Category of Prescribers in Malaysia MOH Setting

Introduction

The drug prescribing system in government hospitals and clinics is categorized into different prescriber categories, as outlined in the Ministry of Health Medicines Formulary. These categories include

• A* - Consultant/Specialists for specific indications only
• A - Consultant/Specialists
• A/KK - Consultant/Specialists/Family physician specialists
• B - Consultant/Specialists/Family physician specialists/Medical officers
• C - Consultant/Specialists/Family physician specialists/Medical officers/Paramedics
• C+ - Consultant/Specialists/Family physician specialists/Medical officers/Paramedics/Paramedics doing midwifery

NOTE: A family physician specialist at a government clinic can prescribe medications listed as A/KK, but not those listed as A* or A.

This categorization system aims to improve the quality of patient care by ensuring that qualified professionals are responsible for prescribing medications, while also controlling drug procurement costs.

Quality Use of Medicines

The prescriber category system implemented by the Malaysia Ministry of Health is a positive step towards improving the quality of patient care by preventing inappropriate medication prescribing.

• The different categories of prescribers are based on the level of training and experience of the prescriber, which helps to ensure that patients are receiving care from qualified professionals.

To illustrate, a medical officer is not authorized to prescribe antipsychotics to a suspected depressed patients or an antiglaucoma eye drop to a suspected glaucoma patient.

Budget Control

The prescriber category system also serves to control the expenditure related to drugs procurement.

• Newly introduced and expensive drugs are initially listed as specialists' or consultants' medications. Over time, they may be gradually moved from categories A or A* to A/KK, and then to category B.

This gradual transition prevents the unjustified use of medications by junior doctors and helps manage costs.

The Rigidity of the System

However, the prescriber category system does have some drawbacks, primarily its rigidity and inflexibility.

• Many commonly used medications, such as rosuvastatin, empagliflozin, esomeprazole, terazosin and Symbicort, require specialist or consultant countersigning.
• When a medication is listed in Category A* or A, it can only be purchased through hospital logistics, but not government clinic. This creates difficulties for those who wish to continue their care at government clinic.
• Since certain medications are restricted to specific prescriber categories, patients may face difficulties accessing those medications if they are no longer under the care of a specialist or consultant. This issue can be particularly problematic for patients who require long-term or chronic medication management.

Summary

The rigidity of the prescriber category system serves as a mechanism to control the prescribing of certain medications and prevent their misuse or overuse by less experienced healthcare professionals.

However, striking a balance between flexibility and maintaining control over medication prescribing is crucial to optimize patient care.

• To address the issue, it is beneficial to periodically review the categorization of medications. This will allow for medications to be moved to different categories based on their safety and effectiveness.
• Also, consider broader access to certainly commonly used medications in government clinics helps to ensure patients can receive appropriate and uninterrupted care.