60 Day Dispensing could have been a good measure to help reduce health related cost of living. Because of the lack of consultation and refusal to modify the policy there are going to be many vulnerable Australians who will be worse off because of the policy.
Every pharmacist and pharmacy wants to help people to save money on their healthcare costs. However, with this policy less than 1 in 10 Australians will receive any benefit while most will end up paying more. The program excludes people taking medications that are not part of the list and people with unstable health conditions. They are in effect punished because of the conditions they have or the sate of their health. This inequality erodes the concept of universal healthcare that is so important.
A much more effective option would be to reduce the patient co-payment. New Zealand recently removed co-payment and many other countries have already does the same. Studies have show that every dollar reduction in co-payments saves $18 in other healthcare costs.
60 Day Dispensing Q&A
Overall, there is still so much confusion about the program. Below are some of the common questions that may help you to understand this poorly designed policy.
Do I need a new Script?
Yes. You will need to go to your Dr to request new prescriptions. The Dr will need to determine if your health is considered stable enough to provide increased quantities.
Will it mean I see the Dr less?
It is unlikely. Proper care of even stable chronic health conditions requires regular monitoring. In any event the Dr can simply reduce the number of repeats to ensure you still see them just as often.
Do I have a choice to stick with current amounts?
Yes. You can request the Dr write for the standard quantity. They cannot force you to get 60-day scripts.
Will it affect the Safety Net?
60-day scripts will mean it takes longer to reach your safety net. The limit is staying the same and a 60 day script only contributes one co-payment amount to the limit. Therefore if you still reach the safety net won’t save anything over the year. Despite saving you nothing it will cut our funding by over $400 a year just from your prescriptions.
Once you reach your safety net you will receive no additional benefit, but our funding will still be cut.
How much will the pharmacy lose?
Every 60-day script will cut our funding by $13 per dispensing or $78 per year as we will be dispensing half as many prescriptions. With almost 30,000 prescriptions affected the expected funding cut for Twin Waters Pharmacy could be as much as $195,000 per year.
What are you doing to manage the loss?
We are reducing our opening hours, reviewing prices in the pharmacy, and introducing charges for previously free services.
How can we help?
You can request that your prescriptions remain as the standard type they are now.
You can also reach out to your local federal member, Ted O’Brien, and the state senators.
If I get 60-day scripts, what will it cost me?
If you are having your 60-day medicines packed, we will need to pass the full cost of packing onto you. Our packing service costs on average $15 per pack. This cost will be charged as our packing fee .
If you get 60-day scripts delivered, we will charge a $10 delivery fee.
Medicines affected by 60 day dispensing
The full list of medicines proposed for 60 day dispensing can be accessed below.
A few of the highlights from the list include:
- Ranitidine – A medicine taken off the Australian Register of Therapeutic Goods due to cancer concerns
- Calcium Tablets – 2-4 months worth already
- Bisacodyl Tablets 200 – 3-6 months’ worth already
- Esomeprazole 40mg – Currently restricted to 1 month and 1 repeat with no option for increased quantities or repeats.
- Gliclazide 30 mg – currently 3 months supply at a time
- GTN tablets and sprays – when required medicines with short expiry dates
- Hydrochlorothiazide – 3 months’ worth already
- Allopurinol – 2-3 month’s worth already
Are my medicines covered?
There are 325 medicines covered with 92 starting in September 23. The list is here.
Wasn’t this decided by an independent expert panel?
The Pharmaceutical Benefits Advisory Committee was asked by the Health Minister to develop this list. All they did was make a list. They provided no input into the implementation of the policy.
The list includes medicines that were pulled from the market years ago for causing cancer, medicines where you already get 100 days’ worth at a time and medicines regularly used in attempts of self-harm and suicide.
The panel is comprised of mostly hospital doctors and academics. They don’t have detailed understanding of how medicines and therapies work outside of hospitals.
Reading through the list there are multiple questions regarding the appropriateness of the recommendations.
The list of items that are planned for change on 01/09/2023 can be viewed here.
A few points to note with the list. The items selected are primarily off patent items where generics exist. Hopefully this should help to avoid complete outages of medicines but will likely result in multiple brand changes.
The list also comprises 50% of the script volume of the 60 day list and approximately 35% of the total PBS script volume. Despite the Government promising to introduce the changes over 12 months the majority of the changes will occur on day one of the program starting.
How much will I save?
If you have a concession card, the maximum you will save is $132 a year or $2.54 a week. Unfortunately, if you are on more or less than 3 regular medicines, the savings will be less. I can calculate your saving for you if you would like.
- 1 medicine $43.80 pa or 84cents a week
- 2 medicines $87.60 pa or $1.68 per week
- 3 medicines $132 pa or $2.54 per week
- 4 medicines $87.60 pa or $1.68 per week because of the safety net
- 5 medicines $43.80 pa or 84cents a week because of the safety net
- 6 medicines $0 because of the safety net
If you don’t have a concession card, the maximum saving is $781or $15 per week.
To get this you would need to be on four 60-day medicines that cost you $30 per script. If your medicines cost less than $30 the savings will be less. As there is no funding for these medicines from the Government the full cost must be paid by you, including the increase for supplying a double lot.
Medicines Access and Safety Concerns
Medicine Shortages
Australia is experiencing an unprecedented number of medicines shortages. There are over 450 medicines (as of 23/04/2023) either unavailable now or expected shortly. These include medicines for diabetes, blood pressure, cancer, glaucoma and so many more. (Therapeutic Goods Administration, 2023) These shortages affect the health and wellbeing for a lot of people already. It takes up your time as you are searching around for the medication you need, and it takes up our time as we are calling doctors on your behalf or trying to find alternative supplies of medication.
60-Day medication shortages
Of the 2018 list of recommended 60-day dispensing medications (Pharmaceutical Benefits Advisory Committee, 2023) 27% are unavailable. If we end up in a position where we are required to supply a double quantity of these medicines, the stock shortages will take even longer to resolve. Some pharmacies and some people may get plenty of supply while others continue to miss out.
At the same time, medicines that are currently available in Australia will face increased demand as patients start expecting double supplies. This was an issue that was seen early COVID in 2020. (Mian et al., 2021) It will be a return to the supply issues of early 2020 as demand for medicines increase without a chance to obtain greater supplied from manufacturers. The time required for additional supplies of a medication to reach pharmacy shelves is approximately 9 months. Australia is a small buyer of medicines and therefore a low priority customer. This 60-day dispensing proposal is slated to start in 2 months’ time. there is not enough medication in the supply chain currently to start supplying double lots to everyone.
The recommendation from the Therapeutic Goods Administration at the time of COVID was to limit supply to one month of essential medicines. (Therapeutic Good Administration, 2020) This action ensures equitable supply of medicines to as many people as possible. Many pharmacies have experiences times during natural disasters where the supplies are cur off. They have needed to ration out medication because of shortages. Fixing shortages by supplying people more makes no sense.
Conflicting Advice
The TGA has released an updated advice the still recommends supply of one month at a time for equitable access to medicines. (Therapeutic Good Administration, 2022)
Price reductions of medicines over the last 15 years have reduced pharmacy incomes significantly and reduce the value of medicines on pharmacy shelves every few months. The cuts have gone so far that they are in part responsible for medicines the shortages experiences today. (Pharmaceutical Benefits Scheme, 2022). An increase last October to minimum wholesale cost of some low value and high-volume medicines was implemented. This increase was to ensure there would be always at least six month’s supply of the medicines in Australia. So far, no manufacturer has been able to comply with this arrangement and many are requesting exemptions from the 30th of June deadline. The buffer the Government has factored into making 60-day dispensing doesn’t exist.
Safety
“Supplying multiple quantities of medicines does not align with the principles of Quality Use of Medicines and can impact patient safety.” (Commonwealth of Australia, 2022; Therapeutic Good Administration, 2022)
A report published in the journal Australian Family Physician outlines many medications that can easily kill with small doses. (Braitberg & Oakley, 2010) The medications listed in this report all appear the 60-day dispensing list. this proposal will increase the access to deadly medication in the community for the sake of convenience and a questionable cost savings.
Advice on Medicine Safety lists causes of accidental medication overdose and poisonings including, medications stored at home and no longer needed, taking more than recommended potentially from multiple brand (see shortages section above), or from medicines not stored correctly (an issue with increased quantities of medicines). (Better Health Victoria)
References
Attwooll, J. (2023). Fall in bulk billing a rising concern for patients. News GP. Retrieved 23/04/2023 from https://www1.racgp.org.au/newsgp/professional/fall-in-bulk-billing-a-rising-concern-for-patients
Better Health Victoria. Medicines – safety issues. Victoria State Government. Retrieved 23/04/2023 from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/medicines-safety-issues#storing-your-medicines-safely
Braitberg, G., & Oakley, E. (2010). Small dose… big poison. Aust Fam Physician, 39(11), 826-833.
Commonwealth of Australia. (2022). National Strategy for Quality Use of Medicines. A. Government. https://www.health.gov.au/sites/default/files/documents/2022/04/national-strategy-for-quality-use-of-medicines_0.pdf
Mian, M., Sreedharan, S., & Giles, S. (2021). Increased dispensing of prescription medications in Australia early in the COVID‐19 pandemic. Medical journal of Australia, 214(9), 428-429. https://doi.org/10.5694/mja2.51029
Pharmaceutical Benefits Scheme. (2022). Medicines Supply Security Guarantee. Australian Government. Retrieved 23/04/2023 from https://www.pbs.gov.au/info/industry/pricing/medicines-supply-security-guarantee
RACGP. (2023). GP poll results tell the story: Patient wellbeing must come ahead of pharmacy owner profits. RACGP. Retrieved 23/04/2023 from https://www.racgp.org.au/gp-news/media-releases/2023-media-releases/april-2023/gp-poll-results-tell-the-story-patient-wellbeing-m
Therapeutic Goods Administration. (2023). Medicine shortage reports database. Australian Government. Retrieved 23/04/2023 from https://apps.tga.gov.au/Prod/msi/search?shortagetype=All
Therapeutic Good Administration. (2020). Limits on dispensing and sales of prescription and over-the-counter medicines. Australian Government. https://www.tga.gov.au/news/media-releases/limits-dispensing-and-sales-prescription-and-over-counter-medicines
Therapeutic Good Administration. (2022). Limited dispensing and supply of medicines. Australian Government. Retrieved 23/04/2023 from https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/limited-dispensing-and-supply-medicine