P211 PRESCRIPTION AND DISPENSING DURATION OF MEDICINES FOR CHRONIC CONDITIONS: A REVIEW OF INTERNATIONAL POLICIES AND EVIDENCE TO INFORM THE AUSTRALIAN SETTING

Abstract

Objective: To summarize the current legislative and regulatory framework in Australia and abroad, as well as evidence on the potential impact that dispensed quantity and prescription durations may have on patient outcomes and costs. Methods: We searched the PubMed database for peer-reviewed articles using the search terms “prescription duration”[title], “*duration prescriptions”[title], “prescription length”[title], “prescription period”[title], “extended prescription”[title], “repeat prescription”[title], “repeat prescribing”[title], and “dispensing duration”[title]. In addition, for a selection of countries, we also searched for and asked national health care authorities or local experts via e-mail regarding dispensing and prescription duration limitations based on legislation, health service guidelines, and subsidy program regulations. To achieve a representative sample, we included the world's 5 most populous countries, as well as the most populous country from each continent. We defined “prescription duration” as the entire period of treatment, based on the quantity of medication, for which a healthcare provider may prescribe a medication, and “dispensing duration” as the period of treatment for which a pharmacist may dispense the medication at a single time point. Results: In 31 countries, the most common limitation for dispensing durations were either 30, 60 or 90 days, and for prescription durations either 3, 6 or 12 months. Evidence on the impact of dispensing and prescription durations is limited in quality, but suggests that longer dispensing durations are less costly to the patient (and funder) and improve adherence compared with shorter dispensing durations. There is not enough evidence to draw any conclusions regarding the effects on medicines supplies or health outcomes. To understand the full effects of different prescription and dispensing durations, and to improve the quality of evidence of what previous studies have thus far suggested, randomized controlled trials are needed. Conclusions: Prescription and dispensing durations vary widely between countries, but the effects of such limitations are largely unknown. More rigorous research is needed to identify the ideal prescription duration by also addressing the impact it has on other aspects such as health outcomes, medicine waste, savings to the health system and loss of working hours.