COVID-19 has ‘exposed’ systemic problems: rural pharmacists

Small pharmacies – including rural pharmacies – are still having problems obtaining PBS medicines, as advocacy group calls for a drastic change in the medicines supply chain

Temporary nationalisation of the medicine supply chain should be considered as rural and remote pharmacies struggle to get access to medicines for their communities, says the Rural Pharmacy Network of Australia (RPNA).

The group has announced it is “ramping up pressure” on the Federal Government to take drastic action, arguing that the events over the past few months have shown that the Community Service Obligation (CSO) does not function in the way it is supposed to.

“This is not just about resolving the short-term supply problems but also about the long-term issues with the CSO that have been going on for a long time now, and which have been exposed on a larger scale as a result of this crisis,” RPNA spokesperson Katie Stott told AJP.

Many pharmacies around the country, irrespective of which wholesaler they use, are still reporting out of stocks, items on back order and shortages of some medications, the group told AJP earlier this month.

“Some pharmacies are on a drip feed of five Ventolin a day regardless of need. Many pharmacies have been dumped by their second line wholesalers. In some instances wholesalers have explicitly stated that they cannot meet their CSO obligation,” said RPNA.

Meanwhile two weeks ago, the ACCC announced that wholesalers of medicines had been granted interim authorisation to co-operate to facilitate distribution of essential medication and pharmacy products.

“Allowing pharmacy wholesalers to work together to help make vital medicines accessible to everyone during this pandemic is clearly in the national interest,” ACCC Chair Rod Sims said.

Mark Hooper, Chairman of National Pharmaceutical Services Association (NPSA), which represents wholesalers including API, Sigma, Symbion and National Pharmacies, said: “This is an important development, which will build on emergency measures taken by each wholesaler, government and other stakeholders to appropriately calibrate and optimise the medicines supply chain as we respond to increased demand for both medicines and pharmacy products during this crisis.”

However RPNA, which represents rural and remote pharmacies across Australia, says the ACCC move is not enough.

“The government has sought to intervene by adjusting wholesaler deeds, allowing wholesalers to collaborate and so on. But these interventions are not addressing the root cause of the problems,” it says.

“The root cause of the problem is that CSO funds have been diverted by the CSO wholesalers to underwrite group trading terms, a purpose for which they were never intended. These funds should be used solely to equalise freight charges in order to put rural and remote pharmacies on an equal footing with metro pharmacies.

“COVID-19 may be a ‘force majeure’ event but it has exposed the systemic problems with pharmaceutical distribution in Australia.”

The group calls for total reform and re-engineering of the system, including consideration of radical options such as temporarily nationalising the medicine supply chain for the duration of the pandemic.

RPNA says it has made representations to a number of rural MPs about its views on the CSO and medicines supply issues, including Rural Health Minister Mark Coulton.

NPSA chairman Mr Hooper has reassured in recent statements that the NPSA is “working 24 hours in distribution centres across Australia to ensure everyone can access the medicines they need, no matter where they live.”

An NPSA statement delivered on 12 March stated: “Our established national infrastructure network is geared to rapidly and efficiently transport to every part of Australia including rural and remote areas, and servicing these areas is a particular focus.

“NPSA members are working with Government and the full supply chain to help ensure Australia’s health system continues to deliver timely access to medicines to the community.”

Meanwhile, a poll run by the Small Pharmacies Group (SPG) found over 96% of the 57 respondents (as of Wednesday evening) report that they are still having problems obtaining PBS items.

SPG covers small pharmacies across both rural and metro areas.

“The situation has most definitely not gone back ‘to normal’,” says Dr Stott, who also represents SPG as a spokesperson.

“The medications in question include Ventolin, Seretide, Symbicort, Eutroxsig, Pyralin, Panadol.

“Many are having problems getting enough flu vaccines to meet demand as well, but it is our understanding that this is distributed outside the CSO.”  

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