Cap on or cap off?

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A recent column has restarted the debate over whether the Home Medicine Review cap needs to be lifted. Here’s how our readers responded

A recent AJP column by pharmacist Karalyn Huxhagen has reignited debate over the contentious cap on HMR numbers, as well as other costs relating to the program. a lot of comment from our readers.

“When I receive an HMR request I must action that request within 90 days of the referral being written by the GP. That rule was fine when I could perform as many HMRs as I had in my inbox. That rule is no longer viable now that I can only see 20 patients a month,” Ms Huxhagen said.

“On any given month I receive 20 referrals from each of the practices that I provide services for, plus referrals from at least five pharmacies who use my services. At last count I service 20 general practices which in turn multiplies to 80 GPs plus five regular pharmacies. On any given 1st of the month there are 90 referrals to be actioned in my in-tray”.

Ms Huxhagen was also critical of the lack of any kind of improvement in allowance for some of the costs associated with providing HMRs.

“Those of us that took on that challenge had to upskill, spending a lot of money on becoming accredited, staying accredited and jumping through more hoops than anybody else in the profession to keep practising. 

We were given pittance to perform an important role… payments such as travel allowance have stayed at their original price while fuel, costs of maintaining a car and accommodation costs have skyrocketed”.

A number of readers have endorsed Ms Huxhagen’s views. Here’s a selection of responses: 

Debbie Rigby – “I do not accept that the caps on HMRs should continue. Caps are a blunt instrument to restrict access and contain the funding pool. The recently announced auditing of HMRs claims is a positive step to assure compliance with program rules. Karalyn highlights the challenges of the caps in delivering high quality HMRs in a timely manner, especially in rural and remote areas.

Ongoing negotiations for the 7CPA provide an opportunity for reflection on the value of HMRs to the funder and to patients and the health system. Refinement of the program rules can still occur. Targeting of high risk medicines has been suggested many times through numerous expensive evaluations. And yet no action has been taken to date. Other changes to the program rules have also been recommended in evaluations. And yet no action has been taken to date”.


David Cannalonga – “7CPA Negotiators, HMR’s are one of the most effective tools available in Australia to improve medication management and quality use of medicines. Reducing caps, extending referral life, increasing travel allowance are the only ways to see the true benefit of this service, period”.

Christine Wise – “Well said Karalyn. We just butt our heads on that brick wall. I also service a remote area and just last week travelled 1600km round trip, 2 nights away from home, for HMR/ RMMR work. We do it for the love of it, certainly not the financial profits!!

Before caps, I could spend a week and provide service to as many patients as the GP wanted me to see and still come out on top. Now, I have to limit the time away and balance the number of HMR referrals in the remote towns with those I receive closer to home. Why travel hundreds of KMs to do HMRs when I could stay home and do just as many? Certainly makes better sense financially to just work around home.

BUT, like Karalyn, I have spent many years building the relationships. I grew up out there. I have a connection and if I don’t do the travel, this region misses out completely!! I have tried to share/ give away the region and no-one will take it on”. 




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1 Comment

  1. Big Pharma

    Not really much of a debate….

    Accredited pharmacists, community pharmacists, hospital pharmacists, patients, GPs, carers, specialists, hospitals…..all in favour of HMRs

    The only opposed group is the most powerful in the political arena. A group that called for a HMR moratorium….to be replaced by the almighty “medschek”

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