Continued dispensing or conditional dispensing?

Why can’t pharmacists directly access the PBS for their patients? wonders Angelo Pricolo

Many times we have heard various people, organisations or even other governments talk about the Australian Pharmaceutical Benefits Scheme (PBS) being the best in the world. If people are saying this then it probably is a pretty good system, but could it be better?

The PBS system was established by the Labor Chifley Government in 1948 and covered about 140 life-saving and disease-preventing drugs. Medicines on the PBS were free until 1960, when a 50 cent co-payment for general patients was introduced by the Menzies Government.

Then in 1983 a co-payment of $2 was introduced for concession card holders and the general price was increased to $4. Today the general price is $39.50 while the concession price is $6.40 (notwithstanding the $1 discount).

So when we hear how good our system is, is reference being made to price, accessibility or something else? It probably refers to a combination of factors and highlights the fact that although the current PBS has its roots in the 1948 system, it has been able to change and adapt to trends and needs.

Continued dispensing was made available to pharmacists in September 2013 but has been underutilised. Again, probably a combination of factors is to blame.

The guidelines on the PSA website are extensive and for those that have read them, they are quite limiting in the pharmacist’s ability to utilise the scheme. It might be time to consider the conditions under which the scheme can be accessed.

Recently I heard a pharmacist say “That medicine is on the PBS unless a pharmacist recommends it.” How many medicines fall into this category especially in the ‘Pharmacist Only Medicine’ or S3 group? As a pharmacist you have been given the authority to supply and the responsibility to counsel S3 items but this does not extend to having the PBS pay for it.

So we have a situation where the pharmacist assesses appropriateness, counsels and trains but then needs the patient to see a doctor and obtain a prescription, or the price is different. The patient should be at the centre of the PBS, not the doctor.

So what if we change the name of this scheme from continued dispensing to conditional dispensing? Conditional on the dispensing being appropriate.

As pharmacists we make that judgement call every day, and when the decision is that it’s appropriate to refer, then that is what happens, or should happen.

If, on the other hand, it is appropriate to supply—and the conditions will vary depending on the drug and the patient—then the patient should be able to access the PBS via their pharmacist.

So we then have a system in place that could potentially cover a scope of practice that would extend to cover drugs where pharmacists can diagnose and appropriately access the PBS for their patients. Many drugs could fall into this category, and would enable patients to take advantage of the PBS without the current reliance on GPs.

This would have many benefits which are obvious, and include financial and health. Trimethoprim for simple UTIs or flu vaccine, for example: the system is in place, it just needs to be approved to be accessed in this way.

It would save time, money and improve health outcomes as people would have improved access.

Naloxone is a drug that has recently become an OTC medicine, but like many other drugs is also available as a PBS benefit… unless it is recommended by your pharmacist. In an historic decision by the TGA and for reasons which recognised the importance of wider access to save lives after an opioid overdose, naloxone can now be purchased at your local pharmacy. But the price is prohibitive for most.

As S3 drugs are entering a new phase where advertising will be allowable, what better time to make this provision available to such a vulnerable group? Why not embrace this broader advertising platform to inform people on high-dose opioid painkillers or people who inject drugs that naloxone is available OTC?

The next step in the puzzle is to allow the pharmacist access to the PBS so that this life-saving drug becomes affordable.

Surely, as we await a nasal delivery device for naloxone, which has the potential to save many lives, we should be able to rely on the PBS to be dynamic enough to see the benefit in changing the rules. The PBS has survived since the 40s and is still hailed as the best in the world because it has changed.

Who would have thought that after almost 70 years, pharmacists are still excluded from directly accessing the PBS for their patients? Nurses, optometrists, dentists and podiatrists can prescribe but the one group whose speciality is drugs cannot.

Pharmacists are trusted and trained providers of primary health and must be utilised to improve patient outcomes and to save the Australian taxpayer millions of dollars.

Provided we have appropriate and conditional dispensing, the PBS should be there for the patients who are entitled to it not for the practitioners entitled to access it.

Angelo Pricolo is a National Councillor with The Pharmacy Guild of Australia and a member of the PSA Harm Minimisation Committee.

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  1. Debbie Rigby

    Community pharmacy software needs to enable patient care notes. In my opinion every provision of care and sale of a therapeutic product to a patient/customer in a pharmacy should be recorded. And pharmacies need to be registered to access My Health Record – there is so much valuable clinical information there and it’s growing.

    I acknowledge there is no funding model for this now, although clinical interventions program goes some way. But it’s chicken and egg…. What other health professional does not record patient notes at every visit, eg optometrist, physio, speech pathologist etc.

    Until this occurs, it will be difficult to negotiate for PBS, MBS and private health funding.

    • PeterC

      Agree 100% Debbie. We are being held back all the time by things such as ‘last century’ software and regulations that fail to put the patient at the centre. My favourite analogy is that it is like being challenged to a race around the block and having your legs tied together before you start. We fail because things are set up so that we cannot succeed.

  2. Jarrod McMaugh

    I agree with you Angelo.

    In the case of Naltrexone, we either need the ability to have PBS subsidy for schedule-3 items, or we need the ability for schedule 4 items to be prescribed to an individual to administer to another person…. since this is unlikely, PBS supply would be more appopriate.

    I believe there is a case for PrEP to be available on schedule 3 with PBS funding, with either a GP or a pharmacist requesting pathology to monitor for signs of side effects or transmission…. it seems unusual to me that the preservation of health needs to be medicalised.

    Vaccinations is yet another issue, and should attract medicare funding. I can see no good reason why one health professional cannot access public funding to provide a service that all other health professionals can access when providing the same service.

    Debbie’s comments below are also very valid. We should be demanding from our software suppliers greater capacity to record our consultations with our patients.

  3. Realist

    The problem is that a few unscrupulous pharmacy groups will encourage/force their pharmacists to dispense medicines which are not totally necessary/given to the patient.

    We have already had big problems with Clinical Interventions and Medschecks where people have been claiming stupid numbers, so why would the Government allow us to prescribe and dispense directly under the PBS? It would be fantastic, and I believe there are a lot of S4 items we should be allowed to prescribe, like a nurse practitioner, but unfortunately a few dodgy pharmacists have ruined our chances…

  4. thebarefootpharmacist

    I’m with Realist. It’s a fine idea, which would be exploited by the dollar driven big boys, subsequently ruining it for the rest of us and reinforcing the public’s and the government’s general impression of us as all being greedy, money grabbing millionaires.

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