AIP as we’re calling it, is part of a $1.8 billion investment announced to reduce the drugs bill in five years.

Charlotte Middleton (00:16)
Shane, I might start with you. Across the board though, GPs seem to be largely unaware of the initiative. And I’m just wondering if you could give a little bit of a background for our GPs, of where it sort of come from and what we’re sort of hoping to achieve with it.

Dr Shane Jackson (00:31)
Yeah, absolutely Charlotte. And thanks for the question. So this was an announcement in the 2018, 2019 [inaudible 00:00:40] budget, as a component of the electronic prescribing initiative. And I think what we need to do is, we need to see this as a quality and safety plan essentially. And there’s a couple of key elements to that. One is to reduce to PBS spend on medicines, and what that does, it means that we’ve got a sustainable health care system, but it also creates head room to fund future drugs, and current drugs in the future. So it’s a cost saving measure to be able to make sure that we can fund the PBS in the future. But the other element is to make sure that we have patients aware of what the active ingredient is that they’re using on a ongoing basis. So instead of being, I suppose, more familiar with the brand names, patients over time are going to be more familiar with the active ingredient. I know that’s been delayed due to COVID but I think we’ll start getting information out to GPs and pharmacists and other people in the near future.

Charlotte Middleton (01:46)
Fantastic. Really appreciate you giving us a little bit of background on that. Jill, I might just ask you, as a GP, what you feel is some of the benefits to patients in implementing this?

Dr Jill Gamberg (01:57)
I think consistency across the board is going to be good, so if all GPs are on the same page, prescribing the same medications, then we’re going to get away from being particular with specific pharmaceutical companies, so I think in that way it’s a bit more fair. I think in terms of affordability for all, certainly generic prescribing is more affordable for the individual patient, as well as for the PBS in general, and for Australia, for the tax dollars that we’re paying for these medications that we’re subsidising. So, I think that’s all good stuff. I think that once we have all the systems in place, it will likely reduce prescription error long term. I think that’s a definite benefit because I know that there are a lot of deaths associated with prescribing errors across the board, in many countries and Australia is definitely included in that, so anything that is going to make a change across the board that is going to decrease prescription error as well as cost, sounds like a good idea in my book.

Charlotte Middleton (03:12)
Fantastic. Thanks, and Liz from Medicines Australia, what’s your point of view on this?

Elizabeth de Somer (03:18)
We think it’s really important to introduce these new efficiencies in the system. Where there are multiple brands of products we want to improve health literacy. We know that medication errors and medication misadventure, as it is called, is a source of many hospitalizations. And that errors are more likely to occur, the more humans you introduce into the system. So electronic prescribing, direct delivery of the script from the prescriber to the dispenser will reduce error. And anything that increases a patient’s understanding of the medicines their taking is critical to their own health care, which we also think is really important. And the savings that are generated through competition in this multi brand market, free up some head room for the government to these new breakthrough medicines and for new discoveries to be made available for Australian patients, which is also critical for our health care system.

Charlotte Middleton (04:13)
Fantastic. Thanks, and Gloria, what is your take on this?

Gloria Antonio (04:17)
Active ingredient prescribing, Charlotte, helps patients understand their medicines and encourages shared decision making in very much along the journey of the prescribing journey. And it also allows for reducing likelihood of taking medicines that interact in an adverse way. It encourages the patients or the consumer to reduce the risk of taking multiple doses of an active ingredient. So overall, this is a good activity and objective to be had to encourage the use of these medicines to ensure that we do actually reduce the out of pocket cost for consumers as well.

Charlotte Middleton (05:09)
Fantastic. Thanks for that. Jill, can I ask you, what other benefits do you think there will be to this active ingredient prescribing?

Dr Jill Gamberg (05:17)
So, unfortunately there’s a lot of medication related death in Australia, as there are in other parts of the world. And ultimately, all of our aim is to decrease this. And if prescribing generically is a step towards reducing error, reducing death, reducing disability from medication error then that’s an excellent benefit in my book.

Charlotte Middleton (05:40)
Fantastic. Thank you, but guys what about any possible negatives to this. Shane, can you think of some negatives that people might be a little bit concerned about this type of prescribing?

Dr Shane Jackson (05:51)
Well, if I can just build on Jill’s point first, if that’s okay.

Charlotte Middleton (05:55)
Yeah, absolutely.

Dr Shane Jackson (05:57)
Medication related harm, and here’s some figures. And I think the figures are always useful. So we 250 thousand people who are admitted to a hospital each year because of medication related harm. 400 thousand go to ED because of medication related harm. And that admission harm, so those 250 thousand people cost of 1.4 billion dollars annually. So building on what Liz was saying, electronic systems can help us with some of that harm. And so active ingredient prescribing is some of that foundation stone work that needs to happen with electronic systems. And I think if we come back to the core, the core of why we’re trying to do this is to reduce that harm. Because that harm is really, really costly and doesn’t actually include the harm of people who go to jail because they’ve got a side effect from their medicine. No, we don’t even capture some of that cost, which is just extraordinary. So there’s some of the positives.

Dr Shane Jackson (06:58)
Some of the negatives is, I think that we could potentially have some confusion, right? Because a lot of people are probably more used to their brand name than what they are the active ingredient. And I think it’s just incumbent on all of us as healthcare professionals to try and transition our discussion with people to the active ingredient.

Dr Shane Jackson (07:21)
And I’ll bring it another reason behind that is because of the medicine shortages. And I’m sure Liz has got some comments on that as well, but we… Due to COVID at this point and time, the medicine shortages that we’re having are a real challenge for people. And so sometimes there’s one brand out of stock and so we have to, at the pharmacy level, we need to use another brand. But if a person’s familiar with their active ingredient then the change in brand is going to be less of an issue because they’re familiar with their drug. And so we’ve got some challenges. I think we can overcome that by making sure that we communicate adequately. But we’ve also got some benefits as well, which is that medicine harm and the medicine shortages that we’re seeing day to day in our practice.

Charlotte Middleton (08:12)
Liz, did you want to actually add anything to that? On that conversation.

Elizabeth de Somer (08:16)
Thank you, Charlotte. I will build on what Shane has said, and I think that health literacy is critical because the more patients understand their medicine, the better and safer it will be. And reading the medicine safety report written by the Pharmaceutical Society, I believe as much as 50 percent of the harm is preventable. So that’s really important. However, it’s not going to be a magic turn switch once you have active ingredient prescribing the problems will go away.

Elizabeth de Somer (08:48)
And we can say that shortages are critical to try and manage, and litigate. And therefore, if you understand your active ingredient name, you may be willing to take another brand when you turn up at the pharmacy and your particular brand is not available. If there is another brand available you’ll be willing to take it because you understand that it’s the same medicine and it’s going to have the same affect.

Elizabeth de Somer (09:12)
However, that doesn’t preclude choice. And prescribers can still prescribe a brand if they think there is a specific reason why you as a patient want a particular brand. And same for patients. Patients still can choose if they want a particular brand when they go to the pharmacist or when they go to their doctor. The actual measure mandates that the active ingredient must be on the script. But the brand name can be on the script as well. And in some ways that might be also helpful because people will learn to recognize the active ingredient associated with their brand name at the same time.

Charlotte Middleton (09:49)
And it’s my understanding too, Liz, that the doctor can dictate or the patient can dictate if they want that particular brand. And the doctor can, in fact, in the prescribing software, will be able to tick a box that says not to substitute for the brand for the generic or a brand for a different brand even, as well. So they can be quite specific about what drug they want that patient to take.

Elizabeth de Somer (10:16)
And that could sometimes be the generic or biosimilar brand that they’ve selected. That in certain cases, that in certain instances, a doctor will want the patient to stay on the same brand of medicine where there is a narrow therapeutic index of if they are stable, if their disease is stable on a particular brand, whether it is a biosimilar or not. They may want to stay on that particular brand during the duration of treatment.

Charlotte Middleton (10:43)
Absolutely. Jill, any other concerns or negatives that you can think about this type of prescribing?

Dr Jill Gamberg (10:50)
Well, yeah I mean, I do think that they’ll be a few issues. For example, sometimes patients seem to have allergy or adverse reaction to certain brands of medication. And we’re quite unsure why that is. We don’t exactly know. It’s probably unlikely to be the active ingredient that’s causing the issue. But certainly different companies will make different brands with different fillers. So quite possibly that’s a reason for not wanting brand substitution or generic brand.

Dr Jill Gamberg (11:21)
The other thing that I think would be worth thinking about is active ingredients where it does make a difference in terms of brand. And I’m thinking specifically, for example, the thyroid medications. So they’re not equivalent, one to the other. And so we just need to be a little bit careful in terms of slight differences in terms of active ingredient when we’re talking about different brands. Or just confusion in terms of names. Again, once we have education out there for GPs and patients alike, I think these errors will be avoidable in the long run. But certainly in making the change, we need to be a lot more careful.

Dr Jill Gamberg (12:01)
My other worry is about, just what you’re used to. So for example, in terms of the oral contraceptive pills, quite likely the GPs and the patients alike are used to their, usually it’s female brand names, and that’s what everybody sort of knows. I’m guilty myself of having to sometimes look up what the active ingredients are in different contraceptive pills because I’ve been prescribing them by name for years. And so, you know, it’s fine.

Charlotte Middleton (12:30)
With you on that.

Dr Jill Gamberg (12:32)
I’m open to a bit of education, but I can see errors happening in those types of ways. So I think it’s going to take some time before we can make it a very safe system. But I think we need to be very wary while we transition that we don’t make more errors.

Elizabeth de Somer (12:45)
It really highlights the importance of the relationship between the patient, their prescriber, and their pharmacist, to provide this education. Because the concern for me is when people are transitioning or their getting a script filled and they get a different brand and they think it’s a different medicine so they continue to brand in their cupboard and start the new brand that they just got from their pharmacist, and then they’re doubling up their medicines. So that’s why it’s so important, the relationship between patients and the pharmacist who has that front facing role to explain the medicines to patients.

Charlotte Middleton (13:23)
Liz, you’ve brought up a really good point there about how we’re best going to guide our patients through this. And I guess at all the different levels that education is going to need to take place. I think it’s going to really be a complete sort of stake holders contribution to educating our patients on these changes. Shane, would you agree?

Dr Shane Jackson (13:46)
Absolutely. I think it’s incumbent on us all to make sure that we’re adequately communicating. We’re going above and beyond. And if we’re concerned, we’re picking up the phone. And myself as a pharmacist if picking up the phone to the GP to express any concerns. The GP is picking up the phone to the pharmacist to say, you know, how is Mrs. Jones or Mr. Smith going? Is there any concerns? So I just think this whole process is about communication, about team work. And if COVID has taught us anything, it’s taught us to make sure that we do pick up the phone, and we do talk, and we really work constructively which I think is fantastic.

Charlotte Middleton (14:34)
Absolutely. Gloria, did you want to add anything to that there?

Gloria Antonio (14:39)
Yeah, there are risks but I think that as Shane and Liz had said, very much around the conversation with the patients and with the consumers. There are safe guards are in place to ensure that any risk arising is actively addressed through the conversations between the relationship between the pharmacists, and the patient, and the GP. The center of our intention has to be the understanding of the consumer of what is required of them and making sure that health literacy is everybody’s effort.

Charlotte Middleton (15:20)
Fantastic. Thank you. Shane, I will just ask you one question. I think GPs are going to voice some concerns about the fact that they do like some brands and that they don’t want that overwritten. If they have ticked those, the correct boxes on the prescribing software, the pharmacist can’t just override that request, can they?

Dr Shane Jackson (15:41)
Yeah. Can I be very, very, very clear here? If the box on the prescription is ticked or crossed that says brand substitution not permitted. It means brand substitution not permitted.

Charlotte Middleton (15:56)
Good to hear.

Dr Shane Jackson (15:58)
There’s no overriding. Active ingredient prescribing doesn’t override the specification, which presumably has involved a discussion between the doctor and the patient around the preferred brand and there’s a rational behind that. It doesn’t override that. There may be circumstances where, for example, the brand substitution box is ticked, and that brand’s not available and the pharmacist might get on the phone and say, listen the brand’s not available. Right? So there’s a rational behind that but it means what it means. There’s no overriding. And as Liz said before, it doesn’t prevent the doctor from writing a brand along the active ingredient as well. Those things are still in play and still very, very valid and important.

Charlotte Middleton (16:47)
Fantastic. That’s good to know, and I know that a lot of GPs will be pleased with that answer as well. Can I ask generally, obviously there’s going to be a lot of responsibility ensuring that the prescription is written in accordance with these new legislative requirements. How do we think we are going to best educate GPs around these new requirements?

Elizabeth de Somer (17:08)
I think they’ll be a range of mechanisms that we will be used to educate GPs. Some of it will come from the software providers. We understand that the major software providers who build the prescribing software for doctors, the ones that cover as much as 80 percent of the prescribing market in Australia have already started implementing changes to their software. And with it comes guidelines on how to use the software, and instructions on where to navigate your way through it. So I think that’s going to be an initial piece. The Department of Health had certainly commissioned some work to do some educating of prescribers and patients, consumers through their work. And also, doctors, pharmacists, and manufacturers of medicines will play their role in educating prescribers on navigating their way through this new way of working.

Charlotte Middleton (18:05)
Fantastic. Thanks, Liz.

Gloria Antonio (18:07)
Yeah. The Australian Commission on Safety and Quality in Health Care has also developed a lot of best practice guidance to support prescribers. So that will be coming online as well.

Charlotte Middleton (18:21)
That’s fantastic. That’s great to hear. Because I think that, as much as I think a lot of people are going to welcome the changes and are going to see the benefits of the changes. It’s just all about letting us know, and supporting us, and guiding us in terms of these legislative requirements. So that’s great to hear. Jill, you had something to add?

Dr Jill Gamberg (18:42)
I was just going to say, look I’ll be honest, I think this is all a great initiative but until MedicalDirector contacted me last week I had never heard about these changes happening. So that does concern me as a GP. I appreciate we’re in the middle of a world pandemic so things are, you know, not as they should be. But what I think in terms of… General practice can be a very lonely affair, in the sense that, you work by yourself in your room. And yes, you do have a community at work but often times you literally don’t speak to anyone in the day except for your patients.

Dr Jill Gamberg (19:16)
So I think if you want to get GPs on board, I think what you need to do is go for multi-faceted approach. In other words, offer webinars, send emails, send letters. Lots of different ways to make sure that we’re all on board, that we’re well educated about the changes about to happen. And certainly discussing, or offering feedback, the ability for GPs to feedback about any fears or concerns you might have, I think is really, really important. I’m really keen for change. I think change is wonderful. Humans by nature are very afraid of change. I’m not even different, but I think as long as you’re supported and educated in the process that it can be a really good change without increase in error. Which is ultimately the goal or one of the main goals I think of the change to active ingredient prescribing.

Elizabeth de Somer (20:07)
There’s a massive amount of good will in this area to try and do it correctly. And part of the reason that the timeframes have been pushed out, and this is not the first time. It’s been pushed out again, is to make sure that all of the building blocks were in place for that education and communication to occur. It is surprising that people haven’t heard about it yet. But I’m still optimistic that there is time for that communication to be set up and be put in place before it’s rolled out.

Charlotte Middleton (20:39)
Fantastic. Great points, thanks guys. Thank you very much. I did have a question I guess, that obviously there’s a lot of brand loyalty that’s been built over many years. What do we think moving to active ingredient prescribing will mean for patient trust? Is this something that we need to build over time, and how can we do that? Shane, I might throw that one at you.

Dr Shane Jackson (21:06)
Yeah, I think that there is a fair sense of familiarity. But I think in Australia we have done extraordinarily well at promulgating the use of generic medicines. They’re sort of ubiquitous with how we’re using them in this country. And that’s not to diminish the brands. But I think people, over the last sort of 15 years or so, have really understood what we’re trying to achieve with the use of generic medicines. One, there is the direct patient benefit because often those medicines are less expensive. And second is that great societal benefit with the reduction in the cost of medicine to the PBS. So in the context of brand, I think there is a weigh up there that patients might, but I think ordinarily they’ll understand what we’re trying to do from an active ingredient point of view.

Elizabeth de Somer (22:08)
I’d like to add to that. As Shane says, generics have been around for a long time and the Australian population have quite a lot of trust built up with generics over many years. It wasn’t always that case, when they were quite new. It wasn’t always that case but it certainly is now. And brand loyalty even extends to generic brands. In some of our interactions with patients and some of the companies that I represent also have generic brands of medicines. They see that there is some loyalty to generic brands. I know that I go into chemist and I’m fairly comfortable to buy Chemists’ Own brand because Chemists’ Own brand is a brand that I trust.

Elizabeth de Somer (22:53)
So I think that there is also this, there’s a general understanding that medicines in the Australian market are of high quality, they’re safe and effective. There’s a strong trust relationship with pharmacists and prescribers, and with that over the last decade there’s a really strong trust in the generic market as well.

Gloria Antonio (23:15)
I agree, and I believe constant and ongoing reinforcement of the message and ensuring the conversation with patients are done at the level of the knowledge base of the patient must be the way to communicate it to make sure that this message is going across to the patients. And also from a point of view of positive change, it’s incumbent of us health care professionals to ensure that this is a positive change and reinforce it as opposed to having it as a risk.

Charlotte Middleton (23:51)
Fantastic. Can I ask what… We spoke about, I guess at the ground, what patient education will occur in terms of talking to the pharmacies and talking to the doctors, but is there going to be… Do we know if there’s going to be some high level education around this? Like government initiatives on TV out there for patients to be told that this is being implemented? Because I’m just imagining for the first time a patient hearing about this and then coming to me and me having to explain it all. Is there going to be some sort of higher level education around that for the consumers?

Elizabeth de Somer (24:30)
My understanding is that there is quite a comprehensive program of communication expected. But I think it’s a complex system and our general community has very little awareness of how the PBS operates, where generic medicines sit in that, how much they cost them, how much they cost the tax payer. And I think that so there is some education that I think that we could benefit from teaching Australians how the PBS works, and why it’s important for us to make efficiencies and create savings in the generic market because it does free up the head room for those new, innovative, breakthrough treatment source that will be made available. So I think that’s an important part of that communication message.

Dr Shane Jackson (25:16)
And Charlotte, I’d like to add something there if I can. I think we can all as practitioners do something little on the ground. There’s nothing better, and Jill hopefully you agree with me here. But when somebody comes in, whether they’re in your consulting room or whether they’re in my pharmacy, and they pull out their medicines list, right? You know that person’s really well organized, you might cross something out and you add something, you redo it. But I think we can actually take that now to the electronic world. So I’m not going to talk about any proprietary products here but there’s multiple third party apps that people can have, on the palm of their hand can have their medicines list. And so they can just buy it with the active ingredient and they can display the brand name. They can order their prescriptions however they might.

Dr Shane Jackson (26:08)
Whatever the driver might be, but I think it’s a way that we can say. You now, practices, do you have a medicines list now? Right? Because they’re really easy, in our electronic world, to put together. And they can be really, really beneficial going forward. And I think that that’s one thing that as GPs, as specialists, as pharmacists, as nurses or whoever it might be. Now that question, have you got a medicines list? Whether it’s a hard copy, whether it’s an electronic copy, can be a really powerful way to be able to increase health literacy and make a difference on the ground.

Dr Jill Gamberg (26:46)
What I find mostly happens in general practice still to this day, you’ve either got patients who have no idea what they’re on or has no idea what the names, or they might know, you know, I’m on a blood pressure medicine, that’s about the extent of it. Or you have the people that are more organized with the little list in their wallet. And we don’t have anything better than that. Surely in this day and age, in 2020, we can do better than that. From patient safety point of view, from… And as a GP, the responsible thing to do is try and chase up their previous practice or their previous pharmacy or the current pharmacy and try and get a correct list. But therein lies a big problem in itself and we need to do better to try and get the correct medicines in the first place before we reeducate in terms of generic versus, or active ingredient versus brand name. Which I think is really important as well, but I think we other issues.

Elizabeth de Somer (27:44)
And going back to Shane’s statistics of medication errors, commonly those medication errors change in transitions of care. So if you’re moving from a residential facility to hospital and back again, or from hospital into the community. And if we have electronic scripts and single sources of information then those transitions are going to be managed a lot better. And at the end of the day, we all want quality use of medicines.

Charlotte Middleton (28:17)
Fantastic, thanks for that. Obviously AIP is undoubtedly going to have an significant impact on the way medicines are marketed and sold. How is this going to impact the industry as a whole? Are there positives that are going to come out of this? And considering these changes are still in trial phase, what role should pharma companies take in advising or influencing these policies?

Elizabeth de Somer (28:44)
Well, I’d like to start with that one. Although I welcome others’ views on this. I actually don’t think I agree that it’s going to change the way in which medicines are marketed. At the moment, the way medicines are promoted is governed by the Therapeutic Goods Act and Medicines Australia monitors that through our code of conduct. So nothing is going to change there. Prescription medicines can not be promoted or advertised directly to consumers. So they can only be education or promotion to prescribers. And the conditions around how you promote medicines hasn’t changed because of active ingredient prescribing. Which it’s interesting.

Elizabeth de Somer (29:27)
What it will do, is it may generate more questions. And it may generate more questions from prescribers around understanding when they have information from their patients, if they are having allergies to certain brands, it might actually prompt different conversations understanding the differences between different brands of medicines. But I don’t think it’s necessarily going to change the way that they are managed from a marketing perspective because that’s quite tightly controlled by the Therapeutic Goods Act and the Medicines Australia code of conduct.

Charlotte Middleton (30:02)
Fantastic. Gloria, did you have anything to add there?

Gloria Antonio (30:06)
Again, I concur with Liz. Educating consumers, I’m always coming from a point of view of consumers, and educating these individuals on safety and efficacy of generic and biosimilar or active ingredient medicines. They are approved by the TGA, reinforces the fact that it doesn’t matter how it’s being marketed as long we know that they base conversation we have with the consumers is from the intent of having active ingredients conversation. And so if we actually focus on that then the brand marketing will probably go more into a secondary issue for the consumers. And I’d like to think that that would be the way that we would actually promote active ingredient.

Charlotte Middleton (31:04)
Fantastic. And Shane, I have to ask you, what does this initiative mean to pharmacies. What impact is it going to have on pharmacists and staff and customers?

Dr Shane Jackson (31:12)
I think there’s probably two or three key impacts. One, I think it’s going to make the use of generics more, I suppose seamless from a provisioning point of view. Instead of saying to an individual patient, there’s a generic available because of the active ingredient prescribing, which may well in most cases not specify a brand. Ensuring the patients hopefully stay on the same brand should those medicines be in stock. I think the provision of generics is going to be more seamless.

Dr Shane Jackson (31:58)
I think it’s going to help from a biosimilars point of view. Which, we know will contribute significant cost savings to the PBS over time. So I think that that’s going to be a real game changer, creating head room within the PBS, so that’s important. And probably, from a really patient facing perspective, it’s just going to open up the conversation around the actual medicine. What the medicine is that the person is taking instead of the brand, and I think that’s important.

Dr Shane Jackson (32:33)
And I think coming back to that, a point that I was making about before, a person having an electronic medicines list. I really think that that’s going to be a big game changer from an understanding and a health literacy point of view. And making sure that a person, almost in the palm of their hand, has got their current medicines list. And I think that this will be a catalyst for that, which I think is important.

Charlotte Middleton (32:58)
And talking about I guess the technology that’s going to support this initiative. I would say that needs to be part of patient education obviously. Suppose the doctors and patients of what technologies is available to support doctors and patients and pharmacies through this. So those patient facing apps or the electronic lists that they can have access to, we all need to learn a little bit more about what is available out there.

Elizabeth de Somer (33:32)
I think if COVID has taught us anything. It’s that we can actually… The sky is the limit. We can do anything. Where there’s a will, there’s a way. We’ve introduced rapid approval processes for research and clinical trials. We’ve introduced Telehealth and remote access to your prescriber and to your medicines. So I think that it’s actually shown us that we can set on a pathway of improvement very quickly, under this environment. So it’s forced us to think differently.

Elizabeth de Somer (34:05)
I think one of the benefits and one of the things that I would like to see is more reporting or capturing of adverse effects of medicines. Because it’s critical for adverse events to be captured for doctors and patients and manufacturers to understand if there is an adverse effect related to their medicine, whether it can be attributed to a side effect or whether it can be attributed to the combination of medicines that are being taken, or a worse thing of a disease. And at the moment, we’re still not very good at doing that. So I think one of the advantages of improving our electronic systems is that we may even have the benefit of capturing more reporting of the effects of medicines. Whether they are good effects or even adverse effects.

Charlotte Middleton (34:56)
Good. Great point, Liz. Jill, did you want to add anything to that?

Dr Jill Gamberg (35:00)
I guess one of the only other concerns I have is once we start to look at multi drug medications. I think we’re going to have a lot of problems in that space. Maybe initially again, but in terms of, how do you look up the drug on the software? How do you know which one to put first? This requires memory, right? You have to remember all three of the medications, or all two of the medications that are inside that. So that’s where it gets complex. When we’re talking about one medication, on active ingredient, in a…

Dr Jill Gamberg (35:34)
Sorry, so what I’m saying is one active ingredient versus remembering the brand name. That’s kind of one on one, easy. When we’re talking about two active ingredients or three active ingredients, or let’s face it, there’s even medications out there with more. That’s where we’re going to start having issues. When you have to get to know thousands and thousands and thousands of drugs, I worry that some GPs, patients, and going to get confused. So again, it’s a learning process. But I just think the more complex medications, where probably the reason why we remembered the brand names is because it was easier. And let’s face it. That’s the honest truth.

Dr Jill Gamberg (36:11)
So I do hope there’s some systems in place to try to avoid those type of errors. I also think that going forward education is really key, and it’s really easy to miss a lot of GPs because again, we’re sort of lone wolves in a way, in our own little space. And just making sure, you might send us a great email, but who’s going to read it? So you just need to find ways, I think, to make sure the GPs really know the changes are coming. And I think most people will be on board, ultimately, as well as they’re well educated, given enough notice, have room for feedback, and maybe just some transitional things to help us. Like including all of the active ingredients plus the brand names, or plus several brand names on all of the prescriptions or on the prescriber software, just to help us make that transition. I think those type of things. Although easy might be quite beneficial to making the change moving forward.

Elizabeth de Somer (37:08)
And I think it’s a really good point, Jill. Because it does show that brand names do have a place. And my understanding with the software providers is that you might still type in the brand name as a prescriber because it’s familiar, but what will pop up on script is the active ingredient name. And I think that that’s where you can still have that important role of something that’s easy to remember is the right medication for your patient but you know that when you prescribe it, that the active ingredient will pop up and that’s what will go on the script. So the software providers have got quite a big job I think.

Charlotte Middleton (37:46)
You’re absolutely right, Liz. Yeah, that’s exactly what will happen. Look guys, I think that’s all that we’ve got time for, for today. I really appreciate your time and your voice in the room. Was there any other extra points that you wanted to make before we finish?

Elizabeth de Somer (38:17)
Thanks everyone. Nice to see you all.