Seekwell, a provider of specialised pharmaceutical services in Australia, has launched a new platform that will revolutionise the way medical specialists apply for approval to prescribe a written authority-required drug on the Pharmaceutical Benefits Scheme (PBS).
Seekwell has worked alongside the PBS Authorities team at Services Australia to implement Australia’s first PBS-API based integration via Services Australia’s Provider Digital Access (PRODA) platform.
SAM is great because it will enhance efficiencies… I hope this means more ophthalmologists will feel able to offer injection therapy at no charge
The platform is called SAM (Script Approval Management) and it consists of desktop and mobile device applications. SAM is initially being rolled out for continuing authority script approvals in ophthalmology clinics, where drugs like anti-VEGF injections are required to treat patients with neovascular age-related macular degeneration (nAMD) and diabetic retinopathy (DR) often and over the longterm. Other medical service providers and therapeutic areas are expected to gain access to SAM in the near future.
Retinal specialist Professor Paul Mitchell AO, whose clinic at Westmead in Western Sydney is Australia’s biggest ophthalmic clinic to bulk bill all patients needing anti-VEGF injections, said SAM will save a significant amount of time for clinicians and their practice staff. Additionally, it will help reduce mistakes associated with manual handling of prescriptions. Professor Mitchell, alongside Dr Nagi Assaad, Dr John Downie, Dr Suriya Foran and Dr Randev Mendis, and their clinic staff, were instrumental in testing the SAM App.
Traditionally when a patient is diagnosed with nAMD and treatment is to commence, a consent form and prescription for anti-VEGF were written and submitted, along with optical coherence tomography (OCT) or fluorescein angiogram, via post or in more recent years by fax, for approval by Services Australia. Services Australia administrative staff would enter details of the prescription into the Federal Government’s system before providing an approval number for authority prescription. The process could take between three to seven days, depending on the mode of communication.
Delays were further compounded if the information provided in the submission did not match Services Australia data entry requirements or if there was an error in the information entered.
Continuing prescriptions were applied for in the same way, or over the phone, as were applications to switch treatment medications should the clinician deem it necessary to do so.
While approval for initial and switch approvals still require the submission of relevant documents through the Government’s Health Professional Online Services (HPOS) portal, continuing script approvals are now managed quickly and easily via a two-step process in SAM.
In the first step, continuing script details are entered directly into the SAM application and SAM requests the ‘restriction questions’ from the PBS. The PBS-API responds, the questions are answered by the user, and the script moves into a ‘pending’ status. (SAM supports both single and batch submission and completion of scripts).
The responsible prescriber is then notified by SMS that there is a pending script (or scripts) awaiting their approval.
In the second step, the prescriber opens the SAM app on their mobile device or computer and can review the script details before selecting the ‘Request Authority’ option, for the mandatory prescriber submission to the PBS. Approvals are received back from the PBS within seconds and recorded instantly within the script details in SAM.
Subsequent continuing prescriptions are even faster to apply for as all the patient’s prescription details are stored in SAM ready for submission and immediate approval via the App. The SAM platform allows the clinician to review, at a glance, the status of prescription applications, including any that are rejected.
In the future Seekwell hopes to be able to submit angiograms and OCT imaging via the same process.
STREAMLINING INJECTION THERAPY
In NSW, treatment for nAMD is not provided in public hospitals or even as an outpatient service – it is only available through privatised clinics. Other states do offer a limited number of treatments through the public health system. As nAMD and diabetic retinopathy treatment is ongoing, unless people are able to access a clinic where injection therapy is bulk billed, they will end up paying out of pocket costs. These can be as much as AU$800 per injection, as well as the cost of OCT/angiogram.
While treatment for some patients can be stretched out to 12 or even 16 weeks, injection intensive patients require four to six weekly treatments, which comes at a prohibitive cost for many.
The PBS rebate on injection therapy is $263 for the first eye and approximately $130 for the second eye when treated on the same day; there is no rebate available for OCT subsequent to imaging used in initial diagnosis. Prof Mitchell said that while many clinics will only treat one eye per patient visit, he treats one in every three patients bilaterally on the same day and there are no out-of-pocket costs for any patient.
“This is a big clinic, probably the biggest in the country and we achieve a high level of treatment compliance, I think because there is no cost for treatment. People with nAMD need to be treated more or less life-long but we know from the PBS data, that by the end of the second year, 40% have dropped out due to tyranny of distance, injection fatigue, and one of the biggest impediments – out of pocket costs.
“When people stop treatment for six months their vision goes down, we saw this a lot during the COVID pandemic. The longer people have vision loss, the more chronic it becomes,” Prof Mitchell said.
He continued, “We also have a very high proportion of diabetics in Western Sydney – a lot of people here come from ethnic groups with a high prevalence of the disease. These people often have marginal employment and so they struggle quite a bit – they can’t afford treatment, they have a lot of other health issues to juggle, and so they fall through the cracks.”
Acknowledging that most clinics will offer no out-of-pocket costs to patients on an as-needs basis Prof Mitchell said, “These drugs really are sight-saving. There are people we’ve been treating for 10 years still holding the same vision – for some their vision is better than when they started.
“And over that time, treatment has become increasingly streamlined. SAM is great because it will enhance efficiencies even more, so I hope this means more ophthalmologists will feel able to offer injection therapy at no charge. We have seen so much deterioration in vision during COVID, we need to do what we can to help patients.”
