With the Opioid Dependence Treatment (ODT) Community Pharmacy Program kicking off on Saturday 1 July, Australian Pharmacist explains the steps you need to take before, during and after the transition.

Treatment for opioid dependency is about to become much more affordable and accessible for patients.

From Saturday onwards, Pharmaceutical Benefits Scheme (PBS) ODT medicines will be available under the Section 100 Highly Specialised Drugs Program arrangements.

With dispensing fees for ODT medicines subsidised by the government, patients will only be charged a once-a-month PBS co-payment of $30 (or $7.30 with a concession card) for 28 days’ supply. 

For patients used to paying a $5.66 daily dispensing fee – leaving them more than $150 out of pocket each month – the new system will be life changing, said PSA Victorian State Manager Jarrod McMaugh MPS.

‘The significant difference in treatment costs is a move towards funding these medicines appropriately, just like medicines for diabetes or heart disease,’ he said.

To help pharmacists prepare for the ODT transition and manage the ins and outs of the new process, PSA is hosting two webinars:

• Navigating changes to the NSW Opioid Treatment Program – NSW, Wednesday 28 June 2023 from 7.00pm– 8.30pm
• Navigating changes to the VIC Pharmacotherapy (ORT) Program, Thursday 29 June from 7.00pm– 8.30pm.

To begin with, here are some tips for pharmacists to prepare for the big shift on Saturday.

Pre-transition

Review every patient’s prescription

All ODT prescriptions must be reclaimed on 1 July as the program transitions from the previous funding model. Prior to the change, pharmacists need to check the length of existing prescriptions.

‘Going through the transition phase, prescriptions can’t be extended beyond the existing expiry date of that prescription,’ said Mr McMaugh. ‘So any patient whose prescription is very short or due to run out must be referred to their doctor for a new script [now].’

Annotate all scripts

Pharmacists should photocopy all paper prescriptions and print out a copy of eprescriptions ready for annotation.  

Along with calculating the length of ODT scripts, pharmacists need to determine the daily dose for each patient over a 28-day period, as per the table below.

‘For each client, record when their script is going to run out and what their monthly dosing will be so the prescription can be processed rapidly on Saturday,’ said Mr McMaugh.

Advise clients about the changes

While some clients will be aware of impending changes to the ODT program, many will not be. Pharmacists should ensure they walk each patient through the details. This includes:

• informing patients of changes to funding 
• ensuring patients understand there will be some administration issues to work through
• confirming contact details are up to date in case you need to discuss clients’ prescriptions during the week
• confirming concession entitlements and any other matters that may affect the prescription.

Consider how to minimise client fees during the changeover

If patients are due for a takeaway dose on the weekend, consider whether they would prefer to come into the pharmacy to avoid paying private dosing fees.

Plan your workflow

Once the information for each prescription has been calculated, it’s time to plan Saturday’s workflow and staffing accordingly. This includes adjusting dosing time and anticipating potential problems.

‘Figure out how much extra dispensing and processing is required and consider rostering on an extra staff member to ensure everything runs smoothly,’ advises Mr McMaugh.

Saturday: Transition day

Reclaim prescriptions

Before dosing time commences, all prescriptions must be reclaimed as PBS scripts using a set of authority code numbers provided by the government in the table below.

‘Normally the authority code is supplied by the prescriber, but prescriptions written prior to the new method need to be reprocessed using the [temporary] authority codes so pharmacists can receive payment,’ said Mr McMaugh.

If a high volume of patients is expected on Saturday, consider starting the dose time later than usual to allow time for processing paperwork.

‘However, make sure you communicate to your client base in advance if you’re going to start later than usual on Saturday,’ he said.

Walk patients through the changes again

To ensure patients are fully up-to-speed with the changes to the ODT program, Mr McMaugh advises explaining the new process again. 

Pharmacists should also conduct transition housekeeping by:

• ensuring dispensing payments are covered up to 1 July
• considering how to approach refunds of any unused private fees  that have been prepaid.

Review patient consent forms

Before claiming for daily ODT dispensing fees, patients must sign a consent form granting pharmacists permission to provide their details to the Pharmacy Programs Administrator (PPA) and the Department of Health and Aged Care.

‘It’s a one-off form that must be completed by every client who’s transitioning over to the new process, or starting the ODT program,’ said Mr McMaugh.

‘On Saturday, go through what their entitlements are, get them to sign the consent form, then move on to providing the dose.’

Post-transition 

Submit claims using transition time frames

To offset the cost of ODT dispensing fees, the government will pay pharmacists $5.66 per client per day, claimed back from the PPA at the end of each month. 

‘You will need to claim payment for all of the doses provided that month, whether they are supervised or takeaway doses,’ said Mr McMaugh.

‘That entails gathering the records of the doses you provided, and claiming X number of doses per Z number of clients through PPA.’

Still have questions?

The PSA webinars will be recorded for repeat referral for those unable to attend, said Mr McMaugh.

‘Pharmacists who have further questions are advised to contact PSA’s Pharmacist to Pharmacist Advice Line,’ he added.