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

* In the field of dentistry, Dental Senior Consultants/Consultants/Specialists and Dental Officers are included in the prescriber category as mentioned above; however, this applies only to medicines used in dental treatment.

* As highlighted in FAQ section of Garis Panduan Formulari Ubat Kementerian Kesihatan Malaysia 2025, Public Health Physicians, Epidemiologists, and Pathologists are not included in the "Specialist" group that can initiate treatment for categories A or A/KK. The specialists mentioned above can only initiate medications that fall into prescriber category B. If medications with prescriber category A or A/KK are to be used, a relevant specialist must be consulted.

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.

The prescribing category for drugs listed in the MOHMF is determined by the MOHMF Panel.

• This determination is based on current needs and practices, taking into account the expertise and availability of equipment at facilities required to monitor treatment while using these drugs.

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.

Government healthcare facilities operate on a limited budget that must cover all medication usage.

• Without a prescriber category system, any medical officer could attend a continuous medical education talk or read the latest guidelines and begin prescribing expensive medications to patients without restriction.
• Such unrestricted prescribing would quickly deplete the allocated funds.

Nonetheless, cost is a significant limiting factor in providing patients with the most advanced treatment.

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.
• Nonetheless, the prescriber category system is crucial for budget control.

Garis Panduan Formulari Ubat Kementerian Kesihatan Malaysia 2025 has clarified several key issues to overcome the rigidity of the Prescriber Category system.

• A visiting specialist can initiate treatment by prescribing category A* medications, and the subsequent prescription can be continued by the Medical Officer at that hospital.
• Additionally, a Medical Officer at a Hospital Without a Specialist can also initiate treatment using category A* medications after consulting with or obtaining consent from a Specialist/Consultant Specialist at a State/Specialist Hospital.
• In the absence of a Facility Medical Specialist (FMS) at the clinic, a medical officer can initiate treatment using a particular medication after consulting with or obtaining consent from the FMS. The most effective and impactful method for verifying this consultation for drug use would be to decided at the facility or state level during their respective Drug and Therapeutics Committee (JKUT) meetings.
• Any use of prescriber category A or A* medications in primary healthcare facilities (clinics) requires approval from the MOHMF Panel via a Dossier D3 application. This application to amend the prescriber category can be submitted by the State-level Drug and Therapeutics Committee (JKUT).

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.