An ‘anachronism that needs to go.’

Frequent critic of the community pharmacy sector Dr Evan Ackermann has taken to MJA InSight to encourage longer script durations – saying the main obstacle is pharmacy itself

But the Pharmacy Guild’s Anthony Tassone has hit back at the claims, telling the AJP that Dr Ackermann is “cherry picking” support for his argument.

In an opinion piece titled “Exorbitant costs of routine medication repeats,” Dr Ackermann writes that “it is time to cease an anomaly which increases costs and inconveniences patients without any health benefit”.

“The Pharmaceutical Benefits Scheme (PBS) requirement that dictates monthly medication dispensing for many long-term health conditions is an anachronism that needs to go.”

Dr Ackermann says that having to visit a pharmacy regularly for medication repeats has been described by patients and carers as a “recurring hassle”.

He cites a number of reviews which find “little support” for monthly medication supply, and says that longer script lengths have been linked to improved medicines adherence and lower costs for patients.

“With these medications, there is overwhelming evidence that medical supervision and treatment result in improved patient outcomes, but the rationale for lifelong pharmacist involvement every month is unclear,” Dr Ackermann writes.

“Currently, there is no evidence of clinical or other benefit from going to the pharmacy on a monthly basis to obtain these medications.”

He writes that such an extended script life would not be suitable for medicines used to treat all long-term conditions – antipsychotics and analgesics being less suitable.

“The main obstacle to this reform is pharmacy,” writes Dr Ackermann.

“Loss of revenue from prescription, administrative and handling fees would be significant. If you went to a chemist today and got 3 months’ supply of a drug, they can charge you three times the drug cost and three times the markup on the drug, plus three times the administration fees and three times the dispensing fees.

“Under the new proposal, they could charge three times the drug cost and markup, but only charge you once for the dispensing fee.

“Pharmacy may well invent any number of reasons why this change should not be implemented, but the PBS was introduced for efficient and effective delivery of medications, not to sustain the business models of pharmacy.

“If two-thirds of medical visits were demonstrated to be unnecessary, there would be a major review and immediate change to clinical practice. Pharmacy should be no different.”

At the time of writing, MJA InSight readers largely agreed with Dr Ackermann’s position.

In a poll below the article, 67% of readers (108 votes) selected “strongly agree,” with another 6% (10 votes) selecting “agree”.

However a sizeable minority – 23% or 37 votes – selected “strongly disagree,” with another 2% (4 votes) selecting “disagree”.

The article also attracted a number of comments, with one respondent saying that “the only reason why this proposal wont suit pharmacists is that they lose dispensing fee income – ignore their shroud waving about waste or hoarding or patients at risk of overdoing or whatever” (sic).

Another said such a move would be “long overdue” while a third said that “there is simply far too mich (sic) political influence of pharmacy on government, for all the wrong reasons”.

However another commenter said that Dr Ackermann was “blurring things” and that the articles he cited showed such costs were “primarily the costs of going to the GP monthly for a new prescription prior to dispensing (e.g. as per NHS model), not the dispensing of medication when a number of repeats have been prescribed”.

Other commenters pointed out the existence of Regulation 24 (49), with one stating that the uptake of this option is “very low”.

Dr Ackermann responded to this comment, noting that several conditions surround this regulation.

Victorian branch president of the Pharmacy Guild Anthony Tassone expressed disappointment in the MJA piece.

“Unfortunately, Dr. Ackermann is at it again cherry picking the ‘facts’ of his own convenience,” he told the AJP.

“For instance, in one of the journal articles he cited as ‘evidence’ to support his argument, the study found that not only did longer length prescriptions were associated with more medication waste per prescription but that the ‘prescriber time costs accounted for the largest component of total unnecessary costs’.  

“Also, expecting patients to see their doctor more frequently when starting a new medicine—rather than collaborating with their local pharmacist and medicines expert hardly makes for a sustainable health system given that the MBS continues to grow at a far quicker rate than other parts of the health system including the PBS.

“I can’t say I have heard patients complain about the frequency they need to visit a pharmacy, the most accessible and convenient primary health care destination compared to having to pay a consultation fee for a prescription from a doctor,” said Mr Tassone.

“Perhaps what we should be really talking about is the opportunity to expand the role of pharmacists for medication continuance as happens in other countries which will bring benefits to not only patients but the broader health system.”

Dr Ackermann’s MJA InSight piece can be read in full here.

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