Codeine: the fallout

Australians have been warned they may have to pay more for low-dose codeine now it’s on script… and pharmacists are cast as the culprits

In a Herald Sun article this week, News Corp national health reporter Sue Dunlevy has examined the codeine upschedule and highlighted the issue of cost to patients.

“Now the pills are prescription only, chemists will be able to charge a dispensing fee for supplying the drugs that will raise their price,” wrote Ms Dunlevy, who has written a number of articles critical of pharmacists and dispensing fees in the past.

“The dispensing fee for PBS medicines is around $7 per pack but chemists can decide to set their own dispensing fee for private scripts, some may not charge one at all.”

The article does point out that formerly-S3 codeine will not be PBS subsidised.

One pharmacist told the AJP of his surprise when he went to order Nurofen Plus with the new Prescription Only packaging – and how the price change affected his ordering decision.

“They used to charge us $6.91 for a pack and it cost us $17.95 – it went up $11! I’d have thought RB would be a bit more cautious about tripling the price overnight,” he said.

“The thing is, there’s a big difference in what the public are going to pay for it. Forget about the fact that they may have to see the doctor and pay a copayment and wait to see them – in addition there’s this tripling in the cost price to pharmacies.

“It’s important [for us as pharmacists] to get it out there that because it’s prescription, the price will have gone up. It’s not necessarily because pharmacies are hiking it up, but because we’re being charged this ridiculous amount.”

He says he suspects that when generics come out with Prescription Only packaging brand prices may drop.

“We still ordered, but instead of a dozen we got three, because I think there’ll be some resistance from patients to paying that.”

Pharmacy Guild Victorian branch president Anthony Tassone told the AJP that many patients were already frustrated with the upschedule, concerned about the time needed to visit a GP as well as out-of-pocket costs; the increased cost of the product itself will likely not help.

“It’s a concern to some of our members that the public may perceive that this has been instigated by pharmacists themselves, when it hasn’t – there’s been an increased cost at the manufacturer level,” he said.

Pharmacy fallout

A backlash from patients angry that they can no longer access codeine over the counter has been expected by the pharmacy sector.

NSW Health Minister Brad Hazzard spoke on 2GB and asked the public not to take their anger out on pharmacists, as the decision was made by the TGA, not pharmacy – a comment which prompted NSW Guild president David Heffernan to call the Minister’s office and thank him on behalf of pharmacists.

AJP spoke to several pharmacists, several of whom had done their best to advise of the upschedule ahead of time, and thus did not have to deal with angry patients.

Others spoke of consumer anger – but generally, this had occurred before the measure was implemented.

Elise Apolloni from the Wanniassa Capital Chemist in the ACT told the AJP that the pharmacy had served one patient who “honestly didn’t know about the change and used OTC codeine infrequently”.

This patient had been prescribed a stronger variant in the past but preferred OTC codeine-containing analgesia as they did not like the strength of the prescription product.

“They were very civilised and understood, and we arranged an appointment with their GP for them,” Ms Apolloni said.

“We did spend many many months preparing our community for this and have been dispensing a reasonable amount of codeine medicines since December anyway because of the awareness raising.”

Several pharmacists spoke of the “frenzy” on the last day of January as patients attempted to stockpile.

“There was a guy coming in to try and get it – he knew it was finally up and he wanted two packs of codeine, but we would only give him one,” said Tim Rudd, of the Capital Chemist Ulladulla, NSW.

“He got quite aggressive and tried to intimidate the staff to get a second box.

“Then the lovely gentleman decided to knock a few things off the shelves and knock our Thermoskin mannequin into the street.

“Pharmacy will probably get a bit more of this as withdrawals kick in. I’m on the lookout, I’ve got a feeling he won’t be the last. But we’re at the coalface, and we just have to deal with it and try to triage these people as best we can.”

Angelo Pricolo from the Tambassis Pharmacy in Brunswick, Victoria said that on the last day of January, it was as though the “penny dropped” for a number of patients.

“Most we couldn’t help, and there was a little bit of frustration because people legitimately thought they’d gotten in before the change,” he said.

He also warned that some health professionals do not have a good understanding of the upschedule, and that this has not been helped by mainstream media reports which have confused which products were subject to the change.

A Fairfax article, for example, mistakenly referred to a “ban on pharmacists supplying medications like Panadeine Forte and Nurofen Plus”.

“We had a couple of allied health professionals, like nurses, ringing today [February 1],” Mr Pricolo said.

“One in particular wanted to know if we had any Panadeine Forte, because she thought it might be hard to get.

“People don’t really understand the new landscape.”

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