THE pharmaceutical industry believes a shift to 60-day medicine dispensing could threaten the future of Australia's regional and remote pharmacies which rely on government dispensing fees to stay afloat.
Late last month the Federal government announced a 60-day prescribing policy would come into effect from September 1, providing doctors with the option to prescribe a two-month supply of more than 320 medicines on the Pharmaceutical Benefits Scheme (PBS) to Australians with stable, ongoing conditions.
The current dispensing limit is for a one-month supply only.
While the government said the reform would not affect medicine availability or add to shortages and "every dollar saved" would be reinvested back into community pharmacies so they can play a larger role in the provision of healthcare services, the move has drawn backlash from many working in the pharmaceutical industry.
Owner/manager of Shark Bay pharmacy Malcolm Chen, who has been a pharmacist for the past 11 years, said the policy was ill-conceived and would have detrimental flow-on effects for Australia's healthcare system, particularly for those living in regional and remote areas.
Using an independently verified calculator to assess the financial implications of the change to 60-day dispensing on his own business, Mr Chen said his pharmacy would suffer an estimated loss of about $50,000.
"We are only a very small pharmacy, so to put this into perspective that would essentially be the income of my only other staff member," Mr Chen said.
"The loss of that staffing would mean the community would lose access to services such as vaccination (as this requires two trained personnel attending at all times) - a service the government has suggested they will reinvest into community pharmacy, which I will no longer be able to participate in."
With Shark Bay having no resident doctor and the next closest pharmacy a 350 kilometre trip, Mr Chen said the pharmacy was responsible for providing essential health care services to the local community.
He flagged shortages in the supply of medication and stoppages in country pharmacies being able to provide other important health services as potential ramifications of the government's move to the new policy.
"With COVID and all the supply chain issues, we already have pretty significant medication shortages," Mr Chen said.
"For a lot of people, each month, I can supply just enough medication for them to carry on their treatment.
"By doubling the amount of medication we're giving out I have serious concerns that one person may have enough medication for two months, but then suddenly three or four people may not be able to access their medication.
"Living remotely, I can't just tell my customers to try another pharmacy either - because it's a three and a half hour drive to the next town."
With the government's dispensing fees enabling many pharmacies to provide additional services, from basic things like witnessing statutory declarations to wound care assistance, Mr Chen said the move would likely lead to services being discontinued or reduced at many pharmacies, or the costs of previously free services being passed on to customers.
"The government has said this move will reduce the costs to patients, but if in turn it means the services they need on a regular basis now cost more, it could, for a lot of people, ultimately increase the cost of their medication and/ or access to other health care," he said.
However, he said if the bottom lines of country pharmacies were significantly hit when the policy came into effect, perhaps the most significant ramification would be their potential closure.
"In remote areas you can't just see a doctor as easily as you can in metro areas - so the pharmacy is the constant and most successful healthcare professional a lot of regional patients can access," Mr Chen said.
"If you take that away, it puts a lot more pressure on emergency services in those areas - so it's the flow-on effects that are of most concern.
"The healthcare system is under stress everywhere in Australia at the moment, but particularly in remote areas, so the closure of country pharmacies would have a catastrophic effect on people's healthcare and completely negate what the government was trying to achieve in the first place."
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Having recently invested in the construction of a consultation room to increase the number of healthcare services his pharmacy can provide, Mr Chen said he would have to re-assess whether he could continue on with his plans, depending on how much his income is affected by the impending changes.
"We thought we would have fairly steady funding from the government to help build that room - but if that gets wiped away I'll have to weigh up whether it's still financially viable," he said.
The Pharmacy Guild recently negotiated a reduction in the cost of medication so that the maximum amount per prescription on the PBS for a general non-concessional patient is $30, dropping from $42.50 the year before.
While not supportive of the move to 60-day dispensing, Mr Chen said he would support a further reduction in the capped cost of these medications to improve their affordability.
Following the controversy surrounding the announcement of the new dispensing policy, Australia's acting chief medical officer, professor Michael Kidd said he was concerned about reports in the media over the possible exacerbation of shortages of medicines once the policy was implemented.
"It is important not to create unnecessary concerns in the community about medicine shortages, especially for those people who rely on daily medications to manage their medical conditions," Mr Kidd said.
"Given the careful way this initiative is being rolled out in stages, and with patient safety and continuity of medicine supply being paramount, I can confirm that there is no basis for these concerns.
"The Therapeutic Goods Administration closely monitors medicine shortages and facilitates the supply of alternative medicines as a priority.
"Importantly, doctors will still have the choice, in consultation with their patients, to prescribe medicines in the quantity they consider safe and clinically appropriate for each individual patient's circumstances."
As part of the Federal Budget announced this week, the government will invest $350 million to community pharmacy outreach into aged care facilities.
However Mr Chen said the government's reinvestment of the funds into these services as well as potential opioid dependency programs was not particularly equitable for pharmacists and people living in regional and remote areas, who were less likely to have access to these types of services.
