Pulse ·

GPs lose PBS adrenaline authority — a rural patient safety crisis

By Dr HB Lo, FACRRM 3 min read
Verdict Yes — worth knowing about

The Pharmaceutical Benefits Advisory Committee removed the exemption allowing GPs to initiate PBS-subsidised adrenaline for anaphylaxis. Only specialist paediatricians, immunologists, and respiratory doctors can now initiate the PBS prescription. GPs can still prescribe after a hospital discharge or in specialist consultation — but private prescriptions cost $120–$190 versus the $25 PBS co-payment.

RACGP and ACRRM are urgently calling for reversal, citing risk of preventable deaths in rural and regional areas where specialist access involves waits of up to three years. The PBAC is conducting a review and seeking stakeholder feedback.

What just happened

The Medical Republic reported today that the Pharmaceutical Benefits Advisory Committee has removed the longstanding exemption that allowed GPs — classified under the National Health Act 1953 as “non-specialist prescribers” — to initiate PBS-subsidised adrenaline for patients at risk of anaphylaxis.

The change was triggered by the PBS listing of Neffy, a new adrenaline nasal spray developed by CSL Seqirus, which carried the same specialist-initiation restriction as the existing auto-injector listing. That restriction exposed the legal architecture behind the previous GP exemption — and the PBAC concluded the exemption was not supported by the Act.

Under the new arrangement, PBS-subsidised adrenaline can only be initiated by specialist paediatricians, immunologists, and respiratory doctors. GPs can still prescribe adrenaline in two specific circumstances: for patients discharged from hospital following an acute anaphylaxis event, or when consulting alongside a relevant specialist.

For everyone else — the patient with a bee sting allergy who has never had a confirmed anaphylaxis event, the woman who reacts to shellfish but has never had a specialist referral, the child in a town with no paediatrician — the prescription is now private. That means $120–$190 rather than $25.

The both-and

The PBAC’s position is not arbitrary. The National Health Act 1953 contains provisions that govern which prescribers can initiate PBS subsidies for specific medicines. The committee has read those provisions and concluded that the previous GP exemption — while clinically sensible — was not properly grounded in the legislation. That is a governance argument, not a clinical one. It is not obviously wrong.

The PBAC has announced a review and will seek stakeholder feedback. ASCIA — the Australasian Society of Clinical Immunology and Allergy has for years published position statements confirming that GPs are central to allergy care in Australia, particularly for patients outside metropolitan specialist centres. That position has been consistent; what has changed is the legal interpretation now being applied to it.

The clinical argument is not close

The clinical evidence on anaphylaxis management is unambiguous. Adrenaline is the first-line treatment. The intervention window is measured in minutes, not hours. Coroners across Australia have previously investigated deaths linked to delayed adrenaline access and made recommendations about it. The RACGP has covered the same point — the National Allergy Strategy has consistently positioned GPs as the entry point for patients who have never before experienced anaphylaxis: no hospital discharge to trigger the remaining PBS pathway, no specialist relationship established, no referral yet made.

Dr Kathryn Heyworth, speaking on behalf of ASCIA’s medical associates, stated plainly: “This decision risks recreating the circumstances coroners have warned about — delayed access to adrenaline, missed opportunities for prevention, and potentially catastrophic outcomes during a first recognised anaphylaxis event.” Dr Rowena Ivers from the RACGP Quality Care Expert Committee noted that specialist waiting lists for immunologists in regional areas can be two to three years. ACRRM president Dr Rod Martin described the decision as “ridiculous” and made explicit the mortality arithmetic: long paramedic response times in remote areas, combined with the loss of GP prescribing authority, increases the risk of preventable death.

The argument that routing patients to specialists improves safety is not credible when the specialist waitlist is measured in years and the allergic reaction in minutes.

2 cents

If you or someone in your family has a known allergy — to foods, insects, medications, or latex — and has not yet seen a specialist immunologist or allergist, this change is directly relevant to your situation.

The practical question for your next general practice appointment is whether your current adrenaline auto-injector prescription was initiated by a GP or a specialist, and whether your renewal pathway remains clear under the PBS. If you are in a regional or rural area and have not yet had an allergy specialist referral, asking your GP about what has changed — and about the PBAC review currently under way — is worth doing now, not after an event.

The PBAC is taking stakeholder input as part of its review. This decision is not final in the sense that advocacy is actively targeting it. But the interim period represents a real access gap for patients outside metropolitan specialist catchments.

Verdict: yes — a regulatory change with direct patient-safety consequences for anyone managing anaphylaxis risk in a community without ready specialist access.

Sources cited

  1. Medical Republic — GPs lose special dispensation to write PBS adrenaline scripts. 8 July 2026. https://www.medicalrepublic.com.au/gps-lose-special-dispensation-to-write-pbs-adrenaline-scripts/127143
  2. RACGP newsGP — GPs lose PBS adrenaline prescribing exemption. https://www1.racgp.org.au/newsgp/clinical/gps-lose-pbs-adrenaline-prescribing-exemption
  3. ASCIA — Allergic disease in Australia. https://www.allergy.org.au/patients/allergic-disease-in-australia

Frequently asked questions

  • Can my GP still prescribe adrenaline if I have a known allergy?

    Yes — GPs can still write prescriptions for adrenaline auto-injectors. What has changed is PBS subsidy eligibility. A GP can now only initiate a PBS-subsidised prescription for patients discharged from hospital after an acute anaphylaxis event, or when consulting alongside a specialist immunologist or paediatrician. For other patients with known allergies who have not been seen by a specialist, the prescription is available privately at $120–$190 rather than the $25 PBS co-payment. This is the access gap that rural health advocates are responding to.

  • If I already have an EpiPen prescription, can I renew it through my GP?

    The changed restriction applies to initiating a PBS prescription. Whether GP renewal prescriptions remain eligible under the PBS depends on individual circumstances and how the PBS listing is interpreted by the dispensing pharmacist. Patients who currently hold a valid prescription should discuss continuity of supply with their GP. The PBAC review is ongoing and the situation may change — this is an active area of advocacy.