Pharmacy supplier to aged care overcharging.

[Felix1]

I would like to raise awareness of the issue below to ensure that others with loved ones in aged care with similar arrangements with pharmacies take care to review the invoices which are received each month to ensure they are correct. I did also raise this issue with the aged care facility and the aged care commission. The feedback I received from the commission was that they could not take any action on the issue as the complaint was not against the aged care facility so it was outside their purview.

I’d like to be clear that this complaint is NOT about the aged care facility which my father was in, they provided good care.

This complaint is about the pharmacy who dispensed medication to my father. The pharmacy appear to have a single source supplier contract with several aged care residences. It appears that the aged care facility communicate directly with the pharmacy when medication is required and the pharmacy dispense and then deliver the medication. The pharmacy usually direct debits the cost of the medication directly from the client’s bank account on a monthly basis.

I was looking after my father’s affairs while he was in aged care so I declined to provide direct debit details and asked the pharmacy to provide me with monthly invoices. I am so glad I did.

Several invoices I received had charging discrepancies. These discrepancies were:

1. charging up to three times the price of an item compared to if it was purchased from the same pharmacy bricks and mortar store
2. not providing the cheaper PBS medication when it was available. This means the resident pays more for their medication and it takes them longer to reach the PBS safety net (the pharmacy explained this by saying that I had ticked a box to request non-PBS medication however the doctor had ticked a box requesting PBS medication and this discrepancy was never queried)
3. not querying the doctor when an expensive non-PBS medication was selected which was not gender appropriate for the recipient, which would have been expected if a client walked into a bricks and mortar store
4. not recording a monthly payment of $150 which had been paid and then accumulating the same amount on the next periods bill

The pharmacy has not demonstrated that they are acting in the best interests of vulnerable residents of the aged care home. They have not provided valid reasons as to why the invoicing discrepancies have been made or provided any assurances that they will ensure they do not happen again.

If similar invoicing issues are occurring with other clients in several facilities then the over-billing could be worth thousands of dollars per month.

The clients are vulnerable people, not all of whom have family advocates to ensure that they are being treated fairly.

[PhilT]

Welcome to the Community @Felix1

Your experience should interest many readers. While there are some related topics I am going to keep yours separate as it is a different aspect of the many issues surrounding aged care.

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@Felix1

The feedback I received

What was the aged care facility’s response? I presume they are at liberty to contract medicines from whatever provider they wish, or at least that is how it was prior to the current system being implemented.

@Felix1

It appears that the aged care facility communicate directly with the pharmacy when medication is required and the pharmacy dispense and then deliver the medication.

That is the norm and from an operational matter is usually close to but rarely optimal. It avoids meds being missed/out due to human error. Most facilities get a prepack for ‘Mr.X’ in a pack including everything needed in a daily morning, noon, and night blister pack, rather than say a box of Y, another box of Z, and yet more, each individually packaged with varied doses. There is often (usually) a charge for that service. For low cost meds it might seem a significant ‘add-on’ cost.

@Felix1

not providing the cheaper PBS medication when it was available.

Are you meaning generic meds and brand name meds or does he require meds not on the PBS list, or has he been prescribed non-PBS meds when there are suitable PBS meds?

My understanding is that if a GP ticks ‘write as prescribed/no substitution’ the dispensing pharmacist is not able to provide a generic or alternative regardless of customer wishes. When there is face-to-face interaction with a customer that would be explained so the customer could deal with the GP. When a facility does the ordering they order per the GP script. Good practice should, as you indicate, call your attention for followup, but that is on the facility not on just on the pharmacy since the facility was doing the ordering.

@Felix1

They have not provided valid reasons as to why the invoicing discrepancies have been made or provided any assurances that they will ensure they do not happen again.

The best any business would do is improve their processes; I doubt any pharmacy could guarantee ‘it’ would not happen again if only because humans are in the process.

That being written, thank you for flagging your experience. Hopefully it will get visibility and others having similar responsibilities (or letting the facilities operate opaquely under their trust) might take a look and see what is happening re their loved one’s care.

[phb]

Hi @Felix1, welcome to the community and highlighting some of your observations in relation to the purchase of medications for those within an aged care facility.

The following is based on my own experiences as a carer for two elderly at home residents in the past, one who took medications from the manufacturer’s packaging…and the other using pharmacist prepared Webster Packs.

@Felix1

not providing the cheaper PBS medication when it was available.

In relation to this point and #3, unless one specifically asked for a generic brand medicine, pharmacists won’t deviate from the medication presented on scripts to them. There are reasons for this, one of the main being that they dispense medications and don’t prescribe them. Changing to a generic medication may be seen as prescribing. The other consideration is a generic may have additional ingredients not present in the branded medicines, which may cause a reaction to those who take the medications. A doctor will weigh up the risks of a branded verses generic at the time a script is written, and a patient should ask a doctor whether a generic can be substituted in their own case.

It might be worth consulting with the pharmacist, if you have a health directive/power of attorney, to make a note on the scripts for your father to dispense a generic medication where a generic medication is available and cheaper. This will need to be done otherwise the pharmacist will only dispense that on the script.

@Felix1

not recording a monthly payment of $150 which had been paid and then accumulating the same amount on the next periods bill

This is common practice as accounts are issued at a particular date which may not correspond to the date when they reconcile their accounts (which many business do at the end of the month). It is likely that the account hasn’t been reconciled with payments before a new account statement has been issued. It should appear in the subsequent months statement.

Business don’t reconcile payments against accounts every time a payment is made as it takes considerable time. It is easier and more reliable (and cheaper) to reconcile all accounts once a month.

@Felix1

charging up to three times the price of an item compared to if it was purchased from the same pharmacy bricks and mortar store

Is this for exactly the same brand, dose etc of medicines…or has the medicines been dispensed in a Webster pack which is often done for aged care facilities/the elderly where more than one medicine is regularly taken.

If the medicine is dispensed by Webster pack, these are more expensive as the time to make up a pack for an individual takes time and the time is costed into the medicine costs. Webster packs are used in aged care facilities or for some at home residents to ensure that an individual gets the correct medicines, the correct doses at the right time.

If it is comparing generic with brand medicines, then this is possible and possibly see if you can have generic dispensed by the pharmacist if you have the necessary authorities to make such a request.

If it is the same medications, in the same packaging, brand, size etc, then this is concerning. it is something that you should take up directly with the pharmacist.

[mark_m]

@Felix1

The pharmacy appear to have a single source supplier contract with several aged care residences. It appears that the aged care facility communicate directly with the pharmacy when medication is required and the pharmacy dispense and then deliver the medication.

We have a similar arrangement for one of the family in aged care, and declined direct debit. There is a monthly invoice provided electronically, and by mail. We’ve had previous issues with the timely receipt of the invoice and the pharmacy business accounting of payments. The greater concern is reliance on a single pharmacy not locally located. This at times appears to create issues with timely delivery.

While it is up to the professionals to prescribe medications, the facility has been reliable discussing all such needs as they arise. For others who find themselves in a similar situation with the key responsibility, developing effective relationships with the facilities staff may be critical to ensuring outcomes. Or if they are not delivering the outcomes expediting solutions.

It’s worth considering that the more time responsible family can spend inside the facility the better appreciation one can have of the facilities quality of care, or lack of. For those in the larger cities it’s open to look elsewhere if appropriate. For those more regionally based the options are often none close to hand or just one accessible. A decision to move to a different facility is not an option.

[PhilT]

@phb

This is common practice as accounts are issued at a particular date which may not correspond to the date when they reconcile their accounts

It pays to check until one is comfortable they understand. While that is the most likely scenario I had an account with a similar carry-forward balance I attributed to such timings. Since everything was automated I assumed it was as it should be; it was with a major company.

After a few years watching that balance carry along, it changed causing me to have a good look. Despite it not making sense to me the first few passes, I finally realised the statements (my account) had been incorrect for years, their audits did not pick it up, and I was able to point to the original error. I never received an apology, just an amended backdated history with the entries corrected.

[phb]

@PhilT

It pays to check until one is comfortable they understand.

That is true. The pharmacy I dealt with in Brisbane seem to reconcile the accounts mid month and issued the statements end of month. If one paid the account in the second half of the month, it still appeared on next months statement.

I used to confirm payment and account balance when dropping a cheque at the pharmacy…to ensure that the outstanding total was zero.

Edit: I should also say that the two pharmacies I dealt with issued an account (invoice for the new month) and a statement at the same time (should payments and accrued balances). The statements were time delayed as indicated above, the invoices were correct. The medicine issued in the manufacturer packaging were significantly cheaper than the same medicines in a Webster pack. I happened upon this as calcium tablets being taken and we asked for a prescription so it became a PBS medication and then we asked for it to be included in the Webster Packs (which caused the cost to increase again).

[Felix1]

re : charging up to three times the price of an item compared to if it was purchased from the same pharmacy bricks and mortar store

The item was a tube of Voltaren, so not something you would expect would cost three times as much to supply to the resident in aged care as it does in the bricks and mortar shop

[phb]

Did the price include delivery or exclude delivery? If it was delivered to the age care facility by the pharmacy, one would expect a delivery charge to be added to the bricks and mortar store price.

Rather than trying to guess why pricing could be different, it might be worth contacting the pharmacy to see why some products delivered to the aged care facility have different pricing to their bricks and mortar stores. They hopefully will be able to provide an answer which is reasonable/justifiable. If not, then this might provide you with an opportunity to take it up further.

[mark_m]

The pharmacy business that provides products to the Aged Care facility our mum is at does not make a seperate charge for delivery. Products required for all of the residents and the facilities general needs have scheduled deliveries. Common medical products including often prescribed medications appear to be available same day. This suggests the facility has some level of stock to draw on against prescribed or nurse approved needs.

The only recent issue with supply has been access to the Australian Government provided Covid treatment medication. The initial press release by the Minister suggested supplies would be made available at all aged care facilities. Despite ongoing new infections the facility we know needed to get supplies brought in when our mum caught Covid. She has recovered if anyone is concerned. Any more I might add? It’s election time!

[PhilT]

@Felix1

The item was

A number of businesses have in-store pricing and delivered pricing, with the latter factoring in delivery, often for quantities of 1 each, amounts compounded, rather than a single delivery fee added on.

Costco does it where online pricing is higher than warehouse pricing but includes delivery for each item, not a delivery fee shown for the lot of items ordered at once.

ebay ‘free shipping’ includes delivery costs being factored into the pricing for each item. Buy four of the same items with ‘free shipping’ from the same vendor and you pay four times for what may fit into the same satchel for the same postage.

It makes it opaque to the customer and while a common approach it can be a disservice to reputation for one business while a good look for another, products and services dependent. Some customers look elsewhere when the delivery fee is shown as a line item and the consumer thinks it is too high but doesn’t flinch when there is bundled ‘free shipping’.

Following on, providers of on demand services such as pharmacies with delivery have higher costs leading to higher pricing they need to account for one way or another, and they choose a way. An alternative (for perspective) may be to ask if ‘you’ can become the provider and respond to any and every daily requirement within a few hours to see how it goes.