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Subsidised isotretinoin (Isotane) has until now only been available from a specialist dermatologist. General Practitioners have always been able to prescribe the drug.

From 1 March 2009 PHARMAC will widen access to vocationally registered general practitioners. PHARMAC consulted on the proposal last year citing that the restriction has created equity of access issues, because not all potential patients could afford, or had access to, a specialist dermatologist (particularly for people in lower socio-economic or rural areas).

Isotretinoin is a potentially dangerous medicine given that it is teratogenic and there is ongoing debate around the evidence of increased risk of suicidal ideation. PHARMAC says that the access widening decision has been made with full awareness of these safety issues.

The Royal New Zealand College of General Practitioners has publicly welcomed wider access.

Special Authority applications will be required for all subsidised prescriptions and can be made by any vocationally registered dermatologists, vocationally registered general practitioners or nurse practitioners working in a relevant scope of practice.

An article will be published in the next edition of Best Practice Journal (BPJ 20) which will focus on evidence based treatment of acne and clarify the role and relative effectiveness of the different treatment options including isotretinoin (further details of PHARMAC’s decision will also be included in this issue).

The Special Authority form for isotretinoin is available online at: http://www.pharmac.govt.nz/2008/12/21/SA0947%20Isotretinoin.pdf