Despite recent guideles issued by the PSI, many pharmacist are still confused about who and when can prescribe a High-Tech medicines. In particular there is a lot of confusion around the lifelong therapy box and review dates.
There's also considerable uncertainty in relation to foreign Rxs issued for HT medicines. To find out a definitive answer we have written to the PSI and we will update this article when we receive the answer.
Until then it is recommended that all HT Rxs are reviewed every 6 months by a hospital consultant unless a review date is later than 6 months from the prescribed date in which case a GP/nurse should be able to cover the intervening period. This should be a rare exception though.
UPDATE: 10th February 2017 (reply from the PSI):
The High-Tech scheme is a government reimbursement scheme which falls under the jurisdiction of the HSE, rather than a system for the legal classification of medicines.
The operation of the High Tech scheme is under the auspices of the HSE and any pharmacist participating and delivering care to any patient under this scheme must ensure that they adhere fully to the operational requirements published by the HSE. I can provide you with the following information in response to your questions.
1) When exactly can a GP/nurse prescribe a HT item?
It is my understanding that to avail of the High Tech Scheme, the HSE require that High Tech drugs are initiated by a consultant, who is responsible for overseeing the patients therapy and therefore their review at appropriate intervals depending on the clinical particulars.
Regarding the prescribing of these medicines by other practitioners please see the following extract from the PSI guidance,-
Page 2, Section 2.1 Prescription Requirements of the PSI’s Good Dispensing Practice – High Tech Scheme states:
Where necessary a General Practitioner may also issue a repeat prescription in respect of a High Tech medicine provided that the product is for use within the date of review of therapy specified by the consultant on the High Tech prescription form.
A registered Nurse Prescriber may also issue a repeat prescription for a specific High Tech medicinal product. As with all prescriptions, the pharmacist must be satisfied that this is within the provisions of the legislation and that the nurse is operating and prescribing within his/her scope of practice having due regard to his/her place of practice. A Nurse Prescriber is not authorised to initiate High Tech drug therapies under the scheme.
2) What exactly does lifelong therapy box mean? Can the GP technically prescribe that HT item indefinitely without consultant review, if there is no review date specified?
It is my understanding that the ‘lifelong therapy’ box has now been removed from High Tech prescriptions due to the confusion that it caused, however it may still appear on previously printed copies.
Legislation sets out that the maximum validity period for any prescription, including High Tech prescriptions, is six months from date of issue. If the ‘lifelong therapy’ box has been ticked by the consultant, and the GP, having reviewed the patient’s condition and medication, is satisfied that it is appropriate for the patient to continue to take the medicine it is my understanding that they can issue a prescription for the High Tech medicine at 6 monthly intervals. The GP would be accepting responsibility for this supply and must be satisfied that it is safe and appropriate for the patient when each prescription is issued.
Good communication between the various members of the multidisciplinary team caring for these patients should ensure that patients, prescribers and pharmacists are all aware of the patient’s care plan and the arrangements for the patient to receive regular therapeutic reviews and appointments and for issuing further prescriptions (either by the initiating consultant or the patient’s GP).
3) What should we do in the absence of a review date being specified on a HT Rx?
a) without lifelong therapy box ticked
b) with lifelong therapy box ticked
A prescription issued for a High Tech medicinal product is subject to the same legal controls as any other prescription. As stated above, legislation sets out that the maximum validity period for any prescription, including High Tech prescriptions, is six months from date of issue. Some prescriptions may only authorise a single supply, and care must be taken to ensure the prescriber’s instructions are correctly interpreted. If it is unclear as to the prescribers intentions you should contact them directly to confirm. The patient should be reviewed by either the consultant or GP every six months and obtain a legally valid prescription for supply of the High Tech medicine if required.
Pharmacists are required to carry out a therapeutic review at each dispensing and if, in your professional judgement, at any time you believe that the patient requires a review of their therapy to ensure it is still safe and appropriate you should contact the consultant or patient’s GP.
4) Can we dispense HT medication from an EU consultant Rx or should we require it to be transcribed by an Irish GP or should it be an Irish consultant?
The High-Tech Scheme is a government reimbursement scheme which falls under the jurisdiction of the HSE. It is my understanding that if the patient intends to pay for a product themselves as a private transaction between the patient and the pharmacy, then a prescription written by an EU consultant would be legally valid in Ireland. Issue 2, 2015 of the PSI newsletter sets out the requirements for a prescription written by a practitioner practising in another EEA Member State.
In this situation, in addition to the legal requirements, you must be satisfied that any supply of medicine that you make is safe and appropriate for the patient and that the patients therapy is regularly reviewed by an appropriate or specialist prescriber.
I hope this information is helpful, please do not hesitate in contacting me if you require further information or any of this is unclear.
DISCLAIMER: The response provided is for information purposes only. While every effort has been made to ensure the accuracy of the information provided it does not constitute legal advice or legal interpretation and cannot be relied upon as such. The PSI does not accept any responsibility for liabilities arising as a result of reliance on the information given and the information is provided on the sole basis that neither the PSI, its staff or advisors are liable for any loss resulting from any error omission or inaccuracy in the information supplied or provided or any result from any act done (or not done) in the reliance on information supplied.
If any further clarification is required just let me know in the comments below and I'll follow it up with the PSI.