PBAC effort to remove need for specialist hep C consult

A PBAC submission might remove the need to consult with a specialist on the new hep C drugs

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GPs won’t need specialist consultation to prescribe hepatitis C medication if an industry submission to the pharmaceutical benefits advisory committee is successful.

The hope is to eliminate what many consider to be an unnecessary bureaucratic barrier by allowing GPs already upskilled through S100 medication training, or who have gained experience through treating multiple patients, to handle the treatment alone.

The Medical Republic understands that a group of specialists and general practitioners collaborated on the submission for Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), the peak body for health professionals working in the HIV, hepatitis and STI fields.

Initially there was an urgency to get the drugs into the community, and rather than erect barriers like the S100 training, the unusual stipulation to consult with a specialist was seen as a safeguard, Dr David Baker, GP and senior lecturer at Notre Dame University, said.

“[But] there’s definitely a number of groups that hoped to be added to the list: specialist physicians, addiction specialists, drug and alcohol specialists and a broader group of doctors who are already actively involved in treating hepatitis C over the years and have the training and experience,” said Dr Baker, an adviser to ASHM.

He’s optimistic that the changes will go ahead.

“The reality is that most, around 80%, of patients have early disease and are very easy to treat. These drugs are very easy to prescribe for most people and it doesn’t seem necessary to create unnecessary barriers around prescribing,” he said.

From a public health point of view, it was better to get the drugs out there and treat as many people as possible, Dr Baker said. Even an occasional mistake was unlikely to do harm.

“If you give the wrong drug, it’s probably just not going to work. They’re not dangerous drugs,” he said. In terms of harm to patients, the biggest risk was probably overlooking cirrhosis in patients you were treating.

Currently, there was debate around how serious it was to miss patients with early cirrhosis, with some experts arguing that the condition might regress with hepatitis C treatment, he said.

Even specialists could find it difficult to determine if a patient had early cirrhosis, but more severe cirrhosis was harder for specialists and GPs to miss, Dr Baker said.

Aside from safety concerns, an unspoken factor for GPs was probably the emotional element. An opportunity to be a part of a miracle was few and far between, and everyone wanted to be the one curing a patient, Dr Baker said.

Like Dr Baker, past president of ASHM Professor Gregory Dore is optimistic the restrictions on GPs prescribing the drugs will be relaxed.

“ASHM is keen to acknowledge the experience and skill of a relatively significant group of GPs and other physicians that are not gastroenterologists or hepatologists but who also are upskilled, to allow them to prescribe without that consultation,” Professor
Dore said.

It was important to maintain the safeguard for doctors inexperienced in prescribing the medication, but he estimated that a GP who had treated 10 to 20 patients would likely qualify, he said. 

The target was to escalate the number of patients treated from 2000 to 3000 per year to 10 times that, which Professor Dore said was “not a crazy number”.

Meanwhile, the RACGP provided its submission to a separate consultation in support of an MBS item number for Transient Elastography, or Fibroscans.

An item number would have “clear benefits for both patients and GPs” and increased access to the test would be required to ensure the new medications reach their potential, the submission said.