The end of NPS MedicineWise

The National Prescribing Service was established in 1998, by the Department of Health and Family Services, to improve health outcomes by supporting the quality use of medicines (QUM).¹ The establishment of an independent, not-for-profit organisation working alongside government was considered progressive and insightful policy. Over the next 24 years the organisation, now known as NPS MedicineWise, built a trusted reputation for providing national leadership, education, behaviour change and resources to support QUM and medicines safety in Australia.

In March 2022, the Federal Government’s budget included a redesign of the Quality Use of Diagnostics, Therapeutics and Pathology Program. Some functions of NPS MedicineWise would shift to the Australian Commission on Safety and Quality in Health Care, while others would be subject to new contestable funding arrangements.

These unexpected changes to the role and funding of NPS MedicineWise have led to a decision to end its operations in December 2022. It is therefore time to reflect on the impact of the organisation and its people, celebrate the achievements and look to the future of QUM and medicines safety in Australia.

The fundamental role of NPS MedicineWise is stewardship of the QUM objectives of the National Medicines Policy.² Early evidence-based strategies embraced the ethos of QUM with clinical audit and feedback, educational visiting and newsletters. Publications grew to include NPS News, RADAR, and, from 2002, Australian Prescriber, possibly the most widely read medical journal in Australia. As the impact, reach and credibility of NPS MedicineWise evolved, its range of initiatives grew.

A critical strength of NPS MedicineWise programs was behavioural intervention. When NPS MedicineWise was first established, some were suspicious that it was an arm of government set up to save money. However, over time, the organisation built trust, respect and credibility through well-designed interventions, with an evidence-based approach and being mindful of the complexity of prescribing and medication management.

One of the principles of QUM is partnership. NPS MedicineWise therefore worked collaboratively with member organisations, other associations and government to ensure its programs were grounded in issues important to consumers and other stakeholders.

An example of partnership is Choosing Wisely Australia, launched in 2015. This is a key social movement involving NPS MedicineWise working with health professional colleges, societies and associations to address low-value and unnecessary healthcare practices.

With a multidisciplinary view, the Prescribing Competencies Framework was developed. This describes prescribing expectations for all prescribers and also curriculum design for medical, pharmacy and allied health courses.³

NPS MedicineWise’s MedicineInsight program provides important insight into real-world prescribing practices, supporting quality improvement in primary care and postmarket surveillance of medicines. Its reach at a local level also enables evaluation of the impact of NPS MedicineWise programs. NPS MedicineWise has delivered over $1.1 billion in direct savings for the Pharmaceutical Benefits Scheme and Medicare Benefits Schedule, representing a twofold net return on investment for the government.⁴

Consumers are at the centre of every program and resource created by NPS MedicineWise. Their voice is present across every step of program needs assessment, design, delivery and evaluation. Innovative programs including Be MedicineWise Week, Good Medicine Better Health, Medicines Line and Adverse Medicine Events Line, mass audience campaigns such as Antibiotic Resistance Fighter, and the MedicineWise app have made a substantial contribution to the health literacy of consumers to enable Australians to make better decisions about their medicines and health.

A subsidiary, VentureWise, was established in 2015, to extend QUM activities, beyond those supported by government funding, to other areas of the health system. This was a strategic decision to raise revenue to build equity and financial stability for NPS MedicineWise.

In 2018, the Department of Health undertook a review to provide clarity and guidance on NPS MedicineWise governance, performance, transparency and accountability.⁵ The review acknowledged the high quality and valued resources used in the delivery of the programs to support the Quality Use of Medicines and Diagnostics, but made recommendations for improvement. NPS MedicineWise accepted the recommendations in principle. It committed to enhancements to deliver efficient, flexible and innovative QUM programs, while VentureWise was wound up in 2020.

The policy change announced in March 2022, to cease funding for NPS MedicineWise, was met with dismay and disappointment across the health sector. A change of government led to a rapid review to assess the appropriateness of the proposed redesign of the Quality Use of Diagnostics, Therapeutics and Pathology Program.⁶ This desktop review occurred without much stakeholder consultation. When it reported in August 2022, the review identified several risks in the proposal. However, it supported moving QUM stewardship functions to a standards-based organisation, accompanied by competitive tendering for program delivery and design.⁶ As funding for NPS MedicineWise will therefore end on 31 December 2022, the board of directors had little choice but to close the organisation.⁷

The legacy of NPS MedicineWise must drive the future direction of QUM stewardship in Australia. NPS MedicineWise had a remarkable record of excellence, innovation and engagement, particularly with primary care and consumers. The imperative for an independent, evidence-based QUM voice in Australia remains more important than ever.

Conflicts of interest: Deborah Rigby was a Director of NPS MedicineWise from 2008 to 2020.

This article is peer-reviewed.

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