Prescribing practices for PBS medicines
The Pharmaceutical Benefits Scheme (PBS) controls the prescribing of, and payment of Government subsidies for, particular medicines.
If multiple brands of the same medicine are listed on the PBS as being bioequivalent, a pharmacist can dispense a generic medicine when a patient presents a prescription on which the prescriber has (a) written the active ingredient only (eg "rosuvastatin"), or (B) has written the brand name (eg for rosuvastatin, "Crestor") but has not ticked the “brand substitution not permitted" box and the patient agrees to take the generic medicine. Currently in Australia, general practitioners more commonly prescribe by brand name.
Regulatory changes taking effect on 31 October 2019 will make active ingredient prescribing the default for electronic PBS prescriptions, and as a result require changes to clinical prescribing software.
A key purpose of the regulations is to increase the uptake of generic and biosimilar medicines, and improve the long-term financial sustainability of the PBS. The regulations may have this effect by:
(a) increasing the number of prescriptions that allow for generic substitution, and
(b) encouraging prescribers, pharmacists, and patients to refer to medicines by their active ingredient, which should mean that patients are more likely to agree to supply of a generic in place of an equivalent branded medicine.
Impact on future IP litigation
When the owner of a pharmaceutical patent enforces that patent against a supplier of a generic medicine there is often a dispute about:
(a) the extent to which prescribers do or will allow for generic "substitution" of the branded medicine, and
(b) the extent to which pharmacists do or will actively promote dispensing generic medicines in place of branded medicines.
Evidence about such matters is typically raised by both patent holders and generic medicine suppliers in interlocutory injunction applications, substantive infringement claims, damages claims for infringement, and claims for compensation pursuant to a cross-undertaking as to damages.
When involved in such litigation it will now be important to assess whether the new requirement for including active ingredients on electronic PBS prescriptions has had the intended effect of increasing the proportion of generic medicines dispensed. This will involve discussions with doctors and pharmacists about how widespread the use of electronic prescriptions becomes.
Further, the regulations only allow for electronic prescriptions by brand name where 'clinically necessary'. In previous cases involving patents for second medical uses, generic manufacturers have sought to avoid injunctions by undertaking to notify prescribers to specify the brand name and tick the "brand substitution not permitted" box on prescriptions for the patented indication. However, the new requirements for electronic prescribing software may mean that it is not possible for prescribers to take the actions proposed in notices under such undertakings.
What are the new requirements for electronic prescribing?
In more detail, under the National Health (Pharmaceutical Benefits) Amendment (Active Ingredient Prescribing) Regulations 2019 (Cth):
- All electronic PBS prescriptions must include the name of the active ingredient.
- The regulations do not apply to handwritten prescriptions, paper-based medication charts in the residential aged-care setting, and prescriptions for medicines with four or more active ingredients, and items determined by the Secretary to be excluded for practicality and safety reasons.
- Prescribers can still prescribe by brand where clinically necessary, including where the medication prescribed may pose a potential patient safety risk if the brand is not specified, or to promote patient compliance where a patient is familiar with a particular brand.
- Where the prescriber nevertheless makes a clinical decision to specify a brand name on the electronic prescription, the name of the active ingredient must appear first.
- Prescribing software must not default to include brand names on prescriptions. In this way the regulations compel doctors to make a clinical decision regarding inclusion of a brand name.
- Following the 31 October 2019 commencement date, there is a 12 month transition period to ensure that prescribers have sufficient time to update their prescribing software to comply with the new requirements.