• In addition to the PBS requirements, the SA DDU have confirmed that ODT prescriptions will still need to meet all existing requirements.
  • This includes a prescription start date and end date.
  • The end date is the date beyond which no further doses can be supplied and overrides all other considerations including PBS quantities.
• All ODT Program rules are unchanged and remain in place.

• Under the new arrangements every time an ODT medicine is dispensed as a PBS script, the quantity dispensed will not be the actual quantity supplied to the patient at time of dispensing. This is different to other PBS medications.
• The dispensed quantity is instead an ‘allocated’ quantity of medicine for that individual client.
  • This is the theoretical maximum they can be supplied (ideally within the next 28 days) or until the end date specified on the script by the prescriber.
  • Although dispensed and claimed as a PBS script, the allocated stock will remain part of the pharmacy’s stock balance.
  • Pharmacists will NOT need to separate the physical stock for each individual client (i.e. they can continue to use one shared bottle of methadone for all clients).
• Each client will therefore have a “virtual stock balance” which pharmacists will need to keep track of for each ODT client.
  • This running balance is the total amount dispensed/allocated to that client minus whatever has already been provided to date. ‘i.e. the remaining balance allocated on that prescription’.
  • The new dosing records attached will assist pharmacists to keep track of this.
• The Commonwealth have confirmed that in cases where a client no longer requires stock that has been allocated to them, this amount will need to be ‘zeroed’ on the client’s ‘virtual’ running balance, returned to pharmacy stock and can be reused by the pharmacy.
  • The pharmacy will NOT have to destroy the stock, and NOT have to adjust the PBS claim/return payment to the PBS.
  • The pharmacy should obviously NOT return this stock to the client either.
  • Examples of this may be where the script has reached the end date specified by the prescriber, the client transfers to another pharmacy, ceases treatment etc.
  • If a client leaves your pharmacy, ceases treatment etc. the prescription and any repeats must be cancelled. Remaining prescriptions or repeats CANNOT be transferred to another pharmacy, and the client’s remaining allocated stock balance CANNOT be transferred to another pharmacy either.

• As the PBS quantity dispensed will not be the actual quantity supplied to the patient at time of dispensing, pharmacists must NOT record the maximum quantity of the PBS prescription as one entry in their Controlled Drugs Register at the time of dispensing.
• The SA DDU have confirmed that:
  • Pharmacists should instead record the amount supplied to each patient on each day in the Controlled Drugs register.
  • The physical stock balance in the safe needs to match the balance in the Controlled Drugs Register at all times and is subject to audit by the DDU at any time.

• If a client misses doses, they can continue to be dosed beyond 28 days from their allocated stock on the same prescription, provided that the end date specified on the prescription by the prescriber has not passed.
• If a client still has allocated stock remaining from their previous script when a new prescription is received (for example as a result of missed doses) the pharmacist has two options.
  • As a first option the pharmacist can delay dispensing the new script and continue using the allocated stock from the previous script, provided that the script is still current and has not passed the end date specified on the prescription by the prescriber.
  • The second option is to cancel the previous prescription and all remaining repeats, zero any allocation that is excess and return it to pharmacy stock as outlined above. Then dispense the new script and start a new allocation.
• Regardless, once the specified end date on the prescription has passed, any remaining allocated stock must be returned to pharmacy stock and the remaining balance for that script zeroed.

The below updated documents include extra columns to allow pharmacists to track the balance of PBS dispensed ODT stock allocated to each individual client. Please feel free to amend these templates if needed.

Methadone Client Attendance Record

Subutex Client  Attendance Record

Suboxone  Client Attendance Record