A flawed agenda

Capsule with dollar signs spilling out

The Government’s current narrow focus on 60-day dispensing and the $1 discount is doing little to ease fears that universal access to medicines is under threat from its determination to cut costs regardless of long-term outcomes, says Anthony Tassone

It is clear there is a blinkered view about these two policies – flawed as they are – that somehow they are a panacea for problems in the health system.

But they are not.

If you look at the 60-day dispensing proposal it is clear that if implemented the big losers will be the community with some pharmacies perhaps being forced to close, services cut and access limited.

In particular, services to the aged such as Dose Administration Aids and services to aged care facilities will be particularly hard hit with pharmacies having to reassess the viability of providing them.

As a health profession, pharmacists are concerned for the welfare of patients if opportunities to assess patient compliance with prescribed medicine – and intervene if confusion or adverse reactions to medicines are identified – are halved.

Already more than 250,000 Australians are hospitalised every year, with another 400,000 presenting to emergency departments as a result of medication errors, inappropriate use, misadventure or drug interactions. If interaction with pharmacists is halved, the natural consequence will be that these already alarming statistics will rise.

This is of particular significance as medicines compliance and avoiding medication issues take on additional importance with our growing ageing population.

Patients will suffer

So quite clearly, the impact of the Government’s proposal will leave patients worse off and reduce the quality of services our pharmacies can viably offer.

And if the Government needed any further evidence that extended dispensing is fraught with danger it need only look at the experience overseas.

This warning was published in the US National Library of Medicine National Institutes of Health: “There is a need to more reliably evaluate the impact of differing prescription lengths on adherence, on patient health outcomes and on total costs to the NHS. The priority should be to identify patients with particular conditions or characteristics who should receive shorter or longer prescriptions.”

And in an article published in the New York Times, the American Psychiatric Association said it was particularly concerned about CVS, America’s eighth-largest company. “The pharmacy’s practice of providing three-month supplies may inadvertently lead more patients to attempt suicide by overdosing, the association said.”

The extended dispensing model does not work. Similarly the optional $1 discount has to be scrapped because it simply does not work, has never worked, and will never work.

All it does is break down one of the tenets of our health system – universality of access to the PBS.

It also unfairly disadvantages many pharmacies already facing business challenges.

A flawed policy

The policy introduced in 2015 has breached this universality of the PBS by allowing an optional $1 discount of the PBS co-payment.  Only about 28 per cent of prescriptions are being discounted, creating a situation where a consumer in a metropolitan area is likely to pay less than a consumer in rural or regional Australia for the same subsidised medicine. This is just unfair and inequitable.

Even the Government’s own Pharmacy Remuneration and Regulation Review recognised it is neither smart politics nor sound policy.  The Review’s Final Report concluded: “The $1 discount has not led to equitable outcomes for consumers …The Australian Government should abolish the $1 discount on the PBS patient co-payment.”

If we look closely at both the 60-day dispensing and the $1 discount polices it is clear that the underlying basis for their implementation is to save the Government money.

But saving money at the expense of patients is just wrong.

Over the past decade reforms to the PBS have saved the Government in the order of $20 billion – and pharmacists have shouldered more than their fair share of this burden.

And now again we have the Government trying to shift the burden of saving money. In a pea-and-thimble tick, one which is fooling no-one, we have the Government looking for a cheap shout by getting community pharmacies to again shoulder more financial pain with the 60-day dispensing and the $1 discount.

The Government insists these policies are all about increasing patient access to medicines but if it is genuine in this commitment it need look no further than the Guild’s More Affordable Medicines proposal.

Difficult negotiations

The Guild is currently in confidential negotiations with the Government over the next Community Pharmacy Agreement and the More Affordable Reforms proposal forms part of these talks.

While not divulging any confidential details of our proposal, the Guild believes high out-of-pocket costs have an effect on the ability of some patients to be able to afford medicines that are vital to their health, so reforms will have positive health benefits.

As part of the reforms, the Guild – as has been our policy for some time – is calling for across-the-board reductions in the PBS patient co-payments for all consumers. High out-of-pocket costs have an impact on the ability of some patients to be able to afford medicines that are vital to their health, so an across-the-board reduction in the co-payments would have positive health benefits.

To be blunt, the Guild has a solution that will work so it’s time for the Government to stop obfuscating and get serious about making medicine more affordable for Australians. Working with the Guild we can get this done.

Anthony Tassone is president of the Pharmacy Guild of Australia’s Victorian branch

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