Is the CSO just a sham?

Rural pharmacists are being stonewalled by authorities and feeling anything but assured, argues the Rural Pharmacy Network Australia

While pharmacy leaders and wholesalers parade in the media seeking to reassure the public that there are no critical medicine shortages, rural pharmacists are being stonewalled by authorities and feeling anything but assured about their ability to secure life-saving medications for their patients.

After the mass buying event in early March – where some pharmacists allegedly hoarded six to nine months supply of certain lines – CSO limits were applied… but what is the outcome?

Many pharmacies around the country, irrespective of which wholesaler they use, are still reporting out of stocks, items on back order, shortages of some medications etc. Some pharmacies are on a drip feed of five Ventolin a day regardless of need.

Many pharmacies have been dumped by their second line wholesalers. In some instances wholesalers have explicitly stated that they cannot meet their CSO obligation.

Concerns are also mounting about the reliability of freight services. There is no transparency about what is going on and a growing feeling of unease.

And there are bigger questions too – are some pharmacy chains operating outside CSO by paying their own freight? Are some groups getting access to stock before it is distributed to the wholesalers, with deals to purchase though the 3PL warehouses.

How much stock is being siphoned off the system before it even reaches the wholesalers, where CSO limits apply? To what extent are these loopholes causing the supply problems that rural and small pharmacies are experiencing? Is the Department of Health – whose responsibility it is to secure supply – doing anything about it?

RPNA is asking whether the Federal Government should nationalise medicines as soon as they enter the country in order to ensure stability of supply for the duration of this pandemic, and whether it should be a requirement that any item dispensed under the PBS be distributed under the CSO.

RPNA has been informed by the CSO agency that breaches to the CSO requirements, including the requirement to ensure equity of access to rural pharmacies, will involve sanctions against the wholesaler and possible removal from CSO.

But how will removal of the wholesaler from the CSO help rural pharmacies and how will changes to the deeds improve equity of access, if this problem is being caused by bulk buying outside of the CSO?

Small and rural pharmacies have always regarded the CSO as a sham and now it’s proven to be. The question now is, can it even be repaired?

Can we continue to have a national medicines scheme or will it be a ‘Mad Max’ existence from here on in?

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  1. danielle miller

    Breached all the time by multiple wholesalers. “Oh we sent you the wrong thing on a Thursday, reordered it for you but you for some reason didn’t get it Friday as the warehouse didn’t fill that order just ignored it, you’re too far from Sydney for us to deliver it Saturday and you don’t get deliveries Monday so please wait until Tuesday for your medication cheers.” Actually what happened to me only 3 weeks ago. Aripiprazole depot ordered, sent one box of loratadine tabs.

  2. james jefferies

    I fully agree. I’m not rural but just a smaller city pharmacy and equity of access appears to be a total sham. Imposing order limits once the big boys have already emptied the warehouses and there is no stock anyway is just a cynical attempt to appease the regulators. The order limits should have been an existing measure to prevent that happening in the first place. Then I’ve had multiple instances of placing an order for items which show stock on hand when the order is placed, but when the order arrives the product is mysteriously now on back order.
    Don’t even get me started on Flu vaccinations! There’s prolonged delays in receiving preorders (not to mention preorders just disappearing out of the system). All whilst the big chains are happily vaccinating away with plentiful stock.
    I really think there needs to be an investigation by the ACCC when this is all over, and hefty fines if wrongdoing is uncovered. I also strongly believe there should be forced divestment of banner groups by the wholesalers. There’s clearly a conflict of interest and a strong incentive to favour your own banner groups over independents.

    • Jarrod McMaugh

      influenza stock is rarely ordered through the CSO wholesalers for those that are providing large volumes. They are purchased from direct suppliers or vaccine-specific wholesalers

      In addition, CSO only coveres PBS stock, so influenza vaccinations wouldn’t be covered by CSO anyway.

  3. M M

    I have been saying this for the past 3 years CSO and the pharmacy wholesalers are not efficient. All pharmacists have experience this first hand. Good Luck

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