Opioids, prescriptions and approvals in the Pharmaceutical Benefits Scheme (PBS) 012-20101406

Scenarios

Table 1

Item	Description
1	A Service Officer receives a request from a prescriber wanting a quantity that would require a pack to be broken. The Service Officer can provide approval if the quantity and any repeats does not exceed a maximum of one month's supply via phone, or 3 months’ supply (in OPA or in writing, either by post or HPOS form upload only).
2	A prescriber contacts to ask what opioid-naive is. The Service Officer explains opioid naive refers to a patient's previous use of opioids. For the purposes of a PBS approval, a patient is opioid naive if they have not consistently used opioids.
3	A patient is prescribed methadone to treat long-term pain. Only the length of treatment for pain management is considered. When the patient's opioid treatment is more than 12 months the prescriber must provide the length of time for the opioid treatment. The prescriber must also make sure another medical practitioner consults with the patient about the continuing need for opioid treatment. Note: Methadone is not always prescribed to treat pain. It is sometimes prescribed for opioid dependence. However, this does not affect treatment length for pain management approvals.
4	A patient has a new prescriber, who will be their regular doctor in the future. Their doctor can be the reviewing prescriber. However, after 12 months a different prescriber will need to do a new opioid (narcotic) review.
5	A prescriber is requesting an authority for up to 3 months’ supply on the phone. Phone approvals for opioids are restricted to a one month supply only. Prescribers can apply for up to 3 months’ supply via the prescriber self-serve (OPA) or in writing either by post or HPOS form upload. Some requests may reject on OPA due to quantity and/or repeat (multiplier) limitations If a prescriber asks about an OPA rejection and the request meets all other restriction requirements, approve the request by overriding the rejection in OPA. Select reason ‘Quantity and/or repeats greater than maximum allowed is required’ from the Assessment Result Override popup
6	A prescriber has contacted the PBS Authority line asking about an opioid authority rejection in OPA due to multipliers (rejection reason codes 075 and 076). Advise the prescriber the system assesses within regular dosage requirements and may reject due to quantity and/or repeats (multiplier) limitations. If the request meets all other requirements, approve the request by overriding the rejection. Select reason ‘Quantity and/or repeats greater than maximum allowed is required’ from the Assessment Result Override popup.

Scenarios - duration of treatment

Table 2

Item

Description

A patient has never had an authority prescription for opioid treatment. Is their treatment duration defined as less than 12 months?

No, the agency needs to consider the total length of opioid treatment.

This may include non-PBS treatment, PBS treatment with listed amounts and PBS treatment supplied under an authority for increased quantities and repeats. Medicines such as tramadol and paracetamol plus codeine combinations are considered opioid treatment and must be reviewed by the prescriber.