Getting the right agreement


43281150 - medicines with money inside

In the second of a series, Kim Brotherson, Pharmacy 777 Managing Director, discusses five crucial objectives for the 7CPA

In the first of this series, we looked at the scene in which the Seventh Community Pharmacy Agreement is being negotiated. Now we’ll look at the actual detail of what needs to be acheived. 

When considering the outcomes of the 7CPA, these five key points need careful consideration:

  1. Professional Services Funding

It does not make sense to cap a service that is delivering a measurable outcome to patients. No other health professional is expected to see just 20 patients per month. If a service can deliver an outcome that adds significant value or can save expenditure from other parts of the health budget, then that service needs to be treated with respect, along with the Pharmacists providing the services.

As with any service, accountability and integrity checks need to be factored into the framework of the 7th CPA.

Some examples of key services: 

  • Dose Administration Aids (DAA’s)
    The cost and time to deliver DAA’s is well documented. A key challenge for many carers is managing the medicines regime for their loved ones. The Pharmacist plays a key role in delivery of this service and to cap the funding creates an extra hurdle for Community Pharmacists to sustain and invest in this service.
    Non-compliance on medicines where health conditions are complex, can be a significant factor in the patient needing to move out of their own homes, into Aged Care or be hospitalised, at significantly greater cost to the family and the taxpayer.

Managing the continuity of medications plays a significant role in helping all Australians live in their own homes with dignity and prevents the likelihood of hospital admission and re-admission.

  • Hospital discharge medication review

The reconciliation of medicines for a patient after being discharged from a Hospital is important to ensure there is no disconnect from the Hospital to a patient’s home and to the patient’s regular GP. 

A modified medication review could be developed to ensure that medication misadventure is reduced with the aim of reducing unnecessary hospital re-admissions.

A 4-week blister pack could also be incorporated to manage compliance.

There are over a 250,000 unnecessary hospital admissions* every year due to medication mismanagement and is critical we reduce. 
                                                          * PSA Medicine Safety: Take Care Report | January 2019

  • MedsChecks
    The MedsCheck process is a fundamentally sound tool that could be developed in specific disease states.

E.g. Chronic Pain MedsCheck Patient – S B, 40 year old female with chronic pain. Was taking Lyrica 300mg bd on a staged supply. However, became addicted to Lyrica, was buying it off the streets, stealing from her mum. Always came in for early supplies. Convinced her to sit down with us for a MedsCheck. The tool was actually amazing. It allowed us to connect her to local Physiotherapist and Psychologist. Four months on, she is now on just 25mg Lyrica in the morning and 50mg at night, along with Panadol Osteo. Just found herself a job!! She brought her mum in for a Chronic Pain MedsCheck recently as well. It’s amazing what simple interventions can achieve.

Swarup Afsar | 2015 Pharmacist of the Year 2015
and 2016 Pharmacy Year of the Year (Pharmacy 777 Nollamara)

  • Asthma Plan
    which could be targeted prior to allergy season as a priority.

  • Mental Health
    needs to be a key priority and an area where Pharmacists already have a significant role in medication management and compliance.

  • Immunisation
    has been a key success and the opportunity exists to widen Pharmacists’ scope in administering vaccinations into the future. Every vaccination delivered through the pharmacy network, adds up to a significant saving to the overall Medicare spend.

  • Screening for blood pressure
    A nationally funded screening for high blood pressure during Heart Week would be a simple and measurable service.

Many of the recommendations above could be co-ordinated into an Australia wide health calendar.  There is the potential for true collaboration between the Government and the Pharmacy Industry where the focus is on health outcomes with clearly defined and measurable goals.

2. CPA Capping

Is the capping of the 5-year Community Pharmacy Agreement the starting point of best practice and in line with how the medical profession and other essential services are funded for 2020-2025 period?

3. High Cost Drugs

The total spend of the PBS in real terms is split into Community Pharmacy and Hospital Pharmacy. The growth in the Hospital component of the PBS is linked with a higher proportion of the high cost drugs.  It needs to be considered, that a dispense fee of $70 on high cost items is a very small component of the total PBS spend in the key area that is growing.

4. A key policy concern from the 6th CPA must be addressed – $1 Co-payment discount

The time spent negotiating a $1 discount on a prescription, that does not lead to any real saving for the most vulnerable of our community, is not just a massive productivity loss; it is also the cost in time the Pharmacist has to build rapport and trust with their patients.

This is an example of policy that may have been well intentioned yet has been a significant contributor to the de-professionalisation of the Industry and a push to a “customer” focused business model.

A Co-payment is certainly important to ensure that value is placed upon the medicine however to ensure a real saving to all patients, the starting point for the next CPA should see pensioner and concession prescriptions reset for patients minus the $1, to ensure immediate benefit to patients. Eg. Based on 2019 costs – reset to $5.50 for concession and $39.30 for general respectively.

5. Review the proposed 60 day dispensing of 143 common items

A key implication of this policy if it is continued to be championed by Government, is on the two key functions Pharmacists provide to patients, that is ensuring compliance and ensuring the quality use of medicines.

 

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1 Comment

  1. Debbie Rigby
    12/03/2020

    Medication conciliation is not a comprehensive medication review. It can be part of a medication review. Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. It’s a really important role for community pharmacists and accredited pharmacists conducting medication reviews.

    Not sure what a “modified medication review” is. I think consumers deserve a comprehensive medication review if at risk for medication misadventure.

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