PBAC gives nurse practitioner MTX prescribing the nod

4 minute read

The move, described as ‘a significant step forward’, can help take pressure off rheumatologists.

PBAC has recommended rheumatology nurse practitioners be given prescribing rights for low-dose methotrexate at its September 2023 intracycle meeting.

The move, which has still to be signed off by the health minister, is expected to improve patient access to the medicine, particularly as more nurse practitioners come on board.

“The PBAC recommended amending the current PBS listings of low‑dose methotrexate used for the management of rheumatological conditions to include NPs as eligible prescribers,” PBAC stated in its outcomes notice.

“The PBAC noted its intention was for the recommendation to apply to those NPs who have undertaken specific training in managing rheumatological conditions and who are approved for prescribing low-dose methotrexate. The PBAC considered allowing rheumatology NPs to prescribe low-dose methotrexate could improve patient access to the medicine.”

Nurse practitioner Linda Bradbury said that the Rheumatology Health Professionals Special Interest Group of the ARA have been looking at the prescribing rights of NPs for several years, and the recommendation by the PBAC is “a significant step forward”.

“As methotrexate is one of the main medications prescribed to rheumatology patients, it will allow the NP to provide more autonomous, holistic care, maximising their skills,” Ms Bradbury told Rheumatology Republic.

“It will negate the requirement to ask a rheumatologist (or any other doctor) to write a script, thereby saving time for both patient and clinician, providing patients with access to their medications in a timely manner,” she said.

Instigated by the Royal Children’s Hospital in Melbourne, the request was backed by a letter from the ARA with unanimous support from the ARA Therapeutics Committee.

Therapeutics committee chair Dr Helen Cooley told Rheumatology Republic that while there are not very many nurse practitioners at present, the measure will improve efficiency in both public and private settings.

“This recommendation is a really positive step both for our patients and to recognise the competency and skill of our rheumatology nurse practitioners,” she said.

Ms Tracey Rudd, CEO of the Australian Rheumatology Association, said: “While it still awaits sign-off from the health minister, it is a win all-around. For us, it will help alleviate some workforce issues by taking pressure off the rheumatologists”.

The recommendation has also been welcomed by patient groups, led by Arthritis Australia:

“Arthritis Australia has long advocated for an expansion of access to rheumatology nursing in Australia, from the publication of our 2017 report building the case for rheumatology nursing to our proposal for the 2024 federal budget to pilot a program for rheumatology nurse training and access in private practice settings,” said Arthritis Australia CEO Mr Jonathan Smithers.

“We are very pleased to see this recommendation from the PBAC which will be particularly helpful for patients in rural areas and will help prepare rheumatology nurses to play an increasingly important role in care delivery,” he said.

Obviously, the small number of NPs will limit the immediate impact of the recommended measure. At present there are five rheumatology NPs in Australia: three adult and two paediatric. However, Ms Bradbury, who was Australia’s first rheumatology NP, is hopeful that the changes to prescribing rights will encourage other nurses to qualify as NPs.

“Although this recommendation may not make a big difference to the rheumatology NP in private practice, it may pave the way for the next steps, thereby encouraging others to consider the role,” she told Rheumatology Republic.

“My hope is that the PBS agrees with this change and once it becomes the norm, we can then approach the PBAC for our other widely used DMARDs,” Ms Bradbury said.

In a public setting, she pointed out, NPs can only prescribe those medications where there is a PBS listing. This includes steroids (any dose, any route), NSAIDs, and continuing scripts for sulfasalazine and plaquenil. 

“Interestingly, we can even prescribe gold – for which there is no product on the market – and azathioprine. We cannot, however, prescribe methotrexate, leflunomide or biologics, or initiate sulfasalazine or plaquenil.   

“Once the NP can take on this responsibility, it can only help with addressing the current rheumatology workforce shortage.”

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