High prices and falling risk mean GPs are expected to soon rely on pharmacies, not their bags, for emergency covid treatment.
Covid antivirals molnupiravir and nirmatrelvir–ritonavir are set to be removed from Australia’s Prescriber Bags, the Pharmaceutical Benefits Advisory Committee (PBAC) has recommended, citing an “evolved clinical landscape” since their inclusion in late 2022.
RACGP Expert Committee member Dr Michael Tam told Dermatology Republic he was not surprised by the recommendation, especially given the cost of the medications (around $2200 for each course).
“AS a GP and clinician, it’s always good to have extra access to provide medicines at the same time,” he said.
“But I think, from the perspective of someone who’s a custodian of the health system, if you think of it that way, I’m not surprised they were removed.
“Definitely there was a period of time early in the covid pandemic, when the antivirals first became available, when I think it was quite critical for GPs to have access to the antivirals, particularly when they saw a person who was at high risk.
“The risk profile was very different at that time. Many people were infection naive and/or had not been fully immunised, and we knew it made a big difference.
“Now, I think the risk profile is very different. The medicines are very expensive. If you look at the total budget and total annual budget for the doctor’s bag, the vast majority of it is actually just in the cost of these two medicines, the antivirals.”
Dr Tam said there was also the issue of medication wastage attached to the supplies in the doctor’s bag.
“They’re in the bag, but they don’t have indefinite shelf lives, and in fact these medicines don’t have long shelf lives,” he told DR.
“And when they’re expired, of course, you can’t use them on a patient. You have to dispose of them.”
He said he believed the time had come when it was appropriate for covid antivirals to be supplied through community pharmacies rather than the doctor’s bag.
According to latest figures from the Department of Health, Disability and Ageing (accessed 6 November), 11,970 PBS prescriptions were issued for covid antivirals in Australia in October this year.
There have been 170,143 cases of confirmed covid reported to the National Notifiable Disease Surveillance System across the country this year. This compares with 341,840 cases for 2024.
According to the PBAC meeting outcomes document for September, the recommendation was not the only one in a current review of PBS Prescriber Bag medicines.
“The PBAC recommended that all currently listed Prescriber Bag benefits remain suitable, except molnupiravir 200mg tablet and nirmatrelvir 150mg tablet & ritonavir 100mg tablet [COVID-19 antiviral medicines], and furosemide tablets.
“The PBAC recommended that COVID-19 anti-viral medicines be removed, acknowledging that stakeholders may hold disparate views but that the clinical landscape had evolved from the time of Prescriber Bag listing.”
The committee considered the potential for wastage of furosemide tablets due to the pack size (50) but noted support from stakeholders to retain this item in the PBS Prescriber Bag.
It deferred making its recommendation on furosemide and requested the DoHAD investigate with sponsors the availability of a smaller pack size which may decrease wastage.
The review also recommended adding ceftriaxone 2g injection for emergency sepsis treatment and extending prescribing rights of benzathine benzylpenicillin and adrenaline to endorsed midwives, supporting maternal, neonatal and immunisation care.
“In considering a request from the Australian College of Midwives [ACM], the PBAC recommended that the PBS listings of benzathine benzylpenicillin [Prescriber Bag and the General Schedule] and adrenaline injections [Prescriber Bag] be amended to allow prescribing by endorsed midwives,” it said in the meeting outcomes notes.
“The PBAC considered that extending prescribing of benzathine benzylpenicillin to endorsed midwives would harmonise best practice standards, facilitate earlier intervention, improve maternal and neonatal outcomes by reducing congenital syphilis cases, and support the national syphilis response.
“The PBAC considered that extending prescribing of adrenaline to midwives would support their practice as immunisation providers and as first responders in emergency care.”
Dr Tam said the RACGP and the AMA had both made recommendations for additions to the doctor’s bag, and he hoped these would be successful.
“The range of medicines which are funded through a doctor’s bag is quite small, and there are some medicines I think, particularly some of the anti-nausea type medicines potentially for children, so ondansetron for instance, where it will be really useful for that to be available,” he told DR.
“There are some other older medicines which are potentially available, but there are some medicines which you might want to use a little more cautiously, especially in children.
“There are also some newer medicines which would be very useful to be in a doctor’s bag.”
