The health system will likely benefit from the expansion, but GPs may have to fit in a lot more covid patients.
More Australians will now be able to access covid antiviral medicines on the PBS, but the expanded rollout will bring challenges for GPs.
All Australians aged over 70 who test positive to covid can now access the antivirals Paxlovid and molnupiravir, along with people over 50 with two or more risk factors for severe disease and Aboriginal or Torres Strait Islander people aged over 30 who also have two or more risk factors.
Immunocompromised people over 18 may also be eligible.
RACGP vice president Dr Bruce Willett said he welcomed what he called a “sound and timely decision”, but said practices should prepare for the challenges that will accompany the changes.
“This has been dropped on general practice fairly quickly,” he told TMR, “and to be able to see these people quickly, we really need to reorganise the way we structure our practices and make appointments available for the larger number of people who are now eligible for antiviral treatment.
“Practices have got patients booked ahead now and it will take some time to clear the decks to make room for these people that need to be seen at relatively short notice.”
A further complication potentially lay in the government advice provided to GPs.
“While now the PBS criteria have been extended, the national clinical guidelines haven’t actually caught up yet – the PBS and ministerial announcement are out of sync with the guidelines and they need to be brought back in sync,” he said.
“GPs like to stick to the guidelines, rather than the PBS, so that it does create a bit of conflict when they’re not aligned. There’s the media out there saying this is what we should be doing, whereas it’s not what the guidelines are saying.”
PSA president Dr Fei Sim flagged that since the discontinuation of the home medicines delivery service on 30 June, people with covid were going to pharmacies to pick up their medicines, including antiviral treatments.
The service was introduced so patients who were vulnerable or being forced to isolate at home could have medicines brought to their door.
Where covid patients lacked family or friends to help them out by collecting the antivirals – and where they could not find a pharmacy that would deliver – they would be forced to collect them in person, she said.
Prior to yesterday’s announcement, AMA vice president Chris Moy said the expanded antivirals rollout would also be compromised by the discontinuation of Medicare support for phone consults over 20 minutes.
“Antiviral prescribing is complex and time consuming – 30 to 60 minutes – even for somebody familiar with it like me,” he tweeted on Friday, adding that while patients could still use Medicare-funded video consultants, this did not help those for whom video is either impractical or impossible, including older and more vulnerable patients.
Dr Willett also raised concerns about the likely challenges faced by those in rural and remote areas. Reduced access to higher level healthcare and residence in an MMM5 or above are among the risk factors that determine eligibility.
“If you have a lot of cases in a small town, they can quickly deplete the valuable antivirals there,” he said, “and because there’s some degree of remoteness, it can take a while to get them back again within the five days [during which they’re effective]. So localised storage is certainly an issue.”
