Patient safety top of mind with acne drug decision
December 19, 2008
Patient safety `top of mind’ with acne drug decision - PHARMAC
Widening access to a medicine used to treat acne has been made with full awareness of patient safety issues, says PHARMAC’s medical director Dr Peter Moodie.
Isotretinoin (Isotane) has until now only been available subsidized from a specialist dermatologist. GPs have always been able to prescribe the drug, although the prescriptions would not have been subsidised.
Dr Moodie says this had created equity of access issues, because not all potential patients could afford, or had access to, a specialist dermatologist. This was particularly the case for people in lower socio-economic areas.
The decision to widen access will mean general practitioners will now be able to prescribe the drug as well.
Dr Moodie says isotretinoin is a potentially dangerous medicine, with a range of side effects including risks for pregnant women, and there is ongoing debate around the evidence of increased risk of suicidal ideation. The access widening decision has been made with full awareness of these safety issues.
“We know that there are safety issues with isotretinoin and these were highlighted to us by dermatologists in consultation,” says Dr Moodie. “We have thought through the submissions made to us and weighed the relevant material carefully.”
“Our prescribing data shows this drug is less used in deprived areas than it is in well-off areas of New Zealand, so there is clearly an equity issue. Widening access would remove this equity issue. At the same time, we have confidence that general practitioners who prescribe this drug will be well trained and aware of the need to prescribe this medicine carefully, and monitor patients closely.
“We are confident that patient safety will be maintained while the equity issue is resolved.”
Dr Moodie says PHARMAC has worked closely with the College of GPs around the decision and its implementation.
Information will be provided to doctors through the Otago University-based Best Practice Advocacy Centre (bpacnz), and through PHARMAC’s Seminar Series. Additional training will be provided that will contribute to GPs’ continuing medical education.
Dr Moodie says the decision to widen access will probably lead to a 5-10% increase in the use of isotretinoin. PHARMAC’s estimate is this increase will translate to an increase in spending of $55,000 to $100,000 per year.