Face the facts, doctor

Anthony Tassone, Guild Victorian Branch President

Pharmacy Guild of Australia’s Victorian branch president, Anthony Tassone, responds to comments by Dr Evan Ackermann

This is part one of a two-part rebuttal published on the AJP. Read part two here.

Dr Evan Ackermann, in a broad attack on the community pharmacy model, makes the unsubstantiated claim that: “the PBS system for medication delivery has been mostly unchanged over 50 years; it is costly and inconsistent with the needs of the community or pharmacists.”

He gives no figure of this cost or what would be considered a reasonable amount (just that it is “costly”).  The 6th Community Pharmacy Agreement that commenced on 1st July 2016 outlines the specific breakdown of agreed costs for the delivery of PBS benefits through Australia’s 5,500 community pharmacies.

It also outlines the funding for pharmaceutical wholesalers who deliver PBS benefits to the community pharmacy network, including the ‘Community Service Obligation’ (CSO) funding pool whose underlying objective is to ensure all Australians have timely access to the PBS medicines they require, regardless of the cost of the medicine, or where they live.

The CSO was established to help achieve the objectives of the National Medicines Policy which include:

  • timely and affordable access to the medicines that Australians need;
  • medicines meeting appropriate standards of quality, safety and efficacy;
  • quality use of medicines; and
  • maintaining a responsible and viable medicines industry.

Against the backdrop of these requirements and commitment to equity of access, Dr Ackermann provides no substantiation that the current distribution arrangements are “inconsistent with the needs of the community”.

Dr Ackermann also proposes: “A central supplier would take on the role of drug storage and supply of drugs for non-urgent illness medication, rather than pharmacies as is now the case, and medication delivery would utilise IT and transport systems taking the drugs straight to the patient’s door”.

It is baffling to see how a central supplier that delivers to the patient’s door (for 24 million Australians) would be more affordable and cost-efficient in delivering than an accessible network of 5,500 community pharmacy outlets across Australia (that is already underpinned by a Community Service Obligation for guaranteed timeframes).

The inference a central supplier could handle the supply of drugs for non-urgent illness medication shows a disturbing lack of understanding of the challenges with maintaining patient adherence to prescribed medicines in the community which are regularly seen by community pharmacists.

In its submission to the Pharmacy Remuneration and Regulation Review, the Pharmacy Guild cited an extensive array of evidence related to consumer views and beliefs about community pharmacy. The submission can be viewed here

A common myth is that the PBS is unsustainable and a significant drag on the overall Federal Government budget.

The reality is the PBS is sustainable and the Federal Government continues to reap significant savings from the scheme which are worn by community pharmacies.

Federal Government expenses on ‘pharmaceutical benefits and services’ in 2014-15 were $10.3 billion, representing around 2.5% of total Federal Government expenses.

Overall pharmaceutical benefits and services expenses constituted 15.7% of Federal Government total health expenses. Even with the 2015-16 spike related to higher-than-expected PBS payments, expenses were only 2.8% of the total.

Furthermore, PBS spending related to only Section 85 items in 2014-15 was only $7.1 billion, down 3.1% on 2013-14, pointing to the fact that the magnitude of government spending on PBS items that flows through community pharmacies is even less.

Hence a critically important public policy area – the timely access to the medicines that Australians need at a cost that individuals and the community can afford – comes at a cost to the Federal Government of less than 3% of its total expenses.

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  1. Adam

    I suggest that pharmacists be legislated to write prescriptions for all routine & non urgent medications as well as charted regular accommodation home medication charts

  2. Nicholas Logan

    Dr Ackerman seems to feel pressured to blurt out inflammatory and inaccurate anti-pharmacy statements in a bid to remain relevant to the ~30% of registered medical practitioners whom he represents.

  3. Consultant Pharmacist

    For the facts about the Guild defunding the HMR program read the following document using “HMR” in the “search” field.


    • amanda cronin

      Interesting reading. I did also note the 1500 HMR’s done out of the home each month and I can see why this became an issue as it seems a very high number and I bet they were churned out by some less scrupulous operators.
      I had always thought it was sour grapes on the Guilds behalf but I can see some evidence of abuse for the first time. Still the caps are ridiculous, and the Guild clearly wanted to switch to more Medschecks instead to regain control.

      • Consultant Pharmacist

        Note the budget was reduced by 30% from July 2013. Exactly the time when the Guild started rhetoric about unscrupulous operators.

        In the 5CPA document only a breakdown of combined Medschecks and HMR budget by year is given and only a separate budget for HMRs and Medschecks for the full five year period.

        Why would the Guild hide a major budget decrease for HMRs from accredited Pharmacists and then try to lay the blame on operators not the budget?

        Obviously they thought they could withhold this information. It was only made public because of this report.

        • Pharma

          Wow what a joke! Budget reduced at a time when the predictors indicated program expansion. Way to use one’s political clout to sway government decisions. Conflict of interest much ACCC?
          Around the time Medschecks were introduced was it? Further political spin was that the PGA used funding from other programs to “top up” the HMR short-fall, when indeed they withdrew HMR funding to support other programs to begin with.

      • Pharma

        Would be pretty clear where the numbers were claimed from for anyone interested in looking/auditing. No different to a GP claiming a home visit that was done in the surgery…it’s Medicare fraud. Don’t see a capping of all GPs due to the unscrupulous few.
        Sour grapes indeed an element. Not once was an audit called for. Just a moratorium when “funding ran out”. No one else was privy to these stats but the PGA who chose to do nothing until they could push their own agenda.
        Whilst 1500 seems excessive I would be interested in seeing how many indigenous Australians across the country were included in these numbers where the definition of “home” is a vague one. Tracking down these patients with an aboriginal health worker is indeed a challenge which doesn’t necessarily fit the “home” criteria.

  4. amanda cronin

    I would love to know what a lack of pharmacies would do to public health- all those minor complaints we deal with for free each day. It would not be feasible for this to be dealt with by a GP and it would not be financially viable for OTC pharmacies to operate.
    And th delivery to the door part completely misss the part where a pharmacist goes though and helps the patient understands and manage their medications. It is pretty insulting how little Dr’s think of pharmacists. I think as part of both our professions it would do us good to spend a month at Uni in their environment. I think a trainee GP would benefit greatly from the OTC knowledge and PBS understanding, and pharmacists on reception at a GP surgery might also learn a thing of two to make us more empathic to their situation.

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