Guild wins script length war… amid fallout

tug of war vector

A proposal to increase dispensing quantities for some drugs has been scuppered following Guild concerns – and stakeholders have slammed the Guild

The measure, suggested by the Pharmaceutical Benefits Advisory Committee several months ago, did not come to light until this week, when the Pharmacy Guild heard that 140 molecules could be affected.

Mainstream media including News Corp articles say the measure was to have been included in the 2019 Budget, to be handed down on April 2.

Upon learning of the proposal, Guild national president George Tambassis wrote a piece for pharmacy media urging the Government not to adopt it, followed by a strongly worded communique to Guild members in which he said the Guild was now in dispute with the Government over the “retrograde” step.

The Guild then took out a full-page advertisement in The Australian, asking the Government to support community pharmacy in Tuesday’s budget.

The measure has now been scrapped.

Health Minister Greg Hunt told News Corp media, including health reporter Sue Dunlevy, that the proposal would not go ahead at this stage.

“The medical experts on the PBAC have provided a proposal for doctors to be given the choice to prescribe a larger medicine pack size for some patients who have stable and chronic conditions such as high cholesterol, high blood pressure and glaucoma,” he said.

The Guild's advertisement in The Australian.
The Guild’s advertisement in The Australian.

“The Government will carefully consider the proposal and is not proposing to change medicines pack sizes at this stage, the proposal would be the subject of extensive consultation with consumers, the medical community and the pharmacy sector.”

The Minister’s decision not to go ahead prompted outrage from the Australian Medical Association.

AMA national president Dr Tony Bartone told 3AW’s Ross Stevenson on Friday morning that the Government had “caved” to Guild lobbying.

He said that the Guild ad clearly referenced the viability of community pharmacies, and there was “no clinical reason” behind its opposition to the measure. Instead, pharmacists were putting “profits ahead of patients,” he said.

Dr Bartone said that the patients who would have been eligible to get two months’ supply at once instead of one were “well-controlled, well-managed, buying into their own management plan”.

“You can safely say that they don’t need to go every month, there are no unexpected alterations in their condition, and if there are, they’re well informed, they’ll come back, they’ll tell you,” Dr Bartone said.

“They could’ve saved themselves a trip, a set of either $6.50 or $40.50 depending on if they’re concession or not concession, and the Government would’ve saved $7.29 every month.”

CEO of the Consumers Health Forum, Leanne Wells, expressed dismay at the immediate rejection of the proposal, saying that “we can see no reason for this measure not to proceed. It is supported by the medical community, expert advisers, and consumers”.

“It is also safeguarded by only applying to patients with medication regimes that are well controlled, and whose doctor has made a decision to prescribe the increased pack sizes,” 

Ms Dunlevy also wrote that the proposal would have saved money and been more convenient for patients, and that “at a time of low wage growth, the measure would have been welcome relief for Australians struggling to make ends meet”.

Many comments on Fairfax’s piece on the matter slammed the Guild, with a number of readers erroneously believing it to be a union.

“Who is running the country? The interests of 24 million Australians have to bend to the avarice of 5723 greedy pharmacists, have you ever met a poor one?” wrote one reader.

Another called the provision of medicine and pharmacy services “money for jam”.

However a couple of pharmacists also spoke up to explain that pharmacies are small businesses which need to remain viable.

“Will a cafe owner be forced to give out free meals just because there are people starving??” wrote one reader. “Then why do we? P.S. from the cases that we’ve been dealing with for years. More medication at home will mean more issue as there’s no guarantee that you’ll TAKE it. We find adherence issues week in week out.”

Senator Duncan Spender – the Liberal Democrats Senator for NSW who replaced David Leyonhjelm, who was elected in the NSW state election last weekend – also waded in, saying he has diagnosed the Guild as “chronically ill”.

“The Pharmacy Guild predictably has put the interests of its members ahead of the health of everyday Australians,” he said. “And the fact that the Government has appeared to bend to their wishes shows the political system is sick.

“The wishes of the Pharmacy Guild should not have trumped the advice of the independent advisory committee, who investigated the suitability of doctors prescribing a longer supply of much-needed medicine.”


‘We put up a stop sign.’

Pharmacy Guild national president George Tambassis has hit back against claims of “greedy pharmacists,” speaking to 3AW’s Neil Mitchell on Friday.

“We, the Guild… always support more affordable medicines for our patients. I mean, we see that every day in our pharmacies,” he told Mr Mitchell. “When patients can’t afford their medicines, the first people they talk to is us.

“All we did, was we got wind of this idea that the Government was thinking about doing, we’ve only got scant details about it, we only got some details yesterday, we put a stop sign up to start with, and said hang on, we haven’t been consulted. We’ve got a five-year agreement that expires next year, let’s sit down and have a look at these proposed changes.

“They’re very complex. They actually affect patients and the way they take their medicines, and yes, it means that some patients may have access to two months’ supply compared to one month’s supply, but that could potentially seriously affect the viability of our pharmacies.”

He said in response to Mr Mitchell’s question that “of course” the opposition to the proposed measure was about the financial side for owners as it could affect the viability of pharmacies, but there were also other considerations.

“We’re saying to the Government, let’s sit down and consult about this. There’s issues around compliance as well for our patients.”

There are also issues around which medicines would be involved, he said.

“Are we going to be part of that clinical decision-making process? Which medicines are going to be excluded? Does it mean that patients are coming in ad hoc – some come in every month, some come in every two months?”

The measure could mean that patients come in once a month for some medicines excluded from the proposal, and once every two months for those included.

“Will that add to your Safety Net? Are we just putting quantity over quality?”

He said that while there was not a problem with Mr Mitchell filling a script for statins every two months, for example, pharmacists could monitor whether he was actually taking those tablets as prescribed.

Mr Tambassis said that the Guild was open to discussing such a measure in the 7CPA.

He cited the Guild’s proposal to reduce the script co-payment for all PBS scripts to make them more affordable instead.

“Why don’t we look at the really chronically ill patients that take more than five medicines? All of a sudden we’re going to be doubling the quantity of five different medicines… why don’t we just reduce their co-payments to make it more affordable?

“Some of those patients, they want us to pack their medicines every week. Why would they want to be coming in every two months?”

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  1. Rosemary Peacey

    So far much of this debate has focused around Pharmacy viability which, in typical fashion the Guild puts forward time and again as it’s first priority and in doing so creates a media frenzy getting both the AMA and the public offside in the process.
    Having worked in community pharmacy in the UK a few decades ago prior to prescription repeat authorisations being available there, I often dispensed large quantities of medications, particularly in the elderly population who had ‘stable’ conditions. This resulted in the most incredible stockpiling of unused medications the the home, medication misadventure, and a significant cost burden to the NHS (as a direct result of unused medications). Many of our ageing population are living longer in their own homes with less close oversight of their medications compared to an Aged Persons Home environment. I would hate to see an accumulation of unused medications in the home or even increased volumes of medications which could lead to confusion in this demographic. ‘Stable conditions’ also can change with new prescribing regimens which may be beneficial to patient outcomes. Examples of this include changing from warfarin to DOACs, changes in BP medications or discontinuation of LD Aspirin consistent with new prescribing guidelines or deprescribing in the elderly.
    I am not a fan of having multiple medication packs in the home due to wasteage and potential misadventure. This wasteage will cost the NHS more than people realise.
    The Safety Net was introduced to give disadvantaged patients a ‘fairer go’. Let’s focus on improving the way that is delivered in this group, especially for ‘singles’. Let us also invest in medication reviews and G.P. training to prevent overprescribing and, with the assistance of pharmacists, focus on strategies to deprescribe where possible leading to better patient outcomes and decreased NHS costs.

  2. Michael Post

    Multi month supply has considerable community support. Social media commentary is overwhelming and gment are aware- expect this change to dispensing practice come 7cpa negotiation

  3. Alexander Wong

    This was always what it was about… a test of power

    • Tony Lee

      Correct. The guild is a very professional lobby & has rearly lost.

  4. Ai Nguyen

    The increase in quantity would affect pharmacy viability which is not about profits but about medication access to patients. Some (or many) pharmacies in the rural are struggling to get enough profits to pay all the bills. They would have to close down. Patients have to drive further to other towns nearby that costs their time and fuel. Those trips may be between 10km to more than 60km or more. That would cost money for patients, right? Time is also precious. They save a few dollars in a box of medication but lose time and money in those trips. What is the point of being able to buy 2 months supply but having no access to medications. This is the hidden “clinical reason” that AMA national president Dr. Tony Bartone could not realise. The Guild’s proposal to reduce the script co-payment for all PBS medications would help all patients.

  5. Mimimomo

    Dear AMA, if you want to pretend to be good n fighting for the patient do it in your industry. Example please do not charge patient extra on top of the Medicare claim. Or reduce the Medicare rebate by half, that would safe the government more money to invest else where. Stop attacking pharmacy industry.

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