Issue 1. Medications with a palliative care listing or requiring authority script

• A palliative care listing allows larger quantities of medications used in symptom management to be prescribed. The intention is to reduce patient burden in terms of costs and need for repeat prescriptions.
• All palliative care listings are 'authority required' and an initial authority can be requested for a 4 month supply for palliative care patients. Subsequent prescriptions will require confirmation that a palliative care service has been consulted.
• To support this PBS initiative, use the authority system and not the general benefits system if a drug is available in both lists.
• For palliative care patients on long-term opioids, using authority scripts is extremely helpful as standard scripts provide only small quantities.

Issue 2. The discharge plan requires medications not accessible to a GP via the PBS

• Sometimes hospital based prescribers are unfamiliar with relevant PBS listings and alternatives may be readily available. But at other times the prescribed discharge medications may be essential for ongoing care of the patient and PBS alternatives are not suitable. A discussion with the prescriber is essential to clarify this.
• If non-PBS listed medications are required, a plan for how the patient can access them will be needed as well.
• Sometimes a hospital pharmacy or palliative care service will take responsibility for ongoing supply and review of such medications. As they are frequently expensive, budgetary implications may be a consideration and a plan to review the ongoing need for them will also be important.

Issue 3. 'Off-label' medications are prescribed by the palliative care service

• These are medications prescribed for a different indication or route than the one for which they are licensed under the PBS, for example:
  • Antipsychotics or antihistamines for nausea
  • Antidepressants or anticonvulsants for neuropathic pain
  • Administration of IV preparations by the subcutaneous route.
• Often evidence for the off-label use of these medications is actually available, but has not been used by the drug company to obtain a listing for their medication.

TIP - In general, injectable medications that do not require dilution or a separate diluent can safely be given subcutaneously, with the exception of prochlorperazine and diazepam.

• Generally there is considerable experience with the main off-label uses of medications in palliative care. The Therapeutic Guidelines - Palliative Care provides guidance for most of the common situations. Your local palliative care team can advise you on their own approach.

More detailed information …

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This page was created on 26 May 2009 and is due for review in May 2011.