Problems for extended dispensing plan


“Stupid” 60-day dispensing push is “dead in the water” say Guild leaders

Leaders of the Pharmacy Guild of Australia believe that events around the Coronavirus pandemic have helped their push to quash the Department of Health’s push for extended dispensing. 

Speaking at the ‘State of Pharmacy’ panel discussion at APP2020 Online today, Guild leaders said the current crisis had exposed the flaws in the policy proposal, disagreements over which has held up Seventh Community Pharmacy Agreement negotiations.    

The Guild’s lead 7CPA negotiator and Queensland branch president, Trent Twomey, said he believes “MDQ (maximum dispense quantity, ie. 60 day dispensing) is dead in the water”.

“You can’t have two different arms of the one department saying different things,” Mr Twomey said. “The TGA came out yesterday saying we can only give out one box, dispense one months medicine, then you’ve got another arm of health coming out and saying, gee you ought to give out two. Those two things can’t be true at the same time”.

John Dowling, president of the Guild’s Tasmanian branch agreed, saying: “One of the only positives, I suppose, to come out of the COVID-19 pandemic, is that it has shown that giving people greater quantities leads to stockpiling and can cause other problems.

I feel much more optimistic in the last week or so with our discussions with government we may be successful in stopping this particularly stupid measure,” he said.

Natalie Willis, WA branch vice-president, said the PBAC policy was not based on real world situations.

“You can’t make a policy that only applies when everything is smooth sailing. You have to consider the worst case scenario,” she said.

“Everything we said could happen with this problematic plan has proven to be the case, and if this policy had been in place now the outcomes would’ve been catastrophic both from a patient outcome and health care point of view, and it also would’ve completely collapsed the supply chain”.

Mr Twomey said if the Guild hadn’t been “strong in blocking that interim PBAC recommendation last year, it would’ve resulted in catastrophic drug shortages now”.

 

 

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20 Comments

  1. Andrew
    20/03/2020

    60 day dispensing is probably a useful tool in circumstances like this. Pharmacies are likely a huge vector in the community with a high throughput of patients shedding various viruses and touching all kinds of common surfaces. Any reduction in community exposure is a positive.

    • Russell Smith
      21/03/2020

      In theory yes, but if 60-day was to happen, there may well be fewer pharmacies esp in rural areas, so the same ppl will still visit fewer pharmacies, may need to travel further, and the same greed/hoarder types will still come and annoy us the same as the last 2 weeks
      Facing ppl is what we do, and we face disease transmission risks just like drs and their staff do. Getting sick is a risk we take in life not just at work, so theres no point worrying about it – we are all going to die eventually – other than the news media – they are going to go on and on an on and on

    • Michael Ortiz
      21/03/2020

      Hello Andrew, There is no evidence to support your claim that Community Pharmacies are currently a vector for Covid19. If it were, then we would have seen multiple closures of community pharmacies. On the contrary, community pharmacies continue to supply essential medicines to the Australian population in a professional and ethical manner. Medication shortages caused by panic buying are consuming valuable pharmacist time and energy. One has only to walk the supermarket aisles t o see that there are no medication supply controls – just empty shelves. If Amazon was to be permitted to supply medications without restriction, then would a similar situation occur?

  2. Robert Broadbent
    21/03/2020

    Am unsure about the whole proposal – have not analysed pack sizes et al – would the 60 day rule be enforced across all products? and if manufacturers don’t comply with pack sizes will there be problems with access? will pack sizes of 100 (currently giving 3 months supply) be dispensed at the broken rate? Maybe move on to something that can better serve the community. And not let what’s happening at the moment be grounds for a knee-jerk reaction. That’s what I think anyway. If our customers/clients/patients are scared, guide them, don’t politicise their fear.

    • Paul Sapardanis
      22/03/2020

      M M point 11. Do you believe if supermarkets offered pharmacy services that they wouldn’t use their market strength to decimate the pharmacy network?

      • M M
        22/03/2020

        they wont use their market strength. Pharmacies think that they are strong enough but the current COVID-19 crisis has shown us how fragile our pharmacies are. Our pharmacies need to step up, use technology, be prepared for situations like pandemics, epidemics etc. It is a collective work. Also, I have mentioned the Horizontal Digitization of the pharmacy industry. This approach/strategy and framework should align everything together.

        • Paul Sapardanis
          23/03/2020

          I love your first sentence, they wont use their market strength. Gold.

  3. Russell Smith
    21/03/2020

    Not all ppl will take a rational and reasoned view, and will not react well to an end of civilisation event – and not all will actually have 60 days supply of xyz on hand – some will but many will not so then a wotif scenario is this – jo blow had 60 days of xyz 30 days ago, but now has 30 days on hand, demands another 60 days supply – once supplied he now has 90 days. Multiply this by the panic and greed vs need factor and suddenly the supply chain is even more fxxxed than right now. To add to the problems a high% of doctors will write reg24 rxs for other products just to cap off the supply chain breakdown – not only will there be a repeat of the present scenario but it will be deeper and longer

  4. M M
    22/03/2020

    I enjoy reading Guild official comments and opinions.

    The current COVID-19 crisis has revealed the following:

    1- Our pharmacy supply chain is so inefficient, it couldn’t stand less than a month since the start of COVID-19 situation started. – The Government has been wasting taxpayers money on CSO agreements.

    2- Five years community pharmacy agreements makes the pharmacy industry so inflexible to new changes. There should be NO CPAs.

    3- PBS cuts and PBS savings should be directed to Pharma manufacturers to invest in R&D – Pharmacy services such as Medschecks and Clinical interventions add no value to patients. It only lines the pockets of pharmacy owners. It is great that all the current CPA services will undergo audits.

    4- Pharmacy Readiness for pandemics and other problems is ZERO All Quality Control certifications aka QCPP have provided nothing to patients in this current crisis. It is a waste of time and money.

    5- Pharma companies should be an integral part of any future CPA agreements. Why? Because without their R&D efforts we wont be able to find new medications or vaccines.

    6- PSA and PGA responsiveness to the current situation is very poor and lacks strategic depth and long-term planning.

    7-Now, It is proven that DIRECT SUPPLY could have solved many of current drug shortages as they are out of stock at the supplier level.

    8- Smart Consultation to Collection and Order to Reception (Horizontal Digitization of the Pharmacy industry) can certainly fix many problems.

    9- If the 60 day prescription legislation was passed when it was proposed, it could have prevented the current rush to our pharmacies.

    10- The government MUST invest in using NEW technologies in health and pharmacy. Australia is 50 years behind the world.

    11- If supermarkets were able to offer pharmacy services ie. more than 800 new service points we could have been in a better position now. Supermarkets work longer hours and offers better distribution. What will our community do if the local rural pharmacy had to close?? NOTHING – It will be very bad.

    12- Telehealth is not about Telemedicine ONLY – Telepharmacy is equally important just in case the pharmacist couldnt attend to their pharmacy if they contracted the COVID-19 their pharmacy couldnt still be fully operational remotely.

    13- The fight with DOCTORS MUST STOP – if you cant have a collaborative framework then PGA and PSA must stop this mess. People’s health needs collaboration. The solution is easy and it should start/initiated by the treating doctor.

    14- We need Hi Tech companies like AMAZON to enter the pharmacy market in Australia, they will be able to provide flexible digital solutions to the industry in hard times and will help our industry to use the technology better.

    • Michael Khoo
      23/03/2020

      Actually, I am so proud of how myself and my fellow independents in our local area have held up these last two weeks. We went from around 40 lines out of stock to around 200, yet we still managed to fill almost every script, and most of our increased demand seemed to come from people not wanting to line up at a certain large chain outlet. The rationing of supply by our wholesalers and their working through the weekend to restock ( I was receiving back in stock notifications this Sunday !) suggest that the system we have right now is reasonably resilient. Let’s see how things pan out this week.

      I am no fan of Government propping up private industry via things like the CSO, but credit is given where it is due! And yes without a CPA community pharmacy would be much more profitable, but the Australian public would pay the price.

    • Jarrod McMaugh
      23/03/2020

      Welcome back Mina – you’ve been quiet for so long I figured you may have gained some perspective. I guess not?

      Responses to your talking points:

      1- Everyone would note that in fact all supply chains have been affected – this is why supermarket issues are making the headlines.

      It should be noted that CSO Wholesalers identified issues with opportunistic bulk buying from individual pharmacies and sought direction from the department to instigate limits so that medications would be evenly distributed to the PBS network pharmacies. I don’t see how this would have occurred without CSO

      2- Your opinion is noted. When you have evidence, it would be great to see it. I’d be even more interested in seeing an alternative mechanism for ensuring even distribution of commodities within the economy to those areas of high need but low return on investment for the industry *without* a mechanism like the CPA. If your response is to name different economic theories, try harder and apply them to the issue to demonstrate how they would make your case.

      3- R&D Investment by pharma companies is of an order of magnitude greater than the savings within the PBS. To suggest that the savings to the government on pharmaceuticals sold in Australia would actually impact on R&D worldwide suggests that you aren’t familiar with the typical investment needed to create new medications. It also shows a lack of understanding of *who* does this research.

      Agreed on the audits for CPA services. These should always have been audited, and now that they will be, there will be greater clarity on the value they bring to patients.

      4- AUSTRALIA’s Readiness for pandemics and other problems is ZERO.

      Fixed it for you.

      You will note that there are no sections of Australia’s health system that is prepared for a pandemic. While there clearly needs to be strategies to address this, it isn’t isolated to pharmacies

      5- Again, the amount of money in the CPA isn’t comparable to R&D to bring new medicines to market (especially new classes of medicines). This comment also misses the point of the CPA – it isn’t about bringing new medicines to market; it is about ensuring efficient & equal access to PBS medicines and certain services by all Australians in all areas of Australia.

      6- You’re welcome to do a better job Mina. The responses by PSA and Guild (and SHPA, I might add) have been timely, focussed, and in line with both government announcements and advice from epidemiologists & experts in public health.

      7- If stock is unavailable at the supplier level, how is it that direct supply would have done a better job?

      8- “Smart Consultation to Collection and Order to Reception (Horizontal Digitization of the Pharmacy industry) can certainly fix many problems.”

      Please expand Mina. It’s great that you have this opinion – why not make it a thesis and actually give depth to your position.

      BTW I don’t disagree with you on this point – although I’m pretty sure your opinion on implementation would differ to mine.

      9- Regardless of whether 60-day dispensing was implemented, your assertion that it would have prevented panic buying or over-prescribing holds no weight.

      As with all industries, the amount of product available to be sold is balanced against the risk of lost (ie expiry, etc). 60-day dispensing wouldn’t alter the amount of stock held in Australia, it would have caused a contraction in the amount sold and dilated the time in between sales. The net result is the same amount of stock available in Australia.

      60 day dispensing would have zero impact on stock levels, it will only impact on dispensing fees paid to pharmacies. As a result, a sudden increase in demand due to panic buying & inappropriate use of regulation 49/24 would still result in temporary lack of stock.

      60-Day dispensing – if the government is serious – can only be considered if it is designed to reinvest money in to patient-level services agnostic of setting.

      10- Both true and false.

      Yes there must be an investment in pharmacy.

      Australia is not 50 years behind the rest of the world. In fact, Australia is ranked 12 by WHO in overall attainment of health goals; Australia is used by FIP as a reference country for service delivery & practice standards

      11- This point makes no sense. Supermarkets are as affected by panic buying and risks to staff as everyone else. The same question about rural supermarkets could be asked and the same conclusion would be reached – either one closing is a bad outcome.

      12- Telepharmacy is equally important – sure is. It would be great if this could be offered and funded going forward, starting with all HMR services. At the same time, pharmacists offer telepharmacy services every day when they counsel people about their medicines over the phone….. unfunded just like many other services provided by pharmacy. Quantification of the value of those services should be accounted for by yourself whenever you argue that the
      current pharmacy model is inefficient – accounting for the value of volunteer work is a fundamental aspect of determining he replacement cost of a service; the significant unpaid work undertaken by pharmacists needs to be calculated whenever an alternative model is touted as more efficient.

      13- Collaboration requires equal & mutual respect & consideration. It is easy to say that health should start with doctors when doctors don’t have to do anything or change anything in that model.

      There is clear evidence from other jurisdictions that pharmacist-led health interventions are efficient & effective. While collaboration is the aim for pharmacists, collaboration is not “just do what makes the doctors happy”

      14- Maybe, maybe not. I’m not certain they (or similar) would do it in a manner that adheres to required standards in Australia. Disruption is good, but only if it actually creates innovation. Just because Amazon is big and ubiquitous, doesn’t mean it’s innovative.

      There is something to be said for their logistics, and data; how such a model is developed and implemented is key.

      • M M
        23/03/2020

        Points Breakdown…1/14

        1- Our pharmacy supply chain is so inefficient, it couldn’t stand less than a month since the start of COVID-19 situation started. – The Government has been wasting taxpayers money on CSO agreements.

        1- Everyone would note that in fact all supply chains have been affected – this is why supermarket issues are making the headlines.

        It should be noted that CSO Wholesalers identified issues with opportunistic bulk buying from individual pharmacies and sought direction from the department to instigate limits so that medications would be evenly distributed to the PBS network pharmacies. I don’t see how this would have occurred without CSO

        A- Identifying that the opportunistic bulk buying is something easy. A year 5 student can pin point it easily. It doesn’t need millions of taxpayers money to be wasted.
        B- It seems that the pharmacy supply chain informatics (Analysis) always happens after fact. An efficient and responsive system should give us live updates.
        C- The consequence of point B is the massive shortages that have hit our pharmacies and left our patients desperate, frustrated and in danger.
        D- An efficient system should have identified the problem at its early stages and worked on it. This didnt happen and it will not happen. The pharmacy wholesalers are not equipped to do so.
        E- We are still 3 weeks in COVID-19 crisis we haven’t reached the peak yet.By the time we hit the peak there will be no medications in our pharmacies. If the pharmacy wholesalers were so efficient they would have held a press conference, identified the problem and their solution to fix the problem in the coming days or week. This didn’t happen and will not happen. They have cash-flow problems. What is the PGA or PSA solution (NOTHING).

    • Anthony Tassone
      23/03/2020

      Mina

      Jarrod has done a very good job in responding to your comments which I broadly disagree with, but I will say this on point 7, Direct Supply is NOT PROVEN by any stretch of the imagination in the case of prescription medicines to have solved current drug shortages or timeliness of access to patients.

      There’s a reason why AstraZeneca, Amgen and most recently Pfizer all have abandoned exclusive direct supply models of distribution over the past 6 months and that was service delivery levels and impacts on continuity of patient care.

      Anthony Tassone
      President, Pharmacy Guild of Australia (Victoria Branch)

      • M M
        24/03/2020

        Haha, I enjoy reading the funny and interesting comments by Guild Reps.

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