‘Someone will die needlessly.’

remote rural regional Australian animals sign

A former Guild state president has lashed out at current and proposed Government policy, saying the PBS is already “crumbling”

Ian Todd, an honorary life member of the Pharmacy Guild and a former president of the South Australian branch, has written an open letter to health stakeholders in which he says he has never seen such catastrophic stock shortages, and outlining his fears if certain proposed policies are legislated.

Mr Todd writes…

I’ve been helping a pharmacy out in a small single-pharmacy town 300 km from Adelaide in the last couple of weeks so I thought I’d just share my experiences in the light of the recently proposed ‘two months’ supply fiasco.

I did about 150 prescriptions on my first day and maybe 40 of those were originals; the rest were repeats. Most of these were for blood pressure, cholesterol, diabetes and mental health drugs. All of the big killers in Australia and all the more so in the bush where services are stretched already. The town has one doctor, a nursing home and a small hospital. 

Out of my 8.5 hour day, I spent about two hours doing the following largely unproductive and unremunerated work:

  1. I had to re-pack four lots of Avapro 300mg in packs of 15 tablets so that I could give people the equivalent of 150mg a day for a month. I then had to re-label their packets and alter their repeats. Luckily I had spoken to the GP in the town and he OK’d me doing this if necessary.
  2. One male patient is on HALF a 150mg Irbesartan a day so I can’t give him a half pack of 300mg because they can’t be quartered. I gave him one box of 75mg, labelled take TWO a day and I owe him a box. I checked both wholesalers and there were THREE boxes left in stock of any brand. They were a brand no-one has ever heard of, luckily, so I got the last three in South Australia.
  3. I couldn’t source any brand of Elocon cream from the usual wholesaler. I had to pull in a favour from another wholesaler to get the last few tubes of Novasone to fill three prescriptions. Two were authorities for increased quantities so no-one got their full supply. Hopefully it will be back in stock soon.
  4. There was no prednisolone 1mg at Symbion to fill a script for a sliding scale that requires 1mg increments. I managed to find some in a patient’s Webster supplies that they aren’t using at the moment so I borrowed them, had to make the appropriate notes in both patients’ files so that I can reverse the loan when the product is back in the warehouse.
  5. In each of these cases I have to reprint the labels and repeat forms so that they are correct, speak to the patients to get their OK, explain ad nauseum how the government’s price slashing of the PBS has led to the medicine shortage problem and tomorrow I’ll have to show them the new tablets to make sure that they know what they’re taking.

I’m pretty sure that the two hours I spent propping up the PBS today could have been spent much more productively dealing with the health issues of the people who were coming in because the GP was booked out. This has been how I have spent every day of the last two weeks and every week looks like being the same now.

I’ve been at this for more than 35 years and I have NEVER seen the catastrophic levels of stock availability that I have over the last six months. I know that there will be misadventure despite our best efforts and someone will die needlessly either through mixups or lack of stock.

Now somebody in the bureaucracy wants to double the quantities for all of these ‘safe’ medicines. It’s laughable that the Government and the Department of Health can be so divorced from reality that they don’t see that the PBS is crumbling.

How will patients’ lives be improved by exacerbating the shortages by doubling quantities, closing pharmacies and forcing the sick and elderly to travel further for life saving supplies? The nearest big centre from this town is Mt Gambier. If all of those pharmacies survive it’s still a 320km round trip. Not far in a Commonwealth car obviously, but a bloody long walk when you can’t drive.

The current approach to the PBS spending, medicine prices and pharmacy support is destroying one of the world’s best and most equitable drug delivery programs that has delivered immeasurable health benefits.

There will be no alternative than for us to take sides in this election, supporting the major Party that acknowledges these problems and vows to address them. It is a very sad state of affairs for quintessential small business people and health professionals to be having to make this choice.

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  1. Paul Sapardanis

    Sounds like my typical day in metro Melbourne as well. Was abused today as the only no disolving potassium was Euro K isn’t PBS listed. Private Rx. No Rosuzet 10/20 private ezetrol and rosuvastatin. Lercanidipine no generic available candesartan no generic. Why are the branded ones last to go out of stock but they’re the first to come back? That is a question that I would like answered. Please.

  2. Jeff Lerner

    You wrote: “One male patient is on HALF a 150mg Irbesartan a day so I can’t give him a half pack of 300mg because they can’t be quartered. I gave him one box of 75mg, labelled take TWO a day and I owe him a box.” This appears to be a dosage error, unless I’m missing something?

  3. Apotheke

    Can someone explain to me why Pharmacy owners think that the Liberal party is the “best for small business” despite all the evidence to the contrary. Who presided over the $1.00 discount fiasco? Who has kept dispensing fees low and cut your markup to 10% and abolished it entirely for really expensive medications? When you look at the evidence then you may wake up to the fact that it does not matter who is in government the Health bureaucracy only seems to have one goal in mind. Cut the operating costs of the PBS. They are not interested in your financial viability! Wake up!!!

  4. Wilson Tan

    So true, the words Ian Todd used about govt & DOH being “so divorced from reality they don’t see the PBS is crumbling.”

  5. Bruce ANNABEL

    What Mr. Todd and others have encountered is the result of the supply chain under enormous duress resulting from price disclosure, a policy that was instituted in 2006. Since then it has been tweaked by both sides of politics in order to contain the growth of PBS expenditure resulting in pharma companies, generic distributors and wholesalers being forced to cut costs, address their business models and even trim stock holding quantities plus even ranges.
    Let’s remember too that pharmacy chased the trade discounts hard, and why not, that resulted in more cuts hence additional pressure on suppliers followed by pharmacists pushing harder for discounts and so the cycle went on until where we are today. However, much of the discounts pulled out of pharmacy dispensing profitability have been put back by the current government through indexation, AHI replacing the old mark-up 1 July 2015 (a master stroke) and the risk share compensation applied from 1 July 2017. So compared with the supply chain sectors pharmacy is in far better shape.
    There’s not much left for the supply chain though. Mal and I explained all of the factors and impacts in our May 2018 AJP column and we predicted it would get worse…and it has.
    The published government data is the key and tells a story of the policies both sides of politics really are about which is keeping PBS outlays from growing and any new listings have to be internally funded. In 2017/18 PBS net expenditure was $9.3bn compared with $8.8bn in 2013/14. And the April federal budget papers reveal it’s not expected to grow much over the next four years with 2022/23 expenditure forecast to be $9.7bn. So while the politicians on both sides make grandiose new drug listing promises the question is how will these be funded particularly if the department(s) (Finance and Health) expect net PBS expenditure to only grow by $400m compared with last financial year?? Expect more pressure on the supply chain. It seems the most common drug shortages are generics (because distributors have been hit very hard) meaning originators are, comparatively, in most cases more readily available.

    • Karalyn Huxhagen

      Some time ago I was part of a high level meeting with big pharma discussing the impact that the generic substitution rules would bring to Aus. Big pharma outlined very clearly how tiny Australia is in the global medicine market. The presentation showed us population growth expectations across the globe and where pharma would put their research and money. There were dire warnings in that meeting and we are now seeing the outcomes that were predicted. Once the dept of finance became the firm controller of health budget discussions by 3CPA a whole new tactician controlled our destiny.

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