National Professional Services Manager
- This information is for final-year optometry students who are about to commence practice and outlines what you need to know about prescribing scheduled medicines, understanding the Pharmaceutical Benefits Scheme (PBS) and how to get a PBS prescriber number and pad.
- All optometry students who graduate in Australia from 2012 are authorised to prescribe scheduled medicines. Forty per cent of the optometry profession can prescribe scheduled medicines and this number will increase in future.
- The list of scheduled medicines optometrists are authorised to prescribe is found in the Optometry Board of Australia (OBA) scheduled medicines registration standard.
- Some but not all of the medicines optometrists are authorised to prescribe provide eligible patients a subsidy through the PBS.
- Guides and information on writing PBS prescriptions and how to order PBS prescription stationery is found below.
Which drugs can I prescribe?
Authorised optometrists can prescribe Schedule 2, 3 or 4 medicines from a list maintained by the Optometry Board of Australia. The list includes anti-infective, anti-inflammatory, anti-glaucoma and other drugs used in the detection and treatment of eye conditions. The OBA-approved list is known as the ‘common list’ and can be found in the OBA registration standard (Table 1). An optometrist who is authorised can obtain, possess, administer and prescribe any drug from this list for topical use.
Nearly all of the drugs on this list are available in Australia; however, there are some drugs, like cyclosporine, that are not yet available in Australia and in general need special approval to prescribe through the Therapeutics Goods Administration (TGA), which is responsible for importation of drugs. You might want to keep an eye on the OBA-approved list from time to time as it will change when new drugs are developed and become available for use by optometrists. If you are member of Optometry Australia we will tell you if this happens.
Pharmaceutical Benefits Scheme (PBS)
Under the PBS the government subsidises the cost of medicine for many medical conditions and the benefits are available to all Australian residents who hold a Medicare card. The PBS schedule lists all the medicines that are available to patients at the government subsidised price and is available online and undated monthly. It even has a specific section on the drugs that optometrists can prescribe that are eligible for subsidy.
The PBS works under a co-payment scheme that means for PBS-listed drugs patients pay no more than $38.30 for each PBS script, or no more than $6.20 if they have a concession card, Commonwealth Senior’s Card, Health Care Card or Veteran’s Card. The government subsidises the cost of the drug above these co-payment amounts. This means when you prescribe a drug and it costs $15.00 at the pharmacy, a non-concessional patient will pay $15.00 but if you prescribe a drug that costs $38.30 or more, the non-concessional patient will pay only $38.30.
Which drugs are eligible for PBS subsidy
The list of drugs that optometrists prescribe with eligibility for PBS subsidy can be found on the PBS website. If a drug that an optometrist is authorised to prescribe (as per the OBA-approved list) is not listed for PBS subsidy, you can still prescribe it and this is known as a private (or non-PBS) prescription. Some PBS-listed drugs have special criteria that must be met in order for you to write a PBS prescription. In general, all PBS drugs fall into three groups:
There is no restriction on these drugs and you can just write the prescription for eligible patients. Most of the drugs that optometrists prescribe are unrestricted.
These drugs are eligible for PBS subsidy only when a specific condition is present or special criteria apply. As an example, prednisolone is eligible for PBS subsidy only when the clinical condition being treated is uveitis. Restricted drugs that optometrists are authorised to prescribe can be written as a private (non-PBS) prescription when the restriction is not met.
- Authority required benefit
These drugs require prior approval from the Department of Human Services before being prescribed. An example here is Systane unit dose eye-drops, which can be prescribed only under the PBS for severe dry eye syndrome in patients who are sensitive to preservatives in multi-dose eye-drops. It is an offence to prescribe these under the PBS without seeking prior approval. You can call the department on 1800 888 333 for an approval code to enter on your prescription.
How do I become a PBS prescriber
- Get a PBS prescriber number
Optometrists authorised to prescribe scheduled medicines need to apply to Medicare for approval as a PBS prescriber. You will need to download the application form and submit to Medicare. You must include information that you are authorised to prescribe by the OBA before you submit this application. It is best to wait until you receive written confirmation form the OBA that you are registered and your name is on the practitioner register. When you submit your PBS application, you will be given a PBS prescriber number by Medicare. Don’t lose this number as you will keep it forever and it will be on all the prescriptions you write.
- Prescription stationery
Hard copy PBS prescription pads and computerised prescription forms are available free of charge from Medicare. You can download the prescription stationery forms PB028 and PB029 and it is important to include your practice address, qualifications and so on as this will be printed on the pads or computerised forms. You can do this only once you have been approved as a PBS prescriber and have a PBS number. Prescriptions stationery is location specific so if you work at two practices, you will need to order prescription stationery for each location.
Medicare has produced useful guides that are relevant for graduate optometrists new to prescribing. If you any specific question you can always contact Optometry Australia as we would love to help you.