Deregulating pharmacy across the ditch

Man tears up page that reads "rules" (Harper Review)

New Zealand’s government is preparing changes to pharmacy ownership which will mean pharmacies will no longer need to be part owned by a pharmacist, but by any “fit and proper” person.

According to Pharmacy Guild of Australia Victorian branch president Anthony Tassone, it’s a clear indication of what can happen when ownership restrictions are relaxed.

New Zealand legislation already permits non-pharmacists including supermarkets to part-own pharmacies, though each must be majority owned by a pharmacist (minimum 51%). Pharmacists can hold a majority stake in up to five pharmacies.

NZ Minister for Health Jonathan Coleman describes these rules as “an anomaly”.

“Licences do not normally seek to restrict business owners, but rather regulate the risk of an activity via conditions,” Minister Coleman notes in the documents.

“Conditions on a licence, rather than ownership restrictions, better manage risks and enable a competitive market.

“These ownership controls are unnecessary to ensure the integrity of the supply chain and manage risks to public health.”

The documents state that ownership controls are only needed to limit prescriber interests in pharmacies.

The Guild’s Anthony Tassone says New Zealanders will be worse off under the changes, which are currently in a draft stage, with a Bill expected to be released for consultation later in the year.

“What this will mean not only for pharmacy in New Zealand but for the broader community is an eventual lack of competition in the sector – there is likely to be a concentration of ownership by larger corporate players,” Tassone told the AJP.

“Ultimately the consumer will lose over a lack of choices and lack of access in regional areas. This has been demonstrated repeatedly in a number of overseas jurisdictions.”

He says that the changes will make it easier for international chains such as Walgreens, CVS or Boots to move in.

“There’s every possibility of that. We only have to look at the recent media regarding concerns around the conduct of Boots management towards its employees to consider that there’s a possibility of that kind of activity happening closer to our shores,” Tassone says.

“And there hasn’t been any demonstrable evidence to my knowledge that deregulation of ownership has increased opportunities for pharmacists to go into ownership for themselves.

“There are some from within the industry advocating for a relaxation of ownership, and have pointed to the current split ownership model of New Zealand as a possible consideration.

“This clearly shows that any relaxation of ownership may very well result in a fully deregulated system. So let’s not be naïve enough to think corporate interests will be satisfied with a minority shareholding.”

He says patients will likely experience delayed access to medicines, poorer quality of health care and management of chronic disease.

“The list goes on. It’s sad that there’s another example of deviation from an evidence base of pharmacist owned community pharmacy providing significant health care benefits.

“This is why ownership and location rules are die in the ditch issues for the Pharmacy Guild. It’s not just for the sake of members but for the sake of the Australian community and the great outcomes community pharmacy offers.”

Under the plans pharmacies will continue to require a licence, issued by the regulator, which will set conditions on licences, require information and “assess whether the applicant is a fit and proper person or, if a corporate, of good repute to hold a licence”.

A Responsible Pharmacist would need to be identified and be responsible for the pharmacy’s day to day operations.

Minister Coleman also proposes that “pharmacy licence applicants be required to name a Supervisory Pharmacist with responsibility for advising owners on, and overseeing, the implementation of professional pharmacy standards and licence conditions.

“The role of Supervisory Pharmacist is aimed at ensuring that professional practice standards are upheld in a commercial environment and would be additional to the current requirement for a Responsible Pharmacist.”

In a small pharmacy, these could be the same person. Both would be answerable to the licence holder.

“The Medicines Act also contains provisions restricting prescribers from taking any interest in pharmacies, unless granted an exception by the regulator,” notes the Minister.

“While designed to prevent prescribers benefitting financially from their prescribing decisions, the current wording may negatively affect the development of integrated health services.”

He proposes “a more focussed prohibition on prescribers benefitting from their prescribing decisions through investment in pharmacies” which enables prescribers and pharmacies to develop more patient-centred integrated services (for example, shared systems, staff, or working space).

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