Guild President’s fierce response

Pharmacy Guild of Australia’s National President George Tambassis has penned a passionate open letter to raise awareness of the dangers of tinkering unnecessarily with the PBS. In particular, Mr Tambassis raises serious concerns over the recently proposed idea to increase quantities of routinely dispensed medicines.

Below is Mr Tambassis’ 26th March letter in full.

Don’t wreck the best medicine system in the world

All Australians can be rightly proud of our subsidised medicine system the Pharmaceutical Benefits Scheme (PBS).

And they should also be highly sceptical about proposals to tinker with the system in a way that could bring it crashing down.

One such bright idea that has been put forward recently is increasing the quantities of medicines routinely dispensed for a PBS prescription – that is, instead of a month’s supply, maybe dispense two, three or even six months’ supply to cut down on “inconvenient” visits to the local pharmacy and the number of PBS dispensing fees to pharmacists. What could possibly go wrong?

Well, let me tell you, lots could go wrong and it is an idea the Pharmacy Guild resists fiercely on behalf of our patients, our staff, and our health system.

Back in January the Medical Journal of Australia published an article by Dr Evan Ackermann under the headline “Exorbitant costs of routine medication repeats.”  In a nutshell, Dr Ackermann proposed bigger prescription quantities – three to six months’ supply – for people with selected chronic conditions, so that they visit their pharmacy less often and avoid what he called “excessive pharmacy fees.”

Canada and New Zealand are often cited as jurisdictions in which larger quantities are dispensed in some circumstances but these comparisons invariably compare apples with oranges – the system of distribution and dispensing of PBS medicines in Australia is unique the temptation to cherry-pick one aspect of another country’s system must be resisted.

Let me say at the outset that it is true that a reduction in the number of dispensing fees received by community pharmacies for dispensing larger quantities of high-volume medicines would be disastrous for the pharmacy small businesses, and jeopardise the entire network. Frankly I believe it would force many local pharmacies to close their doors. But that’s not the sole reason we strenuously oppose such a change.

In medication management there is a concept known as adherence – the extent to which patients take their medicines on time, in full, and as directed by their prescriber doctor and overseen by their pharmacist. Poor adherence may compromise the effectiveness of treatment, as well as the individual and public health costs in the longer term.

A recent OECD working paper found that poor adherence to medications affects approximately half of the population that receives prescriptions, leading to severe health complications, premature deaths, and an increased use of healthcare services. It identified face-to-face interactions with healthcare professionals as the best way to improve adherence.

It is clear that if a patient is receiving three to six months’ supply of their medicine without a return visit to their pharmacy, the likelihood of low medication adherence is magnified.  Any financial arguments in favour of larger quantity dispensing put quantity and cost ahead of quality use of medicines.

The evidence is overwhelming that having patients consult regularly with their pharmacist has positive benefits. For instance, a PROMISe study, Evaluation of Clinical Interventions in Community Pharmacies, reported that 80% of the interventions were considered to be proactive, that is they were initiated by the pharmacist and were provided in addition to dispensing medication.

The majority of clinical interventions were one of three categories: drug selection problems (22.7 per cent), dosage problems (19.4 per cent) or education or information problems (17.4 per cent), the study found. It should be noted that drug selection problems and dosage problems are errors in the prescribing process – something unlikely to be detected by review by the same practitioner.

The Pharmacy Board of Australia is clear on this issue. Its Guidelines for Dispensing of Medicines state: “Dispensing multiple quantities of particular medicines (whether or not directed by the prescriber) may not be consistent with the safety of the patient.

“When not directed by the prescriber, the simultaneous supply of multiple quantities of a particular medicine (i.e. the supply of multiple repeats at once) may be contrary to the Quality Use of Medicines principles outlined in the National Medicines Policy. It does not promote regular review of therapy and effective provision of medicine information by pharmacists, which may assist in minimising medication misadventure. It may also be contrary to State or Territory legislation.”

The Pharmacy Guild is always open to positive reform of our medicine system in the interests of patients and the sustainability of the PBS. But we will not be silent when ideas emerge which would wreck our network of community pharmacies and devalue a subsidised medicine system which has served Australians well since 1948.

George Tambassis

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