Malaysian pharmacists fight for dispensing separation


doctor wearing boxing glove

Doctors and pharmacists in Malaysia are at odds over a new Pharmacy Bill, with pharmacists concerned that the Bill’s measures will not benefit the public.

A key concern for pharmacists is that the Bill, known as Rang Undang-Undang Farmasi (RUUF) does not separate prescribing and dispensing. Doctors in Malaysia have been able to dispense since before Independence from British rule, under a provision that permits them to dispense as a non-profit service.

“We pharmacists would like to state categorically that we object and reject the proposed Bill in its current form as it will not accord any benefit to the public,” Gan Ber Zin, former chief pharmacist at the Hospital Tuanku Jaafar, Seremban wrote to the country’s Star Online. The letter is reproduced on the website of the Malaysian Pharmaceutical Society.

“Any new pharmacy bill without the implementation of dispensing separation (DS) within a stipulated time frame is unprofessional and unacceptable.

“The most important element for the anticipated national healthcare transformation, DS in the private sector (community pharmacy practice), is starkly omitted in contrast to the public/government sector.

“Feedback and input from consumer groups and pharmacists were ignored while those from the other health fraternities were largely incorporated into RUUF.

“Similarly, consumers’ rights and empowerment were placed on the backseat as though the core values (individual responsibility, community participation and affordability) in the Malaysian health vision were unimportant.”

He says that the Bill does not provide adequate consumer protection in medication matters such as consumers’ right to medication choice, and their right to know their medicines as well as their prescriptions.

“There is no justification in delaying the implementation of DS and denying pharmacists the chance to fulfil their role in safeguarding patients’ welfare and using their training and knowledge towards optimising public health.

“Why the double standards?

“This globally proven doctors-diagnose-and-prescribe and pharmacists-audit-and-dispense system remains elusive in Malaysia although developed nation status is just four years away for us.”

He cited a World Health Organisation report, “Promoting rational use of medicines: core components”, which states that “Prescribers who earn money from the sale of medicines (e.g. dispensing doctors), prescribe more medicines, and more expensive medicines, than prescribers who do not; therefore the health system should be organised so that prescribers do not dispense or sell medicines”.

“This is why most countries, including third world countries, opt for dispensing separation as this removes conflict of interest, such as a doctor prescribing medications that earn him a hefty profit,” he says.

Other measures in the RUUF Bill include price control on medicine and compulsory itemised billing; doctors will not be required to give a prescription unless asked; and pharmacy technicians being able to report directly to a doctor.

Gan Ber Zin says pharmacists also insist that a pharmacist, not a doctor, should head the proposed Malaysian Pharmacy Council.

“There will be a great conflict of interest in having a doctor to head the Malaysian Pharmacy Council.

“The members of the council should be elected by pharmacists, as is the practice in the Malaysian Medical Council, and not appointed as proposed in RUUF.

“In addition, the country’s top public service pharmacist should not be reporting directly to the top public service doctor, as is the current situation.”

There is also opposition to allowing untrained personnel, including doctors, to compound medications.

“Pharmacies wanting to compound medications need to meet several strict conditions imposed by the Health Ministry but the untrained doctors need not,” writes Gan Ber Zin.

“Some of our medical counterparts are always demanding that other people, including pharmacists, should not be playing doctor but why should they want to be playing pharmacist?”

 

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