Reclassification of oral COVID-19 therapeutics for community pharmacist prescribing Q&A

RE: COVID-19 Care in the Community, Reclassification of oral COVID-19 therapeutics for community pharmacist prescribing Q&A This model is based on one from Canada, but the NZ eligibility criteria is far stricter – is there the same need?

While not the same population and eligibility criteria, we are confident there will be sufficient benefit in terms of improving accessibility. In addition, PHARMAC has announced (14 June 2022) expanded eligibility criteria, so this type of dispensing will potentially benefit even more people and relieve pressure on existing prescribers as demand for oral therapeutics increases.

Will this change negatively impact equity of access?

We do not believe it will, but we will monitor closely. Community pharmacies have been widely used for vaccination and have been well utilised by our priority populations. We see no reason why the same access benefits cannot be achieved for COVID anti-viral medicines. Furthermore, eligibility criteria as determined by PHARMAC are our principal strategy for achieving equitable access to therapeutics, and data shows that present our aims are being met. The new revised eligibility that have been released give us confident that equity will continue to be at the centre of PHARMACS thinking on eligibility.

How will communication between GP/pharmacy work?

The System will require documentation of provided medicine into COVID Clinical Care Module (CCCM) and from that system, a message will be generated to the usual general practice. The additional advantage to this is that the supply will be visible to other providers after hours, such as Whakarongorau.

How will the adjustment of other medications be managed if on multiple medications?

Whenever adjustments in other medications are required to safely provide COVID anti-viral medicine, the pharmacist must liaise with original prescriber.

Will pharmacies have access to lab data?

Yes, the dispensing pharmacist will be required to review renal function to ensure safe prescribing. In addition to laboratory results the majority of pharmacies also have access to other aspects of a persons medical record such as disease classifications, discharge summaries and regular medications. Where insufficient information is available to the pharmacist training will instruct them to direct the person to an authorized prescriber who has access to that information.

Will there be additional time pressures placed on GPs with queries from pharmacies re medications, lab data and relevant patient information?

CitC Reclassification of oral COVID-19 therapeutics for community pharmacist prescribing

It is recognised there will a group of people that present to pharmacy where a conversation with the person’s usual general practice team is required. This ‘consultation’ will be funded by Care in the Community.

That being said, there will be a group of people for whom no contact will be required and that will reduce pressure on general practice providers which is a key driver for this work.

Will there be access to hospital specialist teams?

It will be the responsibility of dispensing pharmacists to assess the person and identify any other health professionals that needs to be involved to ensure safe use of the medications.

What connection has been made with CARM to ensure that adverse events are monitored?

We have engaged with Medsafe, who manage the contract with CARM. Safety monitoring for oral therapeutics is provided through CARMs existing systems. CARM provide Medsafe with regular reports of reported adverse reactions and these are investigated. Learnings are forward to the implementation group and inform clinical guidance. At this stage there are no new safety concerns based on reports to date.

Will the change result in an increase in the use of Molnupiravir which has fewer drug interactions and is easier to dispense but is less effective?

Pharmac recommended that unless contraindicated Paxlovid is used as the first-line treatment for COVID-19. We acknowledge there is a risk of an increase in the use of Molnupiravir but we have been monitoring this since Molnupiravir was made available. Training will emphasise the importance of using Paxlovid where safe to do so.

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