Proposals in relation to Nurse Prescribers

Consultation Closed

PHARMAC is seeking feedback on a proposal to amend the Pharmaceutical Schedule rules from 1 October 2016 to:

  • support the new prescribing rights that have been granted to Registered Nurses; and
  • support prescribing by Nurse Practitioners of subsidised pharmaceuticals with ‘Retail Pharmacy - Specialist’ restrictions.

Feedback sought

PHARMAC welcomes feedback on this proposal. To provide feedback, please submit it in writing by Friday, 5 August 2016 to:

Belinda Ray-Johnson
Schedule Development Manager
PHARMAC
PO Box 10254
Wellington 6143

Email: consultation@pharmac.govt.nz
Fax:     04 460 4995

All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal.

Feedback we receive is subject to the Official Information Act 1982 (OIA) and we will consider any request to have information withheld in accordance with our obligations under the OIA. Anyone providing feedback, whether on their own account or on behalf of an organisation, and whether in a personal or professional capacity, should be aware that the content of their feedback and their identity may need to be disclosed in response to an OIA request.

We are not able to treat any part of your feedback as confidential unless you specifically request that we do, and then only to the extent permissible under the OIA and other relevant laws and requirements. If you would like us to withhold any commercially sensitive, confidential proprietary, or personal information included in your submission, please clearly state this in your submission and identify the relevant sections of your submission that you would like it withheld. PHARMAC will give due consideration to any such request.

Details of the proposals

PHARMAC is proposing to amend the rules of the Pharmaceutical Schedule to give effect to the recently-established Registered Nurse Prescriber category of designated prescribers. We are also proposing to make a change relating to the ‘Retail Pharmacy - Specialist’ restriction to support prescribing of these products by Nurse Practitioners.

We are proposing to implement this change by:

  • Deleting references to ‘Diabetes Nurse Prescriber’ from Section A: General Rules of the Pharmaceutical Schedule.
  • Adding a new definition of Registered Nurse Prescriber to Section A: General Rules of the Pharmaceutical Schedule as follows:

    “Registered Nurse Prescriber”, means a registered nurse who meets specified requirements for qualifications, training and competence to be a designated prescriber for the purpose of prescribing specified prescription medicines under the Medicines (Designated Prescriber-Registered Nurses) Regulations 2016”

  • Adding Registered Nurse Prescribers’ Prescription provisions relating to Period and Quantity of Supply to the Pharmaceutical Schedule. These provisions will be aligned to the current provisions for Pharmacist Prescribers’ Prescriptions. Implementing the change in this way means that Registered Nurse Prescribers are treated consistently with other designated prescriber groups in the Pharmaceutical Schedule.  This also means that Registered Nurse Prescribers will not be able to apply for Special Authority approvals.
  • Amending the definition of ‘Nurse Prescriber’ to include both Nurse Practitioners and Registered Nurse Prescribers in Section A: General Rules of the Pharmaceutical Schedule as follows:

    “Nurse Prescriber”, means a person who is a Nurse Practitioner in terms of the Medicines Act 1981, or a Registered Nurse Prescriber”

  • Amending the definition of Specialist in Section A: General Rules of the Pharmaceutical Schedule as follows:

    “Specialist”, in relation to a Prescription, means a doctor Practitioner who holds a current annual practising certificate and who satisfies the criteria set out in paragraphs a. or b. or c. or d. below:

    1. the doctor is vocationally registered in accordance with the criteria set out by the Medical Council of New Zealand and the HPCA Act 2003 and who has written the Prescription in the course of practising in that area of medicine; or
    2. the doctor is recognised by the Ministry of Health as a specialist for the purposes of this Schedule and receives remuneration from a DHB at a level which that DHB considers appropriate for specialists and who has written that prescription in the course of practising in that area of competency; or
    3. the doctor is recognised by the Ministry of Health as a specialist in relation to a particular area of medicine for the purpose of writing Prescriptions and who has written the Prescription in the course of practising in that area of competency; or
    4. the doctor Practitioner writes the prescription on DHB stationery and is appropriately authorised by the relevant DHB to do so.

All of these changes would be effective from 1 October 2016.

Background

Registered nurses are health practitioners regulated under the Health Practitioners Competency Assurance Act 2003 by the Nursing Council of New Zealand.

In 2011, PHARMAC provided registered nurses practising in Diabetes Health with the ability to generate subsidies for subsidised pharmaceuticals classified as a prescription medicine or a restricted medicine and which a diabetes nurse prescriber is permitted under regulations to prescribe; or other subsidised pharmaceuticals from a specified list in the Pharmaceutical Schedule.

Registered nurse prescribers have recently been classified as designated prescribers under the Medicines (Designated Prescriber-Registered Nurses) Regulations 2016 which shall be effective from 20 September 2016 and the Medicines (Designated Prescriber-Registered Nurses Practising in Diabetes Health) Regulations 2011 are to be revoked on 30 November 2016.

This means that there will be registered nurses with prescribing rights working within pre-specified scopes in primary health and specialty teams with authorised prescribers.

As prescribing rights under the Medicines Act 1981 and subsidy rights under the Pharmaceutical Schedule are not automatically aligned, it is necessary to change the Pharmaceutical Schedule rules to give full practical effect to the legislative changes. The proposed changes will mean registered nurse prescribers are treated consistently with other designated prescriber groups in the Pharmaceutical Schedule.

PHARMAC has received feedback that patients under the care of nurse practitioners have faced barriers to accessing some subsidised pharmaceuticals in the community. This feedback has identified the issue as being the definition of “Specialist” in the General Rules of the Pharmaceutical Schedule. This definition prevents the subsidy of prescriptions prescribed by nurse practitioners of pharmaceuticals with a “Retail Pharmacy Specialist” restriction, if a recommending Specialist is not endorsed on the prescription.

The definition of ‘Specialist’ and the accompanying restriction pre-dates the emergence of nurse practitioner roles in DHB hospitals working within specialty scopes such as oncology, respiratory and emergency medicine.

The proposed changes will mean nurse practitioners are treated consistently with other authorised prescriber roles within DHB hospital specialty teams.

Note that these changes will only apply to medicines prescribed by nurse practitioners when written on DHB stationary and that Special Authority applications by nurse practitioners will continue to be limited to medicines where they meet the “relevant practitioner” applicant criteria.

Special Authority applications by other authorised prescribers who are not doctors will continue to be limited to those circumstances already allowed, such as dietitians’ applications for special foods.