60-day dispensing, dollar discount ‘gone in the Agreement’

Guild reveals controversial 60-day dispensing proposal and optional $1 discount are not written into the newly announced 7CPA – though the latter continues indefinitely despite low uptake

The Covid-19 pandemic played a “critical” role in changing the government’s position on 60-day dispensing, Pharmacy Guild national president George Tambassis told the media on Friday.

On Thursday, the Seventh Community Pharmacy Agreement (7CPA) was signed by the Guild, Minister for Health Greg Hunt and the PSA.

However the controversial proposal for extended dispensing lobbied for heavily by groups such as the RACGP and Consumers Health Forum is now off the table completely, Mr Tambassis confirmed.

“It’s gone in the Agreement. Covid-19 played a critical role there. It was panic stations in early March, it was obvious that if anyone in the pharmacy community or the medical community either prescribed or dispensed larger quantities than 30 days, we’d have a serious problem in this country,” he said.

“It was a worldwide issue. Other countries that are on more than 30 days’ supply, like New Zealand, Canada, some other European countries, they all went back to 30 days.”

The measure had been proposed by the Pharmaceutical Benefits Advisory Committee (PBAC) nearly two years’ ago, with the Pharmacy Guild continually voicing strong concerns including potential impact on the viability of the community pharmacy network, as well as impacts to patient medication adherence and medicines wastage.

However the Covid-19 pandemic revealed wider issues with the proposal including how it would impact the medicines supply chain.

“It may have been a great idea two years’ ago when PBAC recommended it, but we’re living in a different world now,” said Mr Tambassis.

“It certainly became quite obvious that it wasn’t something the government could support during the early days of the pandemic, hence the TGA recommendation on their website in early March saying ‘no more than 30 days’ supply, please’.

“I think that the government recognises and acknowledges that, which is why it’s out of the Agreement. Of course we will say our bit about clinical issues, wastage issues, but the Covid-19 pandemic certainly put a stop to that.”

Meanwhile the optional $1 discount on PBS co-payments is still continuing, although Mr Tambassis highlighted that it has not been written into the agreement this time around.

“We tried our best with what we thought was a bad policy decision five years ago – the optional $1 discount, to get that off the table,” he said. “That piece of legislation is still in place, up to $1 discount, up to the pharmacy owner’s discretion.”

However the data shows the measure “has not been too successful” with an uptake of about 28%, said Mr Tambassis.

“The data shows also that the most chronically ill patients don’t take it up anyway, especially now with the safety net being reduced, people are happy to pay the extra dollar to get up to the safety net really quick, end of story. Why delay the safety net?” he said.

“One of the strategic reasons why we didn’t think it was a good idea to even have any a mention about the optional $1 discount in this agreement is because we don’t support. Last time they put it in there and they put a little disclaimer saying ‘the Guild won’t support it’, because we told them we wouldn’t. So that was crazy.

“They certainly still think it’s a decent idea – we don’t. So, just leave it out of the Agreement. Let’s keep advocating for solutions.”

Mr Tambassis confirmed the Guild’s solution continues to be a dollar reduction on all PBS medicines across the board.

“If the co-payments are not at the right level, don’t give the discretion to the pharmacists to decrease the co-payment, decrease that co-payment to everybody. We’ve offered that solution to the government many, many times,” he said.

“But it’s obviously a money issue. If we can find the money to get that solution on the table, I think they’ll agree, but we may need some more time.”

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