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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