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Serious Scarcity Substitution Instruments (SSSIs)
Serious Scarcity Substitution Instruments (SSSIs) allow community pharmacists to substitute specific medicines without prior approval from the prescriber so long as the permitted circumstances within the SSSI are met.
Through an SSSI, patients can receive their medicines from their pharmacist without delay, ensuring treatments are not interrupted. It also relieves workload pressure on prescribers and pharmacists.
The following table displays all current SSSIs along with links to the alerts and the issued web statement for further information.
The legislative instrument remains in effect until the specified date, but it may be revoked before its end date if needed e.g. if the 'scarce medicine' is no longer scarce.
SSSIs are published on the TGA Medicine Shortages website.
|Issue date||Alert||Scarce medicine(s)||Serious Scarcity Substitution Instrument (SSSI)||Duration of SSSI|
|6 August 2021||Tocilizumab (Actemra) Serious Scarcity Substitution Instrument||
||Therapeutic Goods (Serious Scarcity and Substitutable Medicine) (Tocilizumab) Instrument 2021||7 August 2021 to 31 December 2021|
|12 August 2021||Substitution instrument to address shortage of PROGYNOVA estradiol valerate tablets (multiple strengths)||
||Therapeutic Goods (Serious Scarcity and Substitutable Medicine) (Estradiol Valerate) Instrument 2021||13 August 2021 to 1 May 2022|
|17 September 2021||Substitution instrument to address shortage of Imdur Durules and Monodur Durules isosorbide mononitrate 120 mg modified release tablets||
||Therapeutic Goods (Serious Scarcity and Substitutable Medicine) (Isosorbide Mononitrate) Instrument 2021||18 September 2021 to 19 December 2022|
For Pharmacists - Dispensing the substitutable medicine.
When you are unable to dispense a prescription for a Schedule 4 medicine (to the current Poisons Standard) because the supply of that medicine is unavailable, you should check if there is a current SSSI. This information can be found on the TGA's Medicine Shortages website.
You can only offer a substitutable medicine specified in the SSSI. You must also ensure all specified circumstances are met before you dispense the substitutable medicine.
Some of the general permitted circumstances for substitutions include, but are not limited to:
- The patient or carer has evidence of a valid prescription for the scarce medicine, unless otherwise permitted by law
- The pharmacist does not have access to the scarce medicine
- The prescriber has not indicated on the prescription for the scarce medicine that substitution is not permitted
- The pharmacist has exercised professional judgement and determined that the patient is suitable to receive the substitutable medicine
- The patient or carer has consented to receiving the substitutable medicine
- The total quantity of substitutable medicine supplied by the pharmacist must be equivalent to the quantity that would have been dispensed for the scarce medicine for the prescribed duration and dosage regimen
- The pharmacist makes a record of dispensing the substitutable medicine in substitution of the scarce medicine at the time of dispensing
- The pharmacist has an established procedure to notify the prescriber of the substitution at the time of, or as soon as practical after, dispensing the substitutable medicine
If you believe the patient is not suitable to receive the substitutable medicine (for example, the patient has a history of hypersensitivity) you should not make the substitution and must refer the patient/carer back to their prescriber to discuss treatment options.
The substitutable medicine must be dispensed in compliance with the legislation relevant to the jurisdiction where the dispensing occurs.
FAQs - Pharmacists
How do I know if the substitution is allowed in my state or territory?
SSSIs are consistently applied across all states and territories. If the SSSI is in force, it is valid in all jurisdictions.
Can I dispense a substitutable medicine if the prescriber has specified on the prescription that brand substitution is not permitted?
No, a substitutable medicine cannot be dispensed if the prescriber has specified on the prescription that brand substitution is not permitted, e.g. the prescriber has ticked the 'brand substitution not permitted' box on the prescription form. This means pharmacists are not permitted to provide any substitutable or alternative medicine and patients must be referred back to the prescriber.
Do I need to tell the prescriber about the substitution?
Yes, the pharmacist must have a process in place to inform the prescriber of the substitution as soon as possible after dispensing the medicine described in the SSSI.
Can an SSSI be used for emergency supply?
Under certain circumstances, individual state/territory regulations authorise a pharmacist to dispense a medicine without a prescription, such as in an emergency or continued dispensing provisions. SSSIs will not affect these arrangements and can be used according to your state/territory medicines and poisons legislation. For example, if you are permitted to provide three days' worth of a medicine under an emergency provision, you can provide three days' worth of a substitutable medicine specified in the SSSI.
Can I dispense the substitutable medicine if I have access to the scarce medicine?
No, pharmacists are not permitted to dispense a substitutable medicine if the scarce medicine is in stock, or if the SSSI is no longer in force or has been revoked.
How does the substitution work with electronic prescribing?
Electronic prescriptions are not fundamentally different from the paper scripts. Pharmacists are allowed to annotate a prescription electronically as part of a dispensing activity to display the annotation and the modification so that any dispensing pharmacist will see the original prescription. The annotation from other pharmacists and details of the last prescription dispensed are also shown. Further information is available on Electronic Prescribing - Frequently Asked Questions
Can I dispense a substitutable medicine for repeat scripts?
Yes, a pharmacist can dispense the substitutable medicine when the circumstances in the SSSI are met, including repeats. You should simply annotate the script, as usual.
What should I do if the patient experiences a problem with a substitutable medicine?
- If the patient experiences a problem with a substitutable medicine, you should report this to the TGA. Make sure the report mentions the problem relates to an SSSI. Your report will contribute to the TGA's monitoring of the safety of the SSSI post-implementation.
- For adverse events, visit the Adverse Event Reporting portal to report.
- Patients should also be referred to their prescriber for review and consideration of alternative treatments.
- The prescriber should be notified if there is a problem with a substitutable medicine that affects the patient.
Can SSSIs be applied to the dispensing of medicines from medication charts in residential aged care facilities (RACF)?
No, due to complexities around dispensing and administration of medicines in RACF, SSSIs are currently not suitable in this context.
Can I compound a scarce medicine if there is an SSSI in place?
A pharmacist should supply a commercial product if one is available as outlined in the current Pharmacy Board of Australia Guidelines on compounding of medicines.
Will substitutable medicines dispensed under an SSSI be subsidised through the PBS?
- A list of the substitute medicines that are eligible for PBS subsidy under an SSSI is available on the PBS website.
- Frequently Asked Questions about PBS subsidy arrangements for PBS listed medicines subject to an SSSI can be accessed at Pharmacist Substitution of PBS Medicines without a Prescription during Shortages (medicines subject to a Serious Scarcity Substitution Instrument) (pdf,184kb).