GPs back renewed push for extended dispensing rules

With the May Federal Budget looming and the state of healthcare in prime focus, a long-delayed cost-saving suggestion, which doctors say would be easy to implement, remains ignored.
 
In 2018, the independent body of experts comprising the Pharmaceutical Benefits Advisory Committee (PBAC) recommended increasing the maximum dispensed quantities on selected PBS items from one to two months’ supply.
 
Dr Cathryn Hester, member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), told newsGP the change would reduce out-of-pocket costs, as well as the risk of patients missing medication dosages at the end of each month when their scripts run out.
 
‘Increasing the supply of medications for stable conditions so that patients can have access to larger pack sizes and need less visits to the pharmacist is absolutely a step in the right direction,’ she said.
 
‘This is particularly important for patients who live long distances from retail pharmacies, and who find it difficult to regularly go to the pharmacy.
 
‘It is also becoming increasingly important to ease the amount of work that pharmacists are needed for, especially in the context of the nationwide shortage of pharmacists and many retail pharmacies reducing their hours of operation, and closing, due to lack of pharmacist coverage.’
 
Meanwhile, Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care (REC–QC), told newsGP there are practical merits associated with increasing prescription supplies.
 
‘My patients often complain that they cannot see any value in needing to pick up supplies of medication each month,’ he said.
 
Dr Morgan says it can also add an additional layer of complexity for patients on several medications where the difference in pack sizes could vary between 28 or 56 pills.
 
‘It is expensive to pay a dispensing co-payment for each collection of medication, so patients sometimes forego a medicine when money is tight,’ he said.
 
‘My patients tell me that collecting their monthly box of pills is just an inconvenience. It is a financial transaction. They certainly don’t report having consultations about safe use of the medicine.’
 
The change would reduce co-payment and dispensing fees thereby saving money for patients and the health system.
 
Aside from being more convenient for patients, Professor Morgan says another benefit is that money saved by reducing co-payment and dispensing fees could be reinvested in the system.
 
The 2018 PBAC decision was flagged again recently when the Australia Medical Association (AMA) President Professor Steve Robson wrote to Federal Health and Aged Care Minister Mark Butler, urging him to consider implementing the recommendation.
 
He cited the measure as a ‘win-win scenario’ for cost-saving and improving access.
 
However, despite near-unanimous support from doctors and medical groups, and the PBAC recommendation, the measure was not picked up by Government after vehement opposition from the Pharmacy Guild of Australia.
 
Once described as ‘the most powerful lobby group you’ve never heard of’, the Guild donated $770,000 to Australian political parties in the 12 months leading up to negotiations over the last Community Pharmacy Agreement, where extended dispensing was also on the table. 
 
In the past five years alone, the Guild has donated $1.8 million to Australian political parties, including in excess of $577,000 for the 2021–22 financial year.
 
The Guild declined to comment when approached with questions regarding the renew extended dispensing push, but Dr Hester says the pharmacy owners’ lobby group has strong financial incentives to reject the PBAC recommendation.
 
‘There are commercial reasons why the Pharmacy Guild, a very powerful lobbying body, has fought this recommendation,’ she said.
 
‘These changes will cause a reduction in dispensing fees and less foot traffic through retail pharmacies and pharmacy owners are worried that this will reduce their record-high profits.
 
‘This is very disappointing, that profits of pharmacists have been prioritised over patient health, and it is clearly time for this to be redressed.’
 
To ensure patient safety, PBAC suggested limiting the rule to 143 medicines, or 348 PBS items.
 
However, Dr Hester sees little risk in the measure.
 
‘As a GP with many patients on stable, long-term medications I can see no downside to this change,’ she said.
 
‘If I’m concerned about a patient and the length of time between medical reviews, I can simply prescribe a smaller amount of medications and book an early review.’
 
Dr Morgan says other recommended reviews for chronic conditions had longer timeframes and thus the risk of harms with a two-month supply would be low.
 
‘It is a strange world we live in where I can decide with my patient that a three-monthly check or six-monthly check of their chronic disease is perfectly adequate, but the system requires frequent trips to a community pharmacy to maintain medication supply,’ he said.
 
‘If I am in the middle of titrating the dose of a medicine, then it might be entirely appropriate for there to be a smaller supply of a medication. For people on stable medications, two or three months of supply make a lot more sense.
 
‘I would like to see a system where the review of interval medications is a shared decision based on clinical need, not arbitrary timeframes like the time it takes for the moon orbit the earth.’
 
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