Price disclosure policy and lack of support adding to our stress, say pharmacists
“There’s not a day when there’s not a medicine somebody needs that we don’t have,” a pharmacist told researchers from the University of Sydney’s Faculty of Pharmacy, who conducted interviews with 20 NSW community pharmacists in 2015.
According to their findings, published in the International Journal of Clinical Pharmacy, medicine shortages and the effort required to supply the required medications are significantly contributing to pharmacists’ workloads and stress levels.
All participants reported having encountered a shortage within their practice and unanimously agreed that shortages were on the rise.
Workarounds ranged from simple brand substitution to more complicated, time-consuming methods.
“There was no generic/equivalent available! We had to speak to the prescriber to ask for a therapeutic alternative,” says one pharmacist.
Others resorted to the Special Access Scheme (SAS) to access products from overseas or turned to stockpiling.
Effects of the price disclosure policy
Australia’s decision to lower reimbursement prices of medicines is impacting stock levels, the study found.
While some participants resorted to stockpiling, many couldn’t because of coinciding price-lowering adjustments.
In contrast to stockpiling, some participants prefer to lower stock levels of medicines for cost-containment purposes – a phenomenon referred to as “just-in-time inventory” (i.e. increased ordering frequency, not quantities).
This leaves less margin of time to react when shortages occur, say the authors.
“Nowadays, I can’t really keep much stock because the government is constantly reducing reimbursements,” says one pharmacist.
“Every quarter, we expect the price of one medicine to go down. If you hold stock, then you lose, and the government doesn’t compensate,” says another.
Based on the price disclosure policy, both wholesalers and pharmacies reportedly delay purchasing stock, anticipating price reductions that inevitably leads to stock shortfalls.
GBMA president Belinda Wood had warned of such stock shortages as a result of simplified price disclosure at APP2016.
Most participants found out about out-of-stock medicines upon receipt of invoices.
Of concern was that the majority admitted they had never heard of the TGA shortage notification website – the Medicine Shortages Information Initiative.
“The TGA should promote the website better,” study author Dr Betty Chaar told AJP at the National Medicines Symposium 2016. “They should notify doctors clearly that there is a shortage, please don’t prescribe, and try to help out with how we can mitigate the impact.”
Pharmacists have not been adequately informed about the website, she says: one pharmacist interviewed only heard about it from an intern, and another from a patient.
Patients may be driven overseas – including to online pharmacies of dubious authenticity – in the search for their medicines, Dr Chaar warns.
“We don’t know if they end up finding their medicines, but that’s not the way we want it. It’s not a safe alternative. We’re driving our own customers overseas.”
She also urged pharmacists to familiarise themselves with the TGA’s medicines shortages website.
“Pharmacists would be better off if they knew about the website and went to it when needed, and in some cases find out the possibility of when the stock might come back in or what to do; some of the companies do give you tips on what to do.”
“Health professionals and consumers have been encouraged to subscribe to the Medicine Shortages alert service to receive an email when there is a new or updated medicine shortage,” says a spokesperson for the TGA.
“Almost 2030 people have subscribed to the Medicine Shortages email subscription list. A number of these subscribers are pharmacies and pharmacists, and we have received positive feedback from them about the usefulness of this subscription list.
“Medicine shortage information is also tweeted by the TGA,” she adds.
However the organisation is currently conducting an online survey about its communications activities and will use the findings to further improve, the spokesperson says.
Doctors were perceived to rely on pharmacists to resolve the shortage, and participants expressed their frustration with the lack of support from doctors in addition to wholesalers and manufacturers.
Good doctor-pharmacist communication is crucial and doctors should be promptly notified about any shortages, the participants agreed.
“Definitely notify doctors. If they don’t prescribe something out-of-stock in the first place, customers wouldn’t have that entire trauma,” says a participant.
Limitations of the study
The researchers note the sample size of their study was quite small. However being a qualitative study, the point was not to represent large population groups but provide “insight into the actual situation” for pharmacists at the coalface, they say.
There is also a need for further research to explore perspectives of other healthcare providers on medicine shortages in Australia, they add.
See the full study here.
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