Does the current pharmacy system reward low-value care?


Discount pharmacies are making a ‘mockery’ of the current remuneration arrangements, say leading pharmacists

The Small Pharmacies Group (SPG) and Rural Pharmacy Network Australia (RPNA) have hit back at allegations that the government is propping up community pharmacy.

Patient-centred community pharmacies, especially those dealing with a higher proportion of sick, elderly and higher needs patients, are in fact propping up the current PBS with free services, say the groups.

Meanwhile discounters and low-care pharmacies make a “mockery” of the current remuneration arrangements, they argue, “by claiming the PBS dispensing fee while failing to provide the care that claiming the fee requires them to provide”.

Consumers are increasingly taking advantage of this system by getting their medicine wherever they can find it cheapest and then presenting at a patient-centred service pharmacy with the expectation of free advice, argues Peter Crothers, 2019 PSA Pharmacist of the Year, who is a member of both SPG and RPNA.

“It creates a real dilemma” he says.

“Not only are legal and professional responsibilities blurred, but the pharmacist being asked for advice is faced with the decision to charge the consumer for advice that the Commonwealth has already paid another approved pharmacist to give, provide free advice and cop a loss, or turn the patient away.”

SPG and RPNA say that this is now extremely common and a source of great anger to their members.

“It is pretty obvious who is propping up whom. We have some pharmacies routinely overlooking their professional responsibilities in a very calculated way while nevertheless collecting Commonwealth payments, with another group of pharmacies acting in the spirit of the PBS by providing a quality service and being paid less than they deserve.”

“This isn’t the only damage being done by the discount model,” says Mr Crothers. “We are also seeing increasing dispensing errors. In August alone, my small, rural pharmacy picked up four separate cases of prescriptions that had been dispensed for the wrong patient – all from pharmacies promoting themselves as discounters.

“With the dispensing technology we have today, these sorts of errors should be next to impossible and it can only indicate that people are cutting corners bigtime.”

SPG member and Independent Pharmacies of Australia founder, Steve Flavel, said: “Discounter marketing has trained the public to accept a model that focuses on customer discounts achievable rather than see the value of quality pharmacy care.”

The two groups want Community Pharmacy Agreement negotiators to explore options such as capping dispensing-related payments at a certain number of scripts per month, and indexing the dispensing fee and other services payments according to remoteness and the socio-economic demographics of the pharmacy.

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6 Comments

  1. Robert Laird
    06/09/2019

    I’ve had this issue for many years. Since the big boxes started opening up really. Initially I would ask them to return to the pharmacy or even go into a long drawn out conversation with them why I couldn’t match their price but explain to them all the things we do for our patients and community the discounters can’t.

    A couple of years ago I decided to change as often the patients would not come back. Nowadays for those we realise are only coming in for advice and professional services and not actually purchasing anything we go absolutely out of our way and ideally make them feel when they leave that they have learnt something valuable. These people obviously value advice, hence why they come in and are ripe for the picking. The ones totally set on price we lost years ago. It sometimes takes a few occasions but when done well I would say at least 70% start using us. Sending them back to the big boxes makes me feel as though I am behaving the way they do, i.e. not in the spirit of traditional community pharmacy.

    On a side note there is a big yellow box close to us that actually routinely sends people to us when they have clinical questions saying, “you’re better off going to a proper pharmacy, there’s one down the road!”

  2. Michelle Gerrie
    06/09/2019

    I managed a pharmacy in San Francisco for 12 years. We noticed this happening there in the mid 90s. The owner had a discussion with all the staff and decided on the following: Free advice on prescription medication only to be given to customers of the store ( some common sense exceptions). eg. Person asks random question re drug A. We say ,let me check your profile and they respond saying they bought the drug elsewhere. We then politely refer them back to that pharmacy and explain that we like to keep complete profiles on our customers and document interventions for best patient care. It worked like a charm and we stayed in business another 10 years before the greedy landlords tripled the rent!

    • Jarrod McMaugh
      06/09/2019

      I’ve had several conversations with people in my pharmacy where I explain to them that I can’t speculate on their medication and health without an adequate dispensing history to refer to, and that they should return to the place they purchased the medication from.

      “But I bought it from a supermarket”

      Then ask the supermarket the advice you are seeking

      I’ve had one specific patient (who asks us all types of interesting questions) say to me that I can’t decide where he shops…. I had to explain to him that I have no interest in telling him where to shop, but that I also will not put my registration and insurance at risk by providing advice on something without the full details. 90% of the time the product people want advice on isn’t even with them, so it’s a complete guess.

  3. Robert Laird
    06/09/2019

    I’ve had this issue for many years. Since the big boxes started opening up really. Initially I would ask them to return to the pharmacy or even go into a long drawn out conversation with them why I couldn’t match their price but explain to them all the things we do for our patients and community the discounters can’t.

    A couple of years ago I decided to change as often the patients would not come back. Nowadays for those we realise are only coming in for advice and professional services and not actually purchasing anything we go absolutely out of our way and ideally make them feel when they leave that they have learnt something valuable. These people obviously value advice, hence why they come in and are ripe for the picking. The ones totally set on price we lost years ago. It sometimes takes a few occasions but when done well I would say at least 70% start using us. Sending them back to the big boxes makes me feel as though I am behaving the way they do, i.e. not in the spirit of traditional community pharmacy.

    On a side note there is a big yellow box close to us that actually routinely sends people to us when they have clinical questions saying, “you’re better off going to a proper pharmacy, there’s one down the road!”

    • PharmOwner
      06/09/2019

      I’ve been saying this for years. CHW are not real pharmacies. They are just retailers/marketers that happen to process (NOT dispense, because that takes a certain level of care) scripts.

  4. Still a Pharmacist
    06/09/2019

    I remember proposing a cap on dispensing by individual pharmacist which was immediately dismissed by a senior pharmacist.

    Putting a cap on dispensing fee per month per pharmacy is a very good idea for saving small independent pharmacies.

    Waiting to see whether Guild really wants to save these pharmacies or they are just against CWH but in favour of other discounters.

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