The Pharmacy Monopoly Racket

My observations vary between localities.

The fear here is that ultimately our local rural pharmacy and those in the nearby towns will come to be the one chain, or worse rationalise to only one pharmacy that is not local. Better to have a local chemist assured than none at all, and preferably a competitor to those in the next nearest towns.

Does more or less regulation assure the best outcome for smaller communities across the nation?

Should rural and regional Australians have equal access to pharmacy services, and at the same cost as those living in large cities?

Consider an example of Goroke Vic pop ~299. It has a hotel, P-12 school with about 100 students according to the net, a little cafe, town hall, engineering company (vehicle and equipment maintenance and fuel(?)), a small IGA, all serving a pastoral and farming region large by Vic standards but maybe not so big by other states’ regions. The ‘nearby’ city with shops seems to be Horsham (68km, about 45 minutes). What would be the price and cost of enticing a chemist to open there to provide city services at city prices? If one could survive it would be a free market decision as there are no local chemists to knock a new one back. The point of my comment being the scale of regulation would necessarily be different between a Goroke, a Horsham (or Toowoomba or Armidale), a Gold Coast (or Geelong or Gosford or Newcastle), and a capital city, would it not? At what point would there be a balance? Does one ‘size fit all’ as it seems to under current rules? How difficult would it be to draft legislation that worked for purpose without unanticipated (or for that matter targeted) side affects? With partisans and lobbyists at work no need to answer because so long as "I am OK everyone must be OK’.

There is always another way.
We just need to look to the NBN for inspiration,
And how not to go about it!
:wink:

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HI Mark and Phil,
absolutely agree, health professionals around the world aggregate in major centres and unmet rural community needs are a huge problem. Towns losing their GPs and pharmacies are terrible for health outcomes, and even if they are retained, it is worsened by them having less support from local specialists (medical specialists largely work in upper middle to upper class areas of major urban centres but many do country trips to regional centres each week). The life expectancy in Australia is also longest in upper middle class and upper class areas, which speaks to the problem.

I saw a great proactive approach from one US state at a conference 10 years ago, where they had plotted cardiac disease prevalence vs the locations of the cardiologists that treat those diseases and seeing the mismatch they were working to support better coverage - I am not sure we have approached it that way here.

Fortunately the more recent CPAs take into account some measures to support remote pharmacies, which helps everyone, but it is said you still need a few thousand people to make a pharmacy viable, so for smaller shrinking towns it is only going to get worse.

That is evolving also. Coming soon to a location near ‘you’. Locally not close yet, but the closest one is (surprise!) ‘conveniently adjacent to the Chemistwarehouse’.

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Here is an analysis of the Pharmacy Guild claim that doubling the supply interval of selected drugs will result in shortages. It is worth a read as they go though the data carefully and explain where all the figures come from, which AFAIK the Guild does not do for their version of reality.

A few interesting quotes:

According to PBAC, in April 2023 “only seven medicines of the over 300 medicines had shortages … where there is no direct alternative brand, strength, or formulation”.

CheckMate examined the list of 46 critical shortages and found it contained only three products eligible for 60-day scripts.

These included two strengths of the same tablet, used for treating hypertension, and another type of (already unavailable) tablet for treating recurrent streptococcal infections.

Stephen Duckett, a health economist and emeritus professor at RMIT University, described the idea as “complete rubbish”, telling ABC News that increasing the limit was “not going to increase the number of drugs dispensed. It’s going to change how often they are dispensed”.

Similarly, Dr Ahumada-Canale said the claim “makes no sense” because “people are going to take the same amount of medicine”.

Pharmacies would need to “overstock so they can cope with demand” in the first month or two, he added, “but after that, it should be the same”.

A fact that I had not heard before:

“[I]n New Zealand, you can get three months’ worth of scripts dispensed, and they seem to be going all right,” Dr Boulton added.

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Of course it was and is a nonsense claim about shortages.

As for stocking levels, last time I went to a chemist to get prescriptions filled, half of them had to be ordered in anyway.

So why do we need pharmacies at all?

For non-prescription items they can be bought at any shop.

For prescription items then the medical center can supply them.

FWIW, my view is that the change to 60 day prescriptions is unlikely to result in the unavailability of any medicines because the Government can easily move the goal posts if any shortages are looking likely.

It is unfortunate, but not surprising, that those at each end of the issue are happy to argue amongst themselves whilst treating the public as mugs.

The only reassurance that I would ask for is one of the following two statements:

  1. If the new system was to start today, we currently have sufficient supply of all medicines to cover any possible increases in demand; or
  2. We don’t currently have sufficient supply of all medicines to cover any possible increases in demand but we have systems in place to ensure that there will be sufficient stocks on hand when the new system commences.

I don’t know whether this is a direct quote or misreporting, but the number of drugs dispensed is likely to increase for various reasons, including the following.

  1. The Health Minister has stated that almost 1 million Australians don’t fill scripts because they can’t afford the cost of the filling the script or visiting the GP to obtain a script. Making those processes more affordable will mean that more medications are dispensed.
  2. A percentage of dispensed medications are not consumed. This can be for various reasons including them being misplaced, stolen, losing effectiveness due to incorrect storage, changes to medications prescribed and the user dying. The larger number of doses people have on hand, the higher the amount of wastage.

Once again, the doctor may have been misquoted. I would be interested to hear from anyone who supports this statement as to why they think that if a pharmacy has to overstock in month one that they would not need to carry the same high level of stocks in month three. Most of the people who picked up 60 days supply in month one will come back with a similar order in month three.

Very reasonable ask IMO.

Assuming most everyone takes their meds as prescribed there should be no increase save for the initial change-over. The process is targetting long term sustaining drugs such as those for blood pressure, cholesterol, and others – not for short term treatments.

An outcome could be a healthier population if more people take their meds?

Why wouldn’t that be the case today and why would it necessarily change more than a minimal percentage? It implies people needing long term meds will consciously choose to not take some, doesn’t it. The argument of losing efficacy from long term storage belies that it is 2 months not 2 years and certainly not 2 decades per script.

I am on the side it is a step ahead. I have 2 long term lifetime required meds and being able to double up, and even have a years script at a time rather than only 6 months, would be beneficial. Why clog a GP’s schedule twice in a year (with fewer bulk billing GPs) potentially for decades per patient when a script is a known commodity for a known patient who is stable? Will the GP’s be forced to write ‘double’ or will it be optional at their discretion?

Perhaps you should read the linked article where the quotes come from and satisfy yourself of the accuracy.

When you first increase the supply for any particular drug for a person you need double the amount to start with but then it evens out over time. Overall the consumption will stay the same, 30 days supply twelve times a years is the same number of pills as 60 days supply 6 times a year. Yes the supply is more “bumpy” being double the amount half as often but that doesn’t mean we will run out.

Isn’t that a good thing? The medicines on the list for this scheme are not in short supply so I expect them to cope.

Possibly so but will it be significant and will it affect demand and so affect supply? None of the players have mentioned this as an issue.

For reasons I have included above, including information quoted by the Health Minister, this assumption is not valid. Not everyone takes their meds as prescribed and not everyone who should get a prescription current does so.

It is the case today, my point is that on each occasion when waste occurs there will, on average, be an additional 15 days of meds wasted.

This is true. However, I did not raise the issue of using efficacy due to 2 years or 2 decades of storage. Medications can lose there effectiveness if stored outside a specified temperature range or mishandled in other ways.

I too and on that side, I think that is only ones that aren’t are those who stand to lose out financially.

I did read the article. However, I was not present when the conversation occurred and am not able to guarantee that wording someone else included within quotation marks is an accurate quote.

Nor did I state that it would cause stocks to run out. I was merely pointing out that the statement attributed to Dr Ahumada-Canale is plainly false.

Definitely.

By itself, it might not be significant. However, along with other factor listed, they illustrate
that the comment attributed to Stephen Duckett is clearly incorrect.

Thanks for making that clear. It wasn’t :wink:

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