Senate inquiry agreed to in Parliament— PBS to remote living Aboriginals to be examined

 

On 24th March 2011 the Senate agreed to a motion from Senator Rachel Siewert (Greens, WA) that the supply of Pharmaceutical Benefits Scheme medicines to remote area Aboriginal Health Services be referred to the Senate Community Affairs Reference Committee. The special  arrangements under Section 100 of the National Health Act have provided a bulk supply scheme with no value added component from a pharmacist.

Three reviews of the scheme in 2004 (Kelaher) 2006 (Urbis) and 2010 (Nova Policy) have failed to produce any significant improvement in the quality use of medicines by Aboriginal clients of health services. 

A matter of equity

The matter to be reviewed by the Senate Committee is a matter of justice, fairness and   equity particularly relevant at a time when Closing the Gap is so much in the headlines and remote living Aboriginal people are dying at such a young age.

After three reviews of the Section 100 supply arrangements little change has occurred. The Senate Inquiry should be able to identify what needs to be   improved and which agency should be responsible for making it happen. The involvement of pharmacists in this process should be a leading principle.

Inequities for remote Aboriginal Health Services (AHS) and the Pharmaceutical Benefits Scheme (PBS) include:

• Over the ten years the scheme has been in place there has been no money made available to the Aboriginal Health Services to develop their own pharmaceutical care program.
• Recording of outgoing supplies (dispensing) by any electronic process incorporating scanning is absent and hand written labels are the norm.
• While the PBS pays a dispensing fee ($6.42) to pharmacies in all situations under Section 85 (mainstream) there is no fee paid for the dispensing  carried out at Aboriginal Health Services.
• The PBS saves $3.68 every time a PBS medicine is dispensed to a remote living Aboriginal person. A handling fee of $2.74 is paid to the supplying Approved Pharmacy for the bulk supply but no dispensing fee is paid to the AHS.
• Mainstream Australians have access to a pharmacist (by law) in every pharmacy in Australia when a PBS prescription is dispensed. No such facility is available to an Aboriginal patient of an AHS or to a  
  person trained by a pharmacist to inform them of the nature of the medicine prescribed.
• No data is analysed to assist in decision making towards improved medicine utilisation across States and regional boundaries. 

Go to the following link for details on the Inquiry and the making of a submission:
http://www.aph.gov.au/Senate/committee/clac_ctte/pbs_medicines/index.htm

Closing date for Submissions is 30th June 2011.

The Terms of Reference seek comment on a  range of issues. The full text of the Motion agreed to by the   Senate follows:

The effectiveness of the special arrangements established in 1999 under section 100 of the National Health Act 1953, for the supply of Pharmaceutical Benefits Scheme (PBS) medicines to remote area Aboriginal Health Services, with particular reference to:

(a) whether these arrangements adequately address barriers experienced by Aboriginal and Torres Strait Islander people living in remote areas of Australia in accessing essential medicines through the PBS;

(b) the clinical outcomes achieved from the measure, in particular to improvements in patient understanding of, and adherence to, prescribed treatment as a  result of the improved access to PBS medicines;

(c) the degree to which the ‘quality use of medicines’ has been achieved including the amount of contact with a pharmacist available to these  patients compared to urban Australians;

(d) the degree to which state/territory legislation has been complied with in respect to the   recording, labelling and monitoring of PBS medicines;

(e) the distribution of funding made available to the program across the Approved Pharmacy network    compared to the Aboriginal Health   Services obtaining the PBS medicines and dispensing them on to its patients;

(f) the extent to which Aboriginal Health Workers in remote communities have sufficient  educational opportunities to take on the  prescribing and dispensing responsibilities given to them by the PBS bulk supply arrangements;

(g) the degree to which recommendations from previous reviews have been implemented and any consultation which has occurred with the community controlled Aboriginal health sector about any changes to the program;

(h) access to PBS generally in remote communities; and

(i) any other related matters.

Question agreed to.

Any person or organisation requiring further background to the Inquiry or assistance with the writing of a submission can contact Rollo Manning at rollom@iinet.net.au or 0411 049 872.

Take medicines - seriously, and help Close the Gap

The life expectancy gap for Indigenous Australians could be significantly closed if the same level of pharmaceutical care was applied to those living in remote communities as it is for the rest of the Australian population. The management of chronic diseases requires urgent attention in the provision of prescription medicines - in both monitoring adherence and follow up adjustment of dosing.

Patients attending Aboriginal health services in remote communities are being dispensed medicines with little recording, probably no label and scant advice on what to expect of it.  This is the outcome of ten years of bulk supply of Pharmaceutical Benefits Scheme (PBS) medicines from an Approved Pharmacy with no involvement of a pharmacist in the dispensing process. The scheme is costing the Australian taxpayer $40 million a year yet even the Department of Health and Ageing admit there is wastage and an analysis of the Medicare records of payment would not be an accurate evaluation of what is being supplied to patients.

Whilst it will take years for medicine taking to impact on the life expectancy gap between Indigenous and non-Indigenous Australians this discreet group of patients with only one supply route should be an ideal target for some primary practice research.

But no!

Researchers admit that the missing element in data with respect to chronic disease management is knowing whether the patient is taking their medicine. Whilst this might apply to the bulk of Australians with chronic diseases, the clinical signs should be there to illustrate the benefits of medicine taking. Otherwise why is the taxpayer paying $8.4 billion a year on the PBS?

With no record of supply and the labelling an unknown quantity – the quality of pharmaceutical care is suspect.

Approved Pharmacies (agents for the supply of PBS medicines) are under no obligation to provide support in the supply on to the patient. That is the job of the Aboriginal health service and done by doctors, nurses and Aboriginal Health Workers with no payment from the PBS to meet the cost of dispensing.

In mainstream PBS supply the Approved Pharmacy is paid $6.42 every time a prescription is dispensed. It is recorded on an IT system that has been paid for and upgraded by the PBS. In remote “drug rooms” there is no such luxury – not even a typewriter for labelling.

Of the $40 million dollar cost to the PBS in this financial year, $10 million will go to the Approved Pharmacy through a combination of a $2.74 handling fee per item and a 15% mark up on the cost of goods. The PBS actually saves $3.68 every time a packet of pills is given to a remote living Aboriginal person. Extended across a year this amounts to $5.52 million and that would employ a lot of pharmacists at Aboriginal health services to add some quality to the supply and give the patients an understanding of what western medicine is all about.

All Australians, when given a prescription by a doctor, take it to a pharmacy for dispensing. They can then ask the pharmacist (always present by law) whatever question they want about that medicine. The salary of that pharmacist is largely contributed to by the PBS through the dispensing fee. For the remote living Aboriginal there is no such practice. There are no pharmacists employed by Aboriginal health services in the NT and only three in the whole of Australia.

This is a shameful situation and one that shows a high degree of discrimination and unacceptable level of unequal opportunity. The National Indigenous Health Equality Council is not interested in this matter claiming that it does not fall within its terms of reference. The Pharmacy Guild is interested in its members being viable entities while NACCHO (the Aboriginal health peak body) is overwhelmed by the Pharmacy Guild into thinking that “this is as good as it gets”.

The diseases killing Aboriginal people at a young age were not there 40 years ago and have been brought on by lifestyle choices. This makes it even more important that information is provided to help the patient understand what the medicine is going to do and how it will work to help them live longer.

Such is the need for a greater emphasis on the quality use of medicine for Aboriginal people in remote communities if Close the Gap is to be taken seriously.

Ends