The inequity of pharmacy distribution

THE INEQUITY OF THE DISTRIBUTION OF PHARMACY BUSINESSES IN AUSTRALIA

Quote from Letter to Editor of the Australian Financial Review (14 November 2013) from Greg Turnbull of The Pharmacy Guild of Australia:

The provision of quality dispensing of PBS medicines at around 5300 pharmacies evenly distributed across Australia is an essential health service for Australian consumers, appropriately subsidised by government since 1948.

Source: http://www.afr.com/p/opinion/fact_is_the_best_cure_for_howes_A0ttA6GrLqkaGxR0gDmb0H

This was posted in a rebuttal of the article by Paul Howes in the Financial Review on 13^th November 2013

See it at http://www.afr.com/p/opinion/no_room_left_for_pharmacy_guild_RHF7RyCxkhd0I65945sCkL

So what? – Just another bun fight between the Pharmacy Guild and a critic of the current Australian retail pharmacy industry. “Nothing new about that” one could say.

Yes BUT there are aspects of the quote that need comment when looking at the provision of pharmacy services to ALL Australians.

There is one group that is left out of the assumption that the pharmacies in Australia are evenly distributed throughout the Nation.

There are 53,000 Aboriginal people living in remote communities in the Northern Territory who would not know what a “pharmacist” is let alone what a pharmacy business looked like.

The reference to quality dispensing of PBS medicines is a joke with no pharmacist in sight at the point of dispensing and supply to the patient – unlike every other Australian who, thanks to the PBS money, has a pharmacist available at the point of supply everywhere a PBS medicines is supplied.

And as for this being an essential health service for Australian consumers well “yes” maybe but NOT if you are an Aboriginal person living in one of the 100 remote communities in the Northern Territory.

It is time the Pharmacy Guild took its head out of the sand and started to look around for ways its beloved “service” can be improved for these Australians with the worst health status in the land and who would not know why their prescribed medicines will work let alone why they should take them.

Adherence is a problem and none more so than amongst remote living Aboriginal Australians.

One more thing – the statement that the PBS has been appropriately subsidized by government since 1948 is wrong for remote living Aboriginal people – it was not until the year 2000 that this occurred for these people through the special arrangements made possible using Section 100 of the National Health Act.

Any pharmacist interested in investing in a pharmacy business and any one of the 20 remote “growth towns” in the NT should contact the writer at rollom@iinet.net.au or on 08 8991 8457 or 0411 049 872.

A Prospectus is to be produced to assist future investors with their decisions.

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.