Extended dispensing left out of new pharmacy agreement

Doug Hendrie

15/06/2020 4:27:27 PM

The decision to reportedly omit the long-sought reform from the seventh Community Pharmacy Agreement has raised questions.

Pharmacist providing pills
RACGP President Dr Harry Nespolon has labelled the decision to reportedly omit the long-sought reform from the seventh Community Pharmacy Agreement ‘disappointing’.

The omission will mean many patients on long-term medications will have to continue to attend pharmacies monthly, an outcome RACGP President Dr Harry Nespolon has labelled ‘disappointing’.
‘Last year we called for the doubling of the dispensing limit to 60 days for many of the most common medications on which Australians rely. We regret that the Government has chosen not to include extended dispensing in the new Community Pharmacy Agreement,’ Dr Nespolon told newsGP
‘Patients should not be treated as customers and foot traffic is not the basis of good health policy.’
The news comes as healthcare reform experts questioned the new five-year agreement – worth an estimated $18.3 billion and negotiated behind closed doors – for opacity regarding where the money goes, as well as the widely criticised location and ownership rules restricting who can own a pharmacy and where they can be located.
The new agreement is the first since the 2017 King review into the pharmacy sector recommended sweeping changes, but only four of 45 recommendations were accepted by the Government.
Dr Tim Woodruff is President of the Doctors Reform Society and Acting Chair of the Australian Healthcare Reform Alliance. He told newsGP that many inquiries had recommended significant changes to these agreements, but these recommendations had been ignored due to the power of the pharmacy lobby.
‘Pharmacy agreements over the years have been directed to the interests of the strong pharmacy lobby and not necessarily in the interests of patients,’ he said.  
Centre for Policy Development fellow and Croakey editor Jennifer Doggett told newsGP that doctors and consumers are strongly in favour of extended supplies of prescriptions.
‘If the doctor is okay with 60- or even 90-day prescriptions, they should be allowed,’ she said. ‘Why do you want older, sick people to stand and wait with other older, sick people during a pandemic?’
The extended dispensing reform was floated by the Government last year following a recommendation by the independent Pharmaceutical Benefits Advisory Council, with swift backing from the RACGP and the Consumers Health Forum. 
But the Pharmacy Guild, a lobby group representing the interests of pharmacy owners, came out against it and the reform was shelved
The Pharmacy Guild is responsible for negotiating the Community Pharmacy Agreement (CPA) with the Government, while professional organisation the Pharmaceutical Society of Australia was involved in the negotiations for the first time for the seventh agreement.
Pharmacy Guild President George Tambassis is now on record as saying the coronavirus pandemic is the reason the mooted reform was not in the final version of the agreement, which has not yet been made public.
He told the Australian Journal of Pharmacy that COVID-19 played a ‘critical role’.
‘It was panic stations in early March, it was obvious that if anyone in the pharmacy community or the medical community either prescribed or dispensed larger quantities than 30 days, we’d have a serious problem in this country,’ he said.
In response to the new agreement, Adjunct Associate Professor at the Menzies School of Health Research Lesley Russell Wolpe noted that the effective 9% funding increase is high relative to other healthcare areas, and questioned the transparency over where the funds are directed.
Long-time healthcare reform advocate Ms Doggett has noted the long history of criticism directed at the secrecy around the way CPA agreements are negotiated, as well as ongoing concerns related to location and ownership rules that reduce competition.

Former Australian Competition and Consumer Commission head Professor Graeme Samuel has previously slammed these restrictions as ‘anti-competitive’.
Ms Doggett said that the anti-competitive restrictions and governance and accountability issues have been raised repeatedly by reviews and inquiries of the CPA agreements, but that no changes have been made.
‘These two key issues are at the guts of the agreement. That’s really at the heart of why [the CPA] is so flawed,’ she said.
‘It protects pharmacy owner interests above the community. 
‘Pharmacies are a crucial service and Government has a crucial role in funding them, but it shouldn’t be tied up with the business interests of owners. If public money is invested, it should be in the accepted standards of accountability and transparency, so we know if we are getting value for money.
‘This agreement uses those nice-sounding words like “sustainability”, “accessibility” and “continuity” to hide the fact that it’s a business sector subsidy for an interest group. But it’s all tied up in health terms, so people are scared to scrutinise it too much.
‘It’s a smokescreen to an industry group that is a very powerful lobby group.’
An Australian National Audit Office (ANAO) audit of the fifth CPA in 2015 found that ‘shortcomings in Health’s performance reporting and 5CPA evaluation framework mean that the department is not well positioned to assess whether the Commonwealth is receiving value for money’.
An additional $100 million in medication management services is also included in the seventh CPA, with medication management and adherence programs such as dose administration aids and medicine checks set to be simplified and more readily available.
But these expansions are likely to attract further scrutiny, after the Medical Services Advisory Committee reviewed the evidence for many of these programs and found little or no evidence for their effectiveness.
Immediate past Chair of the RACGP Expert Committee – Quality Care Dr Evan Ackermann last year wrote in MJA Insight that the ‘evidence reviews exposed the lack of robustness in justifying community pharmacy expenditure’.
In better news, the new agreement does expand the number of Aboriginal and Torres Strait Islander people with, or who are at risk of having, a chronic disease, able to access free or lower-cost medications through an expansion of the Closing the Gap PBS co-payment measure. 
The new agreement will come into effect on 1 July.
After being approached for comment, a Pharmacy Guild spokesman referred newsGP to Mr Tambassis’ quotes in the AJP.
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