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Monday, 7 December 2020
Page: 10585

Health Care

Dear Chair

I refer to your correspondence concerning petition number EN1673. I regret the delay in responding.

The Australian Government appreciates the challenges faced by individuals affected by chronic pain and is committed to addressing the impact of chronic pain on the community.

To support this commitment, the Government is working closely with Painaustralia and state and territory governments on the endorsement of the National Strategic Action Plan for Pain Management (Action Plan). A key goal of the Action Plan is to ensure health practitioners are well-informed on best practice evidence-based assessment and care, and are well supported to deliver this care.

The Government is providing $2.5 million in funding to support early implementation of the Action Plan, including consumer awareness and education activities and training for health professionals.

A further $4.1 million is being provided to support additional specialist pain management services through the Rural Health Outreach Fund. This funding aims to support delivery of outreach pain management specialist services in regional, rural and remote areas of Australia and to undertake upskilling of primary care providers in these areas to improve prescribing habits and awareness of appropriate pain management treatment.

The Government makes a substantial contribution to pain research endeavours through grants provided by the National Health and Medical Research Council. Since 2000, approximately $265 million has been expended on clinical research projects into pain and pain management issues.

On 1 June 2020, the Pharmaceutical Benefits Scheme (PBS) listings for opioid medications underwent a number of changes as recommended by the Pharmaceutical Benefits Advisory Committee (PBAC). These were recommended in response to the Therapeutic Goods Administration's regulatory reforms implemented to minimise the harms caused by opioid prescription medicines to Australians each year.

The PBAC recognised that access to opioid pain relief is an essential component of many pain management plans. While PBS changes include pack size reductions for short term use, adjustments to the 'indications' and changes to the authority process that doctors must follow to prescribe opioids to be subsidised under the PBS, these changes will ensure the safe and effective prescribing and use of opioids while maintaining access for patients for whom they are clinically appropriate.

Following the implementation of these changes, the PBAC considered feedback from Palliative Care Australia expressing concerns barriers to pain management for palliative care patients. The PBAC subsequently recommended additional changes to the opioid listings for palliative care patients and restructured the existing opioid restrictions to reduce the administrative burden on prescribers. These changes were implemented on 1 October 2020.

From 1 October 2020, patients who are receiving palliative care whose clinical condition is such that they are unable to seek a secondary annual review will be exempted from this requirement. For those palliative patients who are well enough to meet this requirement, a palliative care nurse practitioner will be also able to conduct annual reviews.

PBS-subsidised opioids can continue to be prescribed for the treatment of patients with chronic pain. Prescribers are able to request authority approval from Services Australia for increased quantities and/or repeats of PBS-subsidised opioids. These increases may extend treatment up to three months' supply per prescription.

However, patients requiring authority for increased quantities and repeats must have an annual review of their condition conducted by a second medical practitioner to confirm ongoing need for opioid medication when they have been receiving treatment with opioids for 12 months or longer. This secondary consult is an annual requirement only where increased quantities and/or repeats of opioid medication are required. The annual review does not need to be undertaken by a pain specialist; rather any Australian registered medical practitioner will suffice. In recognition of the difficulties for patients to see their doctors due to COVID-19, the secondary review may also be undertaken by phone or telehealth consultation where appropriate.

Prescribers can request real-time authority approval through the Online PBS Authorities system for quantities and/or repeats that provide up to three months treatment. This removes the need for prescribers to call or submit a written application to Services Australia. Alternatively, prescribers can request up to one months' treatment via the telephone or up to three months' treatment via Health Professional Online Services form upload function, or via mail.

Thank you for writing on this matter.

Yours sincerely

from the Minister for Health, Mr Hunt