Registered nurses could gain PBS prescribing rights for more medicines, but the committee has drawn the line at complex conditions and high-risk treatments.
The Pharmaceutical Benefits Advisory Committee has backed another expansion of nurse prescribing, recommending that designated registered nurses be allowed to prescribe a wider range of PBS-subsidised medicines.
The recommendation, published in the September 2026 PBAC outcomes, covers selected medicines used to treat respiratory conditions, infections, musculoskeletal disorders, hormonal conditions, sensory disorders, and cancers, among others.
However, the committee has recommended restricting some medicines to continuing therapy and excluding others because of concerns about complex diagnoses, treatment management, and serious adverse effects.
The decision represents the third tranche of medicines considered for designated registered nurse prescribing as the federal government progressively introduces the new prescribing model.
The PBAC recommended adding designated registered nurses as authorised PBS prescribers for selected medicines across seven Anatomical Therapeutic Chemical classification groups, where nurse practitioners are already eligible to prescribe.
The committee said medicines were generally considered unsuitable where diagnosis or ongoing management was complex, or where treatment carried a high risk of severe side effects.
The published outcomes did not identify individual medicines approved or excluded in this tranche, leaving uncertainty about the precise scope of the expanded prescribing arrangements.
The recommendation comes as the federal government rolls out changes allowing appropriately qualified registered nurses to prescribe Schedule 2, 3, 4, and 8 medicines under formal agreements with authorised health practitioners.
The new arrangements, which began progressive implementation in October 2026, require nurses to hold an endorsement from the Nursing and Midwifery Board of Australia and prescribe within an agreed scope of practice.
To qualify for endorsement, nurses must have at least 5000 hours of clinical experience within the previous six years and complete an approved postgraduate prescribing qualification or equivalent approved study.
They must also have a prescribing agreement with an authorised health practitioner, such as a medical practitioner or nurse practitioner, and complete or be undertaking six months of clinical mentorship.
The agreements must specify the clinical context, medicines, and conditions covered by the nurse’s prescribing practice.
The Department of Health, Disability and Ageing has said the reform was intended to improve access to timely and affordable healthcare, particularly in areas where access to medical practitioners was limited.
Legislative changes have established authorised nurse prescribers as a new category of PBS prescriber, with Services Australia opening applications for prescriber numbers on 1 October.
However, nurses can only prescribe PBS medicines once the relevant listings have been updated to include their prescriber category.
Services Australia also stipulates that designated nurse prescribers can only prescribe medicines that the authorised PBS prescriber named in their agreement is permitted to prescribe.
The changes have previously attracted criticism from the RACGP, which has raised concerns about patient safety, fragmented care, and the prescribing of Schedule 8 medicines.
The September PBAC outcomes also included a separate recommendation to expand prescribing rights for nurse practitioners and non-specialist medical practitioners treating hereditary tyrosinaemia type 1, a rare metabolic disorder.
Under that proposal, nurse practitioners and non-specialist doctors with relevant expertise could prescribe continuing treatment with nitisinone, provided patients remained under shared care with a specialist physician experienced in managing the condition.
The committee acknowledged the important role specialised nurse practitioners play in multidisciplinary metabolic clinics, including monitoring patients, maintaining continuity of care, and ensuring timely access to treatment.
“The PBAC noted the potential benefits of nurse practitioner continuing treatment prescribing, including supporting prescriber capacity for monitoring, clinic schedules, system logistics and patient care,” it said.
The committee considered that expanding continuing-treatment prescribing would improve clinical workflows without materially increasing PBS expenditure.
“The PBAC further advised that prescribing of nitisinone should be restricted to nurse practitioners and non-specialist medical practitioners with expertise in the management of HT-1 and that patient care must be shared with a physician with expertise in the management of HT-1,” the committee said.
“The PBAC considered that this approach was consistent with its past advice supporting nurse practitioner prescribing of other HSD medicines.”
The broader designated nurse prescribing changes remain subject to implementation requirements, including state and territory legislation, local clinical governance arrangements, and updates to PBS systems.
The Department of Health says implementation will occur progressively as jurisdictions and health services become ready to support the new prescribing arrangements.
