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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