RNs will soon be writing PBS scripts. Here’s what you need to know
RNs working with doctors will be able to prescribe S4 and S8 drugs under the PBS after landmark legislation was passed by federal Parliament last week.
The legislation ensures RN prescribers become a so-called ‘PBS category’, but only applies to RNs with the equivalent of at least three years of full-time post-registration clinical experience — 5000 hours in the past six years — who have undertaken additional training.
All nurses wanting to prescribe under the PBS will apply for endorsement with the Nursing and Midwifery Board of Australia and, once endorsed, complete a six-month period of clinical mentorship.
One question is whether the PBAC, the expert committee tasked with determining what drugs are listed on the PBS, will have to assess the cost-benefit of the drugs when prescribed by RNs.
AusDoc has been told that process is already happening, with PBS-listed drugs being assessed in tranches.
PBAC recommendations commonly include whether a PBS listing should be unrestricted, restricted or authority required, as well as any clinical criteria, prescriber requirements and review conditions.
Restrictions may be for specific conditions and comorbidities, but can also mean certain drugs can only be prescribed or initiated by a certain kind of specialist or in consultation with a specialist.
Restrictions can later be amended after PBAC review, including in response to new evidence, safety issues, utilisation, administrative burden, pricing or cost-effectiveness.
It is worth pointing out that the new legislation also means that prescribing RNs can be hauled before the Professional Services Review, the watchdog that investigates potential abuses of the PBS and the MBS.
It is also worth stressing that nurses will not be able to prescribe autonomously. This is not a pharmacist-prescribing model.
Whether prescribing under the PBS or not, nurses will have to draw up a written agreement with an authorised prescriber — a doctor or nurse practitioner — that will stipulate which scheduled medicines they may prescribe, and for which conditions, within their competence and clinical role.
The word landmark gets overused. And the changes its advocates believe RN prescribing will bring in terms of access and patient care, particularly in general practice, will take time.
Five university-based programs have been accredited to train nurses — at Melbourne’s La Trobe University, Perth’s Edith Cowan University, Queensland University of Technology, the University of Melbourne and the University of Tasmania.
But those programs only opened this year, so the first cohort of RN prescribers, many of whom have been endorsed by the Nursing and Midwifery Board of Australia, is graduating this month.
When it comes to the public system, state governments are still deliberating how they are going to begin incorporating designated RN prescribers into their health systems.
For example, Victoria has announced it will only be using designated RN prescribers in hospitals, residential aged care, palliative care, prisons and police jails, at least initially, from October.
Meanwhile, NSW has flagged that it will implement RN prescribers “only where there is demonstrated service need”.
WA and Tasmania have announced they have begun to review and amend their medicines and poisons laws to support designated RN prescribing as well.
What about primary care? The first wave of RN prescribers in general practice is likely to emerge in late 2026, according to Denise Lyons, the president of the Australian Primary Health Care Nurses Association.
Clearly, the business model has to be worked out alongside the clinical model.
This may be unfair, but the medical community’s reaction to the passing of the legislation last week — it is due to be given royal assent in the next two weeks — seems muted.
RACGP President Dr Michael Wright said the changes follow “long consultation and proper consideration”.
“We’ve got to make sure that all the safeguards for patients are in place, and to be able to monitor if things go wrong,” he said.
“With these safeguards, it certainly makes it much more acceptable than the rapid, non-evidence-based pharmacy prescribing changes.
“We look forward to working with RNs to make sure that this is done safely and collaboratively.”
The AMA has not addressed the bill’s passage. AusDoc approached them for comment this morning, but they were unable to reply before publication.
But whatever the future holds, PBS backing for RN prescribing does provide the economic support to make the changes real world.
Read more:
