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On 19 March 2018 a new pathway to enter a complementary medicine in the Australian Register of Therapeutic Goods (ARTG) will be introduced – the assessed listed medicines pathway. Australia will then have three types of complementary medicines available to consumers: listed medicines, assessed listed medicines and registered complementary medicines. These are categorised on the ingredients they contain, and therapeutic indications (claimed health benefits) they use.
Listed and assessed listed medicines may only use ingredients which are included in the Therapeutic Goods (Permissible Ingredients) Determination. Registered complementary medicines may use any complementary medicine ingredient, provided it is not in Schedules 4, 8 or 9 of the Poisons Standard.
The table below assists sponsors in determining the appropriate risk category of the medicine based on based on the claimed therapeutic indications.
Three-tiered risk-based hierarchy of indications
| Low risk | Intermediate risk | Higher risk |
|---|---|---|
A low level indication may refer to:
A low level indication must not:
| Intermediate level indications may refer to:
An intermediate level indication must not:
| High level indications may refer to:
A high level indication must not:
|
Listed medicines may only use lower risk indications drawn exclusively from the list of permitted indications. Provided they only use permitted indications and ingredients permitted for use in listed medicines, they can be listed in the ARTG without undergoing pre-market assessment by the TGA.
Assessed listed medicines must have at least one intermediate risk indication, and may also include lower risk indications. Due to the slightly higher risk of assessed listed medicines, evidence of efficacy for all indications require successful pre-market assessment by the TGA before listing in the ARTG.
Registered complementary medicines may carry higher risk, intermediate risk and low risk indications. All aspects of registered complementary medicines undergo pre-market assessment.
The table below summarises the key aspects and regulatory requirements for each pathway to enter a complementary medicine in the ARTG.
Regulatory requirements for complementary medicines pathways
| Listed medicines AUST L | Assessed listed medicines AUST L(A) | Registered medicines AUST R | |
|---|---|---|---|
| Ingredients | Must draw exclusively from the permitted ingredients list. Ingredients must not be included in a schedule to the Poisons Standard. | Must draw exclusively from the permitted ingredients list. Ingredients must not be included in a schedule to the Poisons Standard. | An ingredient from the permitted ingredients list and/or an ingredient in a schedule to the Poisons Standard, other than Schedule, 4, 8 or 9 |
| Indications | Low level indications drawn exclusively from the permitted indications list | Intermediate level indications that exceed the permitted indications list but are not high level indications, and low level indications | High level indications which are not suitable for the listed or assessed listed medicines pathway, and intermediate and low level indications |
| Application | Self-certification that alllegislative requirements are met | Self-certification of quality and safety with pre-marketassessment of efficacy | Full pre-market assessment |
| Evidence | Evidence held by the sponsor | Efficacy evidence must be assessed pre-market by the TGA | Safety, quality and efficacy must be assessed pre-market by the TGA |
| Manufacturing quality | Manufactured under GMP | Manufactured under GMP | Manufactured under GMP |
| Presentation | Presentation cannot state that the product has been assessed by the TGA | Sponsor able to use a 'claimer' on the label and other promotional material to indicate that efficacy of the product has been independently assessed | Sponsor able to use a 'claimer' on the label and other promotional material to indicate safety, quality and efficacy of the product has been independently assessed |
| Post-market compliance | Products may be selected for random or targeted review to confirm applicant certifications are correct. May include review of evidence to support claims | Products may be selected for random or targeted review to confirm applicant certifications are correct Efficacy evidence would not be routinely reassessed post‑market | Products may be selected for post-market review; e.g. if there are safety concerns |