Changes to dispensing fees recommended

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Should pharmacies be incentivised to dispense fewer tablets of drugs at risk of misuse?

It’s an idea that has been put forward by Alfred Health to the Victorian government’s Inquiry into drug law reform, which handed down its report this week.

The inquiry report highlighted misuse of pharmaceuticals as the leading cause of drug-induced deaths in Australia.

In submitting evidence to the inquiry, Alfred Health suggested that in addition to encouraging prescribers to prescribe less, another option for addressing pharmaceutical misuse was to change the fee structure for prescribed medications to ensure patients receive smaller amounts.

Alfred Health stated:

“…community pharmacies receive almost the same fees for dispensing four tablets of oxycodone that they receive for dispensing twenty tablets…Similarly, patients are required to pay the same amount for receiving four tablets of oxycodone that they receive for dispensing twenty tablets…This rigidity provides a presumption that patients will (automatically, reflexively, unthinkingly) receive – and expect to receive – significantly more of a risky drug than they actually need.”

It advised the Victorian Law Reform, Road and Community Committee, which was in charge of the inquiry, that there could be ways to subsidise or incentivise this process:

  1. Pharmacies could be provided with a larger fee where they dispense less than a full box of tablets, compared to what they would have received for dispensing the full box.
  2. Another way would be to subsidise a patient’s fee for medications where they receive a very small amount.
  3. Certain less well-known medications or formulations of more commonly known medications could be subsidised so that they are only available in smaller numbers.

Meanwhile a TGA consultation paper on regulatory options to address opioid misuse suggested making available smaller packs for treating acute pain, and appropriately sized packs for longer treatment when necessary; and changing PBS listings to better reflect circumstances in which opioids are approved for use.

The TGA paper noted that while there are current options for doctors and pharmacies to adapt their prescribing or dispensing to make only small amounts available, “this is currently not a widely accepted practice”.

In considering the evidence, the Committee made a recommendation that the Victorian Government work with the Commonwealth Government to review the fee structure for dispensing medication with potential for misuse, so that the volumes prescribed and dispensed be based on individuals’ needs.

“Fee structure changes could include: incentivising pharmacies to dispense fewer tablets and subsidising patients who receive smaller amounts of medications,” the Committee recommended.

“As part of this, the Victorian Government should work with the Pharmacy Guild of Australia and other relevant bodies regarding the role of pharmacies in improving dispensing practices.”

However a spokesperson for the Pharmacy Guild told the AJP that a dispensing fee should apply irrespective of the number of tablets dispensed.

“Even with staged supply there is a workload and clinical judgement that must be exercised with each supply and should be recognised,” the spokesperson said.

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