What you said: increased script length

Here’s what you had to say about the rejected proposal measure to allow two-month dispenses for around 140 medicines

The Guild’s objection to the measure– which was widely reported as likely to be a component of this week’s Federal Budget – and the Government’s decision not to implement it sparked a lot of discussion at AJP and more widely across social media…

A lot of readers defended the Guild’s position on script lengths, and its comments that such a measure would undermine the viability of many pharmacies around the country.

“The increase in quantity would affect pharmacy viability which is not about profits but about medication access to patients,” observed reader Ai Nguyen.

“Some (or many) pharmacies in the rural are struggling to get enough profits to pay all the bills. They would have to close down. Patients have to drive further to other towns nearby that costs their time and fuel.

“Those trips may be between 10km to more than 60km or more. That would cost money for patients, right?”

Reader Rosemary Peacey said that instead of focusing on pharmacy viability, there were other factors to take into consideration.

“Having worked in community pharmacy in the UK a few decades ago prior to prescription repeat authorisations being available there, I often dispensed large quantities of medications, particularly in the elderly population who had ‘stable’ conditions,” she wrote.

“This resulted in the most incredible stockpiling of unused medications the home, medication misadventure, and a significant cost burden to the NHS (as a direct result of unused medications)… I am not a fan of having multiple medication packs in the home due to wasteage and potential misadventure.”

Some readers criticised groups, particularly those representing doctors, who had condemned the Guild for “lobbying” the Government on the matter.

“Dear AMA, if you want to pretend to be good and fighting for the patient do it in your industry. Example please do not charge patient extra on top of the Medicare claim,” wrote Minimomo. “Or reduce the Medicare rebate by half, that would save the government more money to invest elsewhere. Stop attacking pharmacy industry.”

Others said change was likely anyway.

“Multi month supply has considerable community support,” said reader Michael Post. “Social media commentary is overwhelming and Government are aware- expect this change to dispensing practice come 7cpa negotiation.”

Consumer reaction in mainstream media comments sections was indeed strongly in favour of the proposal, with many readers attacking pharmacists.

The doctors’ perspective was represented in the comments section by Dr Evan Ackermann, who had written a piece in MJA InSight recently suggesting increased script lengths (though he had told AJP that he had been unaware the Government had been seriously considering it), and Friends of Science in Medicine’s Dr Ken Harvey.

“In defence of current practice, Mr Tambassis cites the PROMISe study, an Evaluation of Clinical Interventions in Community Pharmacies, where pharmacist intervention rates were approximately 1 in 200 prescriptions – in effect 99.5% of the time, consumers and government are paying pharmacy to do nothing,” Dr Ackermann wrote. “Not a convincing argument for the status quo.”

“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,” said Dr Harvey.

“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.”

And Ex-Pharmacist claimed that some pharmacists were already dispensing more than one month’s supply via what they called “the ‘ol ‘Dispense-All-The-Repeats’ trick”.

This suggestion was slammed by Jarrod McMaugh and Wilson Tan, who pointed out that if this was occurring, it was reportable behaviour; and Michael Khoo, who said that “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”.

The rejected measure served as an opportunity for Vicki Dyson, however.

“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,” she wrote.

“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.

“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.”

Michael Post agreed.

“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.”

But pharmacy consultant Bruce Annabel felt that “More engagement opportunities means more potential for professional service interactions. I think we have it about right and allowing the Government suggestion to occur will only lessen that.”

And Michael Khoo had another idea.

“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.”

Meanwhile the issue also sparked a lot of attention on Twitter, particularly in response to this article by News Corp reporter Sue Dunlevy.

And one pharmacist called for discussion, rather than criticism from doctors.

Spelling and punctuation has been edited in some comments.

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