Ahpra worried over online prescribing

Ahpra and several health boards are concerned that practitioners are cashing in on rising demand for prescriptions for medicinal cannabis and bulk-produced compounded medicines.

The Medical, Nursing and Midwifery and Pharmacy boards are reminding practitioners of their long-established responsibilities when prescribing and dispensing medicines, such as the soon to be banned versions of semaglutide, with a new unit to scrutinise practitioners who may not be complying with their codes and obligations. 

Ahpra CEO Martin Fletcher said that while new models of healthcare, including the use of telehealth, were important enablers of greater access to health services, some emerging practice models were dangerously disrupting the traditional therapeutic relationship between a patient and their practitioner. 

“Good prescribing must balance safety and access,” Mr Fletcher said. 

“Practice models of concern often feature clinics that treat a single disorder and prescribe and dispense a single medicine in response to patient demand. Some focus on a high volume of telemedicine consultations or computer or algorithm-based prescribing of medicines, and some businesses also offer direct supply of unapproved medicines to patients.  

“While the delivery of telehealth services is supported by Ahpra and the National Boards, we do not support practitioners or health services taking advantage of patients or ignoring their obligations to provide appropriate care and follow up when needed.” 

The boards and Ahpra have stressed that good practice involved a practitioner consulting with a patient, evaluating their health based on history, examination, and investigations, and then recommending appropriate care based on the patient’s clinical state and the evidence supporting treatment.  

“This includes providing patients with the range of treatment options that are available and appropriate,” Mr Fletcher said.  

“Ahpra and the National Boards are seeing evidence that some health services are instead set up specifically to cater for patients who contact them seeking access to a single pre-determined medicine.  

“Prescribers in these businesses may not be turning their minds to whether the medicine being offered is a safe or appropriate option, and these medicines are then typically provided directly by a pharmacist linked to the same business.” 

There have also been claims that medical certificates have been issued without appropriate real-time consultations via these business models, which may leave practitioners in breach of their professional standards.  

“The Boards and Ahpra consider that the issuing of a medical certificate requires a clinical assessment of the patient and further management may be required,” Mr Fletcher said.  

“It is not merely an administrative function undertaken for a patient who is willing to pay for a certificate.” 

According to the TGA, new business models have seen the use of unregistered medicinal cannabis products spiral in recent years, from around 18,000 Australian patients using products in 2019 to more than one million patients using medicinal cannabis up to January 2024.