This means war


tug of war

The Guild is now in a “dispute” with the Government after news which left national president George Tambassis “staggered”

Mr Tambassis has sent a communique to Guild members advising that the organisation is “currently in a dispute with the Government after we learned of their intention to implement sweeping changes to the Pharmaceutical Benefits Scheme which would have a devastating impact on the viability of community pharmacy businesses across Australia”.

Mr Tambassis wrote of a “sense of astonishment and anger” over the proposed measure, which would see prescription quantities increased from one month to two months to more than 140 molecules on the PBS.

This proposal followed an unpublished recommendation from the Pharmaceutical Benefits Advisory Committee, he writes.

“This would be a retrograde step which would put quantity ahead of quality use of medicines, triggering much lower medication adherence rates among patients with chronic illnesses, leading ultimately to higher health costs.

“The proposed change would also have had a catastrophic effect on community pharmacy businesses.

“Profitability of many pharmacies would have been effectively halved, sending them to the wall, with mass loss of jobs and displacement of vital patient services.

“The knock-on effects of such a measure would be calamitous for our sector and the Australian health system.”

Mr Tambassis says that the Federal Government intended to implement the measure without consultation with the Pharmacy Guild.

“I am staggered that such a measure was countenanced and prepared for implementation without any consultation with the Guild, in clear breach of the Community Pharmacy Agreement,” he writes.

“We believe we have succeeded in dissuading the Government from proceeding with this destructive, unwarranted idea, but we cannot rest until we are confident it is off the table – now and forever.”

Mr Tambassis says that he has written to Prime Minister Scott Morrison and Treasurer Josh Frydenberg regarding what he calls this “near catastrophe”.

He says he has urged them to move to restore Pharmacy Guild members’ confidence in the Government’s capacity to “understand their needs, the needs of their staff and patients, and the needs of the banks who provide the finance that underpins the businesses”.

The Guild has demanded a letter of support for community pharmacy.

Mr Tambassis says that this must include an express commitment that the 7CPA ensure that, “at a minimum, aggregate and per prescription remuneration for community pharmacies dispensing medicines is maintained in real terms as stated in the current 6CPA”.

The request also demands that the Government provide an express commitment that where, during the term of the Seventh Agreement, the Australian Government proposes a health related reform that may impact community pharmacy, any decision to proceed must be with written agreement of the Guild.

It also asks the Government to provide “An express commitment to restore the universality of the PBS by removing the flawed optional $1 discount of the PBS co-payments, in line with the recommendation of the Pharmacy Remuneration and Regulation Review, and replacing it with an across-the-board $1 reduction in the co-payments”.

On Wednesday, Mr Tambassis also provided an opinion piece for publication in pharmacy media, which was published by the AJP.

In this piece, he urged that legislators “not wreck the best medicine system in the world” by increasing the quantities of medicines routinely dispensed on a PBS script.

He referenced a piece penned in the Medical Journal of Australia by prominent GP and regular critic of the pharmacy sector Dr Evan Ackermann, in which the doctor suggested longer script times for people with certain chronic conditions.

Mr Tambassis said that the evidence supporting regular consultation with pharmacists was “overwhelming”.

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32 Comments

  1. Ken Harvey
    28/03/2019

    I have never had anything more than a social chat with my local pharmacist (whom I value) when I get my monthly anti-hypertensive script dispensed. I see no reason why 2 or 3 months supply could not be dispensed at the one time, perhaps along with a written sticker reminding patients to consult your pharmacist &/or GP if new problems emerge.

    • Wilson Tan
      29/03/2019

      Dr Ken, I have the greatest respect for your advocacy and professionalism.

      In this case I do not see eye to eye with your anecdotal experience, even in particular as you are someone of high intellect and learning, that your experience is necessarily representative of the thousands of Australians especially the elderly, retired and busy mums & dads.

      I now ask of you, as an Australian public health doctor, currently adjunct Associate Professor at the School of Public Health and Preventive Medicine at Monash University, when and how often do you release a new policy for public health?
      I understand you do research into this crucial area, for this is your career. Therefore may I kindly ask, how often do you produce research that actually result in public health policy changes?

      So do I conclude that the 90% of the time, when you are not producing public health policy that gets adopted, that these are not important times?
      Do the bureaucrats now stop paying for those “unproductive” time?

      Yours sincerely,

      Wilson
      Pharmacist

  2. Bruce ANNABEL
    28/03/2019

    This one won’t get up pre election nor be included in next week’s budget in my view. The issue is far too explosive politically and the impact on pharmacy would be huge. The measure has been around for a while it seems and the Guild is right to fight it because post election anything can happen.

    • Michael Post
      28/03/2019

      Bruce the Guild is wrong to fight this. Less presentations to pharmacy offer more time for conversation , health and medicine checks instead of the sausage factory that is our current state of practice.

      You have consistently talked up professional service and now when presented with opportunity for a time offering turn up your nose. Hypocrisy.

      • Bruce ANNABEL
        29/03/2019

        Errrr. That doesn’t make sense Michael P. More engagement opportunities means more potential for professional service interactions. I think we have it about right and allowing the Govt suggestion to occur will only lessen that.

        • Andrew
          29/03/2019

          When the professional service interactions result in a compliance rate of 66% that drops to nearly 50% after a month (figures from an AJP article last week) maybe it’s time to look at the quality and efficacy of these “professional services”.

        • Michael Post
          29/03/2019

          Bruce you are an accountant and I am a pharmacist. I know a little about accounting – would compulsory monthly BAS reporting be an unnecessary burden for all parties if voluntary quarterly BAS were removed? Compulsory monthly BAS reporting would increase accountant /client engagement- would this always be quality engagement or would there be an unnecessary administrative burden on your system? Is quarterly reporting and accountant engagement often sensible and lacking in significant impact on financial literacy or reporting capability?

          • Wilson Tan
            30/03/2019

            And yet this is the case of compulsory monthly BAS reporting based on turnover.

            You are not comparing apples. If quarterly reporting is ok, why not yearly reporting.
            If 60 days supply is ok, why not yearly supply?
            Why not pay for seeing a doctor once yearly to get all your prescriptions and a check-over? Why is there no limit? isn’t this inefficient use of limited resources?

            Monthly supply is a fine balance between patient-pharmacist interactions, wastage, timely interventions, and quality use of medicines.

          • Michael Post
            03/04/2019

            I am comparing apples Wilson.

            Chronic medication without addiction lability could be offered at 60 day instead of 28-30 day supply . I think 6 pharmacy presentations per year is a fine balance. 28 day supply is arguably overservicing.

            Your straw man fallacy that 2 month supply might as well be yearly supply does not stack up. Pharmacists will interact with clients > 5 times a year. New meds can be monthly supply for 3 months and if stable extended quantities may be offered.

            Time is a valuable commodity in the pharmacy environment. There are opportunities to enhance our professional service when we have time to really sit with our clients.

            Monthly supply disadvantages many consumers and there are many days of missed meds as a result. We should not discount this proposal with a short term focus on our own back pockets.

          • Willy the chemist
            04/04/2019

            The real purpose of this measure is to try to save money. And this is despite that community pharmacy has arguably delivered & continue to deliver more savings than most other parts of health.
            The PBS spending is in decline and would have decline nearly 20% in real terms since price disclosure began.

            Cost savings is necessary but it is unconscionable behaviour of the government to firstly, disproportionately target one arm of health to get its savings, and secondly to continue to relegate the CPA agreements, even if the spirit of the agreements.

            Time is definitely a valuable commodity, but its not the right reason to increase supply quantities.
            To enhance professional service, you cannot pay lip service. The community has to decide if they want it, they have to prioritise this, and pay for it. Not peanuts for monkeys.

            Increasing the supply quantity is not in the quality use of medicines objective as it reduces patient pharmacist interaction points, increase medication misadventure, wastage and stockpiling.

            While you describe situation where in the minor, certain member of the public might benefit from a 60 days supply, this is outweighed by the majority of patients who benefit from regular monthly patient pharmacist interactions.

            Whatever money is saved is easily lost to the increased hospital admissions, adverse events, increased cost of wasted medicines, and patient outcomes.

            Lastly, there has been a lot of hyperbole, including from the doctor groups who reek of hypocrisy. I reckon we should commission a study to investigate how much public money is being wasted through lack of accountability of the medicare rebate claims.

          • Andrew
            05/04/2019

            >>>this is outweighed by the majority of patients who benefit from regular monthly patient pharmacist interactions.

            Citation needed.

            As both a pharmacist and a consumer this hasn’t been my experience.

          • Wilson Tan
            05/04/2019

            Now this is ironic hypocrisy in the main.
            You are the proponent for change, it should be your onus to provide independent objective verifiable (preferably peered reviewed) studies to prove the need to change to 60 days supply.
            The objective outcomes should be to prove that it saves money, AND it has beneficial health outcomes.

            I maintain that the majority of patient benefit from regular monthly pharmacist interactions, and in the absence of rigorous independent verifiable studies, we are entitled to state the following;
            a) it’s purely a money saving initiative but a bad one, as it encourages;
            b) stockpiling or hoarding
            c) reduces patient pharmacist contact points
            d) reduces intervention opportunities
            e) increases risk of medicine misadventures including confusion, doubling up – 2 months contact point is a long time especially for elderly who gets easily confused and forgets what a particular medicine molecule or brand is for

            I am also entitled to state that in my opinion, the savings are minimal if any. I would not be surprised if indeed it ends up costing everyone more in dollars and health outcomes.

            The initial savings from reduced dispense fees is swallowed up by the doubling of the medicine costs to the PBS, and the inevitable stockpiling.

            Further manifestation of increased quantities result in wastage, spoilage and out of dates.

            And the resultant out of stock situations will be exacerbated, giving more pressures on PBS supply chain. As we all know, well, at least community pharmacists at the coalface, an insignificant number of molecules is chronically in short supply at any one time.

            And most importantly, when we start to count the cost of increase medicine misadventures and increase hospitalisations from missed intervention opportunities, any cost savings will completely evaporate.

            Importantly, academia has downplayed patient pharmacist interactions, a NON MONETARY contribution that community pharmacies all over Australia provides, day in day out without fail. (As opposed to visiting a doctor; trying to get appointments, waiting room scenarios, Medicare claims & out of pocket costs)

            Many people visit their pharmacists for the health advice, prescription & Pharmacy medicines, and many do so on a regular basis.
            And I almost forgot to say, many many people visit community pharmacies socially under the pretext of getting their medicines or seeking advice.

            Loneliness and social isolation is a reality in Australia.
            This is one part that no academia nor consultant pharmacists understand. We are an integral social fabric for the community, and this we do quietly, willingly, every single day and without expectation of a citation or a medal.

        • Michael Post
          08/04/2019

          Bruce. Opportunity for interaction occurs when pharmacists have the time to perform service interactions. There is little to no time in the current sausage factory environment that most community pharmacies operate in to have more than a brief encounter. This proposed multi-month supply creates a potential time opportunity for community pharmacy . I don’t need to make any argument as we are not inventing the wheel – NZ has been performing this dispensing method for years and there is an abundance of evidence for its success.

          With all due respect for your knowledge and skill as an accountant you are not a pharmacist. Having knowledge of the role as well as friends and clients in the role and performing the role as a registered pharmacist are two different perspectives. I am not an accountant. Perhaps we should remove optional quarterly BAS and replace with compulsory monthly BAS so that all your clients arrange a monthly lodgement with you? Would this not improve financial literacy and keep people on top of their figures? Is it possible quarterly BAS wherever possible allows the client and the accountant to engage regularly with time all without significant impact on this financial literacy and money management? Monthly BAS for all clients might just be an unnecessary burden for all parties.

          Regarding the general conversation in other threads regarding wastage of meds there may be some. There has always and will always be wastage. Many elderly people in particular have countless packs of unopened and replicated meds in their homes. I hear patients/customers often complain they have missed multiple days of meds on a regular basis due to monthly (often 28 day) supply. Some people are poor time managers and cannot manage their med pickup well. I believe increased supply can reduce these missed days markedly over the course of a year. Missing meds is a contributor to adverse outcome..

      • Willy the chemist
        03/04/2019

        Talk is easy. Cut presentations and cut pharmacy income abruptly and drastically. This is notwithstanding the CPA agreement, and community pharmacy business model being based on current agreement.

        Lots of people’s job will be jeopardise. Lots of real people, with real family, with real mortgages, with real lives.

        Then, and then, talk up professional servicing, spend more time….at the current renumeration model.

        Not trying to point fingers, but calling Mr Annabel a hypocrisy is a little dishonest.
        Do you own a community pharmacy?
        Wait, I am willing to say that you don’t, maybe you have sold your pharmacy sometime ago? Talk is easy.

        • Michael Post
          04/04/2019

          Talk is easy you are right Willy.

          As a pharmacist I see no issue with reduced patient presentation from a sub-segment of the community. As a consumer I see benefit.

          At no point have I advocated for reduced remuneration for multi supply. If anything reduced presentation should encourage more remuneration at each visit. Quality over quantity is my concern.

          Pharmacy needs to enhance its offering from predominately supply focus to enhanced service plus supply. Reduced presentation from a sub-segment of society is a small step in the time offering direction in my opinion.

  3. Michael Khoo
    28/03/2019

    Perhaps if only applied to scripts with 12 months repeats, as surely patients accessing this volume of medication should only need to see their GP once a year. Perhaps those same medications should be allowed to be pharmacist prescribed. That would save everyone time and money.

  4. Greg Kyle
    28/03/2019

    George Tambassis is quoted as saying “that the evidence supporting regular consultation with pharmacists was “overwhelming”.”
    The Guild has better pull all pharmacies into line to ensure this happens for every patient for every script if they want to make such statements to support their monthly repeats are better claim.
    I hear many 1st hand reports from across Qld (now), but also other states & territories that this claim is not normal practice in a large proportion of pharmacies. (For the record, I believe every patient should speak with a pharmacist).
    Once this happens, then the guild can claim some moral high ground.

  5. Vicki Dyson
    28/03/2019

    The Guild should look on the move to supply two months’ tablets at a time as an opportunity to argue for appropriate recompense for the role that pharmacies and pharmacists play in provision of health care. Patients with complex heath needs and multiple drugs will still need to come in monthly because prescriptions are likely to need renewing at different times and the 21 day rule or similar, presumably will still apply. The reduced number of prescriptions will give pharmacists more time to do that counselling when it is needed. What the Guild needs to do is argue for a greater proportion of the recompense they receive to go to professional activities, associated with dispensing and health triage. Given that a sizable number of pharmacies employ pharmacists, they also need to argue that they should be able to pay their employees a wage commensurate with their skills, without putting businesses at risk. We need to find ways for documenting interventions/counselling with a couple of keystrokes linked to patient histories so that recording does not take up an inordinate amount of time. The Guild needs to continue the push to be paid as a profession, rather than for the number of prescriptions which pass through the till.

  6. Michael Post
    29/03/2019

    ..

  7. Jim Tsaoucis
    29/03/2019

    lets halve your salary and add-ons and see how you fare. Will your electrical supplier halve your bill or council halve your rates or Accountant or solicitor halve their charges or banks halve their lending rates etc etc. Look up the Chemist Care Does Hawke protests of years gone by. Pharmacists have a high approval rating amongst our patients/customers. Approx 6000 businesses employing say 30,000 staff and trusted by a hell of a lot of voting adults. What are you thinking Mr Morrison et al….political suicide??

  8. Ex-Pharmacist
    29/03/2019

    What is well known by cunning pharmacy owners is the ‘ol “Dispense-All-The-Repeats” trick.
    This is how it works. Customer hands in a script to pharmacy with repeats. Could be anything, Antibiotics, Anti-hypertensives, Statins, etc. Customer gets asked if they want all the repeats today, with the line “to save having to come back each time” i.e. convenience. Customer takes their multiple packs and the pharmacy keeps the repeats which is filed in such a way to ensure dispensing at just outside the 20 day rule each time, as to not alert Dept. of Health. Why is this done? Mainly to ensure the pharmacy doesn’t lose any of the repeat dispensing (and the overly generous dispensing fee) to the opposition, especially the cheaper discounter around the corner. So Mr Tambassis, many pharmacies do this already making a mockery of your “end of the world” claims. Bring it on.

    • Jarrod McMaugh
      30/03/2019

      This is illegal.

      If you know anyone who is actually doing this, report them.

      • Wilson Tan
        31/03/2019

        This person doing this has to be called out, reported.

        However the comment by Ex-pharmacist is slanderous, bigoted and ill-considered stereotyping. He should report the person doing this, and also retract his incorrect lies and slander on a whole group of reputable people.
        Were it anyone in an official capacity, political office, this person would have been censured, and made to apologise.
        This is a hate slur on a class of people.

        I’m surprised that his comment is not deemed a hate speech and censured.

    • Michael Khoo
      31/03/2019

      I would refer you to PDL regarding legal liability in the event of misadventure if multiple supplies are given without the approval of the prescriber. Not even the big box discounters are stupid enough to operate in this way these days, which admittedly was common some years ago. Good riddance to a dreadful practise.

  9. Alexander Wong
    30/03/2019

    I’m just astounded that a recommendation such as this could be made without consultation with ANY pharmacy group. Completely short-sighted. Was David Newby an apology for the meeting? Keen to hear his rationale on this.

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