Appendix 2: Transitional arrangements to ensure that prescriptions were consistent with the Medicines Regulations 1984

The first transitional measure Pharmac took was to advise doctors to add a standard notation to all prescriptions that instructed pharmacists to apply the new rules for medicines on the all-at-once dispensing list unless doctors had specifically requested that the medicines be dispensed under close control.

However, the notation could mean that prescriptions could contain 2 conflicting statements about how often pharmacists were to dispense medicines to patients. The notation would achieve compliance with the Schedule (which pharmacists are obliged to do in their contracts with district health boards) but could be regarded as being in conflict with regulation 42(3) of the Medicines Regulations 1984, which requires pharmacists to dispense medicines as doctors prescribe.

To prevent pharmacists being given conflicting statements, Pharmac asked the Director-General of Health to authorise a departure from the regulation to ensure that regulation 42(3) and the Schedule were consistent. The Director-General agreed and her decision was notified to doctors and pharmacists before all-at-once dispensing came into effect on 1 October 2003. The authorisation would apply continuously, but become redundant once the software was updated.

In the last 2 weeks of the transitional period, it became apparent to Pharmac that an unexpected problem had arisen due a change in the way that some pharmacists intended to interpret regulation 42(3) for dispensing non-stat medicines after 1 October 2003. The new interpretation being discussed was a reversal of the interpretation accepted by pharmacists, Pharmac, Medsafe, and HealthPAC from 1996 to 2003.

Pharmac acted quickly to clarify the situation with pharmacists. It wrote to them on 1 October 2003 explaining how to interpret doctors’ instructions to comply with the Schedule so that pharmacists and patients could obtain public funding for dispensing and obtaining non-stat medicines.

However, this meant Pharmac needed to make a second request to the Director-General of Health for her authorisation to depart from regulation 42(3) until the updated prescribing software could be installed in doctors’ surgeries. The request was formally made on 8 October 2003 and the authorisation was signed on 28 October 2003.

In our view, Pharmac acted promptly to resolve an unanticipated potential conflict between the Schedule and regulation 42(3). Nonetheless, because the Director-General’s authorisations are not retrospective, some prescriptions written by doctors between 1 and 28 October 2003 might have complied with the Schedule but not regulation 42(3).