This is the text extract for Changes to Close Control, browse documents here.

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Close Control FAQs

Close Control is a mechanism to permit any subsidised medicine to be dispensed more frequently than its default (i.e. stat or monthly). The prescriber endorses the prescription with the words “Close Control” or “CC” and states the period of supply e.g. dispense monthly for 3 months. PHARMAC conducted a review of the Close Control rule, and following feedback, implemented a number of changes from 1 October 2011. The new Close Control rule is included in the October 2011 Pharmaceutical Schedule Update page 44 and available on http://www.pharmac.govt. nz/2011/09/16/SU.pdf Below are some commonly asked questions and inside is a flowchart outlining the changes.

Rest home and residential care

If a patient in a rest home requires a change of dose or medicine, are they eligible to have the initial period dispensed for a shorter period than 28 days?

Yes. Prescribers will be able to order a one off trial period on the prescription for a dose change or new medication. Pharmacists are not able to initiate this type of Close Control for rest home patients.

Does each item need annotating?

Scripts for rest home patients no longer need to be endorsed ‘Close Control’. The prescriber or dispensing pharmacist must include: • The name of the patients residential placement, and • Their NHI number, and • The maximum quantity or period of supply to be dispensed at any one time.

FAQ’s

Trial Period for change of dose/medication

When the medicine/dose is changed, can the balance of the prescription be dispensed monthly? (e.g. 10 days + 20 days + 30 days + 30 days)?

No. After the initial dispensing of e.g. 10 days, the balance has to be dispensed stat (e.g. 80 days) if it is a stat medicine. If it is a monthly listing or the patient is on Close Control for other reasons (frail, infirm or unable to manage their medicines); then the balance can be dispensed monthly or in accordance with the prescribers Close Control instructions.

Changes to the

If a computer generated prescription has ‘CC’ next to each item on a rest home prescription, does each item need to be initialled?

No. Close Control no longer needs to be initialled on rest home prescriptions. All other prescriptions (i.e. non-rest home prescriptions) need each individual item initialled and marked “CC” or “Close Control”.

Close Control Rules

October 2011

Is weekly dispensing allowed for rest home prescriptions?

No. The rule states that dispensings cannot be for periods less than 28 days, unless the patient is receiving a Trial Period for a new medicine or dose change.

If a patient needs a further change in dose or medicine, can this be dispensed under a new trial period?

Yes. It would be considered a new change in dose or medicine, and can be prescribed and dispensed in accordance with the trial period change dose/ medication rules. The trial period is for the first dispensing only. Please note that trial periods will need to be initialled by prescribers with either Close Control Trial, CCT or Trial Period for each pharmaceutical.

How should Class B Controlled Drugs be dispensed in rest homes and residential care facilities?

Class B Controlled Drugs other than methylphenidate and dexamphetamine should continue to be dispensed in 10 day lots.

Does each prescription require the rest home to be named in the address field?

Yes. The patients NHI number is also required.

Other

Controlled drug prescriptions require Close Control if they are to be dispensed more frequently than every 10 days.

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Improvements to the Close Control Rules

Close Control dispensing funded if: • The supply to be dispensed at any one time is not less than 28 days, and • If prescriber or pharmacist: • Included the name of the patient’s residential placement or facility on the prescription; and • Included the patients NHI number on the prescription; and

Subsidised Medicines Rest Home or Residential Care

Patient resident in a rest home or residential disability care institution.

YES YES

• Specified the maximum quantity or period of supply to be dispensed at any one time

NO Specific Medications

The pharmaceutical is either:

Rest home + residential care patients are eligible for a trial period if initiating onto a new medicine or trialling a dose change. For trial periods each community pharmaceutical on the prescription must be endorsed with either “Close Control Trial”, “CCT” or “Trial Period” and the period of supply included e.g. CC Trial 1 week.

Close Control dispensing funded if the prescriber:

YES

• Endorses each item to be dispensed Close Control with “Close Control” or “CC”; and • Initials each endorsement in their own handwriting; and • Specifies maximum quantity/period of supply to be dispensed at any one time

• • • •

A tricyclic antidepressant; or An antipsychotic; or A benzodiazepine; or A class B controlled drug

NO Stock Issue

PHARMAC has notified pharmacists to implement Close Control for a specified pharmaceutical for a specified time.

Close Control dispensing funded if: • The dispensing pharmacist has: • Clearly annotated each of the specified pharmaceuticals on the prescription with ‘Close Control’ or ‘CC’; and

YES

• Initialled the annotation in their own handwriting; and • Specified the maximum quantity/period of supply to be dispensed at any one time, as specified by PHARMAC at the time of notification

NO Penal Institution

Patient resident in a penal institution.

YES NO

Close Control dispensing not funded.

Requires Monitoring

In the opinion of the prescribing Practitioner, the patient is intellectually impaired or frail, infirm or unable to manage their medication without additional support.

YES

Close Control dispensing funded if the prescriber: • Endorses each item to be dispensed Close Control with ‘Close Control or ‘CC’; and • Initials each endorsement in their own handwriting; and • Specifies maximum quantity/period of supply to be dispensed at any one time

NO

Requires a Trial Period

NO

Close Control dispensing not funded.

Community pharmaceutical has been prescribed for a patient who requires close monitoring due to a recent initiation onto a new treatment, or a dose change.

YES

For trial periods each community pharmaceutical on the prescription must be endorsed with either “Close Control Trial”, “CCT” or “Trial Period” and the period of supply included e.g. CC Trial 1 week.

NO

Close Control dispensing not funded.

These changes have been made following feedback from the pharmacy sector and other stakeholders. If you have further questions regarding these changes or would like to order additional resources, call PHARMAC on 0800 66 00 50 or visit www.pharmaconline.co.nz