RACGP moves to shore up wavering support for 60-day dispensing

Anastasia Tsirtsakis

10/06/2023 12:01:00 AM

Amid reports of crossbenchers becoming wary of the reform, the college has co-signed an open letter outlining the expected benefits for both patients and the primary care system.

A pharmacist holding two boxes of medication.
The reform will save patients up to $180 a year – and even more for those taking multiple medicines.

The RACGP has re-iterated its support for 60-day dispensing, following reports that crossbench MPs may attempt to block the legislation once it reaches the Senate.
The college, together with seven other peak health and consumer organisations, have acted on the reports through an open letter calling on MPs and Senators to support the legislation.
‘We fully support this long overdue change,’ the letter reads.
‘On behalf of our collective memberships, which represent over 50,000 healthcare practitioners and almost 10 million of the most vulnerable health consumers in Australia, we call on you to put consumers first and support this initiative.’
The Federal Government is expected to introduce the reform in the coming weeks to allow its implementation by 1 September. If passed, it will permit GPs to issue prescriptions that allow patients to receive two months’ worth of a select group of PBS-listed medications for common chronic conditions including asthma, cardiovascular disease, depression, diabetes and hypertension.
While vigorously opposed by the Pharmacy Guild of Australia, it has the backing of a number of health and consumer organisations, including the following co-signatories of the letter:

  • the AMA
  • Australian College of Nurse Practitioners (ACNP)
  • Breast Cancer Network Australia
  • National Aboriginal Community Controlled Health Organisation (NACCHO)
  • Australian Multicultural Health Collaborative (FECCA)
  • Lung Foundation Australia  
  • Asthma Australia
Nonetheless, reports have emerged about concerns within Parliament that increasing dispensing limits will worsen the medicines shortage – a Guild-driven claim that has been publicly refuted by the Pharmaceutical Benefits Advisory Committee (PBAC), an independent committee that first recommended the reform, as well as Federal Health and Aged Care Minister Mark Butler and Federal Health Secretary Professor Brendan Murphy.
The open letter also addresses the shortage claim, highlighting that ‘people are still going to take the same amount of medicine – all that is changing is how often it is dispensed’.
‘It has been reported that only three products eligible for 60-day scripts are currently listed in critical shortage,’ the letter reads.
‘These include two strengths of the same tablet used for treating hypertension and another type of tablet for treating recurrent streptococcal infections – which is already unavailable.’
Implementation of the reform is slated to take place in three tranches, over 12 months, to give the industry time to adjust. To assist with the transition, medicine suppliers will be required to stockpile between four- and six-months’ worth of essential medicines from 1 July. 
‘Pharmacy is in a strong position, and this is a relatively small total change to business, including government reinvestment,’ the letter reads.
‘The reduction in dispensing fees amounts to approximately 1.5% of total pharmacy revenue. We welcome the fact that the Government has chosen to reinvest every dollar of the $1.2 billion in Budget savings generated by this measure back into the pharmacy sector.
‘We note also that the Government will also redirect $350 million in funding for on-site pharmacists in Government-funded aged care homes to community.’
The letter also outlines a myriad of benefits that extended prescribing will have for patients, including cost savings of up to $180 a year per script annually, as well as reducing the number of trips to the GP for repeat scripts and to the pharmacist to pick up medicines.
RACGP President Nicole Higgins has been a strong advocate of 60-day dispensing.
‘Sixty-day dispensing is a win for Australians, particularly those with chronic conditions, and those who are more vulnerable and battling cost-of-living pressures,’ she said.
‘I urge MPs and Senators to ignore the scare campaigns and support these changes, there has never been a more important time to save patients money and time.’
The reform, which is expected to benefit approximately six million Australians, will have significant benefits for Aboriginal and Torres Strait Islander people and culturally and linguistically diverse (CALD) Australians who are known to have a higher prevalence of chronic conditions.
NACCHO Acting CEO, Dr Dawn Casey, said the move is sure to ease cost-of-living pressures being faced by the community, including many Aboriginal and Torres Strait Islander people.
‘We welcome this measure,’ she said. ‘It can halve the annual cost of people’s medicines, which is a truly significant impact.
‘In reducing the number of times people must attend a pharmacy for each of the chronic medicines, it will also greatly improve convenience for patients and further add to the value of the measure, especially when considering accessibility of some pharmacies and current cost of transport.’
Meanwhile, by cutting down on the number of visits required to the GP and pharmacy for repeat scripts, the change is expected to improve access to primary care services, which are currently stretched.
ACNP CEO, Leanne Boase, said this will have far-reaching benefits for the allocation of health resources and, in turn, patient access to timely care.
‘Where medicines are long term, especially in relation to stable chronic disease, significant savings for consumers in both cost and time can be made, as well as redirecting more healthcare dollars towards improving health outcomes,’ she said.
‘We are confident the Australian Government is acting in the best interests of the public through better access to medicines, more accessible primary care, and in support of essential pharmacy services.’ 
Lung Foundation Australia CEO, Mark Brooke, said the reform also has benefits for immunosuppressed people who will spend less time in crowded waiting areas.
Beyond that, the change is also anticipated to increase medication adherence among patients.
‘This shift is frankly overdue,’ Mr Brooke said.
‘From our community’s perspective, those with chronic obstructive pulmonary disease [COPD] will be immediately affected and for patients with stable chronic conditions, it also reduces their risk of missing medication dosages at the end of the month when their script runs out.’
Aside from the impact on medicine supply, some MPs are also reportedly concerned about safeguards and a lack of consultation.
However, AMA President Professor Steve Robson reaffirmed the important role that doctors will play in the decision-making process when it comes to assessing 60-day prescription suitability.
‘The Government’s changes are safe and supported by clear recommendations from the independent PBAC, including the requirement to ensure that only patients assessed as clinically suitable by a doctor are eligible,’ he said.
Should the legislation pass both houses of Parliament, it will bring Australia in line with other countries, including New Zealand, the US, France and Canada, where people already have access to multiple months of medication on a single prescription.
‘This policy change will work to the overwhelming benefit of patients who are currently paying more for medicines than they should,’ the letter reads.
‘We hope that you will put patients first in any consideration of this policy as it makes its way through the Parliament, particularly as costs of medicines has been widely identified as a barrier for some patients as they struggle with the growing costs of living.’
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Dr Winston Smith   10/06/2023 9:40:14 AM

About bloody time the RACGP stood up for our patients on this matter. As the bully boy tactics are starting to work, it’s time for ALL doctors to work hard for this 60 day dispensing policy. Now all we need is the AMA to do the job we pay our hard earned money to them for.

PS it is “shore up” not “sure up”

Dr Kay Louise Flynn   10/06/2023 10:29:02 AM

While we are undergoing this change in Prescribing practices, could pack sizes be mandated to allow 30 days per pack for all medication? 28 day supply is not one month

Dr Kirsta Craig   10/06/2023 12:26:33 PM

In the US we dispense a 3 month supply
It makes everyone’s life so much easier. Doesn’t apply to controlled drugs. This is such a laughable storm in a teacup. Get on with it I say!!

Dr Ian   10/06/2023 3:23:10 PM

No-one has mentioned the danger of a suicidal ingestion and the position
of the college of psychologists and psychiatrists or other bodies like Sane and Beyond Blue is lacking because it is too confronting .
A depression screen ought be done judiciously in prescribing medicines , cases are reported of patients tragically taking whole prescriptions to end their lives .

Dr Peter JD Spafford   10/06/2023 4:45:34 PM

It amazes me that race is brought into almost evey argument, used almost like a trump card. ATSI patients on the CTG already get their medications at greatly discounted rates so I am not sure any more would be saved by ATSI individuals in this move. The RACGP admits it will reduce pharmacy income but claims it is insignificant. About as insignificant as payroll tax for practices!! I do not object to the move, but do not belittle the consequences and the impact particularly on small pharmacies operating on borderline profits in rural and remote areas. Pharmacists and pharmacies are our colleagues, not our enemy.