‘This is a stuff-up and it really needs to be fixed.’

Funding program for rural, regional and remote pharmacy misses the mark, say pharmacists who claim they are worse off under recent changes

The new Regional Pharmacy Maintenance Allowance (RPMA) does not serve those who are most disadvantaged, according to rural and remote pharmacists who say they have been negatively impacted by the changes.

Formerly called the Rural Pharmacy Maintenance Allowance, the new RPMA recently received a funding boost from the Federal Government, with Health Minister Greg Hunt announcing an additional $5 million per year towards the program – bringing the total funding to $21 million per year of the 7CPA.

The RPMA program also transitioned from the Pharmacy Accessibility Remoteness Index (PhARIA) to the Modified Monash Model (MMM) for rural classification from 1 January 2021. This saw more than 400 community pharmacies newly eligible for the scheme, taking the total number of eligible pharmacies to 1215, said Minister Hunt.

These eligible pharmacies are expected to receive payments between $3,000 to $51,328 per year under the expansion, depending on their remoteness classification and PBS prescription volumes.

George Tambassis, national president of the Pharmacy Guild of Australia, welcomed the increased support for community pharmacy.

“In many small towns across Australia, the local community pharmacy is the only health infrastructure, and it is imperative that appropriate support is given to enable those pharmacies to sustain their service to patients,” said Mr Tambassis.

“Direct contact with a health professional such as a community pharmacist is a benefit that all Australians should be able to have access to, wherever they live.”

Pharmacist Peter Crothers, who owns and manages a pharmacy in Bourke, NSW, told AJP that some rural and remote pharmacists are highly concerned about the changes, which kicked in from 1 January.

“There are quite a lot of winners and losers,” said Mr Crothers, a member and representative of the Rural Pharmacy Network Australia, about the new program.

“The pattern that is emerging is that the losers are more likely to be in the remote classifications – not necessarily the most remote MMM classification, but certainly the two most remote PhARIA classifications.”

Mr Crothers said that due to the changes, there are a handful of pharmacies “really significantly better off” in receiving thousands of additional dollars in funding, while a lot of smaller pharmacies in the less accessible rural communities are several thousand dollars worse off.

“Because they’re small, that means they’re more likely to be highly reliant on the allowance and so it’s going to make a material difference to them.

“[It’s] shifting funding away from the pharmacies who need it most, towards the pharmacies who need it least,” he argued.

“This is an unusual and unacceptable policy outcome for a program whose purpose has always been to ensure that communities that might not otherwise have a pharmacy can actually have a pharmacy.”

His group, the Rural Pharmacy Network Australia, has calculated that there are over 200 pharmacies around the country – two thirds of which are Guild members – that are “significantly worse off” under the changes.

“I think the unfortunate thing about it is that there was an expectation from the rhetoric following the 7CPA that no one would be worse off, and a lot of those pharmacies are struggling to see what could possibly offset this loss of income,” said Mr Crothers.

The old PhARIA 2020/21 Payment Matrix compared to the new MMM RPMA Payment Matrix. Source: PPA

A spokesperson for the Pharmacy Guild told AJP the new system is intended to provide greater support for remote, rural and regional pharmacies, so that patients living in those areas have access to pharmacy services and PBS medicines.

“The change from the previous PhARIA rural classification system to the Monash model means approximately 400 additional pharmacies are eligible for support. This is an increase of around 50 per cent in the number of pharmacies being supported,” said the Guild spokesperson.

“No system is perfect, but the Guild believes the additional funding and the transition to the MMM system will provide a fairer and more equitable outcome for pharmacies and patients in remote, rural and regional Australia.

“Where a pharmacy believes it has been disadvantaged through an unintended consequence or an anomaly of the system, that pharmacy can submit an exceptional circumstances request for consideration by the Department of Health.”

The PSA has previously stated that while it is supportive of measures that improve workforce challenges and remuneration for pharmacists in regional, rural and remote locations, it remains concerned that there may be some pharmacists worse off under the new requirements.

PSA national president Chris Freeman added: “We encourage pharmacists who believe that there has been significant disadvantage because of the changes to the scheme to reach out to the PSA and the Department of Health through the Pharmacy Programs Administrator to address the issues with the implementation of this change.”

Mr Crothers stressed that something needs to be done soon to fix the situation. The current payment matrix applies until at least 30 June 2021, so he is hopeful there is a window of opportunity for change.

“Any way you look at it, it’s a stuff up. It’s an unintended outcome, I don’t think anybody intended it to come out like this and I don’t know whether there’s been a miscalculation or the whole process has been caught up in some larger political process,” he said.

But he added, “As it stands at the moment, it’s a problem that has to be fixed. The road to hell is paved with good intentions, and that’s not to blame people but good intentions aren’t enough. You’ve got to actually deliver the result. We have to get the outcomes that serve the community best.

“That’s what pharmacists do in our daily lives, we serve communities – that’s why we’re called community pharmacists. And that’s what tends to motivate us and what we care about. But we’ve got to get a bit of a hand at doing it, in these situations where you’ve got disadvantaged communities… and all rural communities are disadvantaged.

“I don’t think the Guild can just wave a magic wand and change this, it’s going to be a matter for negotiation. With a tiny amount of goodwill and a tiny amount of imagination, this can be fixed.”

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