Bridget Archer (Bass, Liberal Party) Share this | Link to this | Hansard source

Just yesterday, I was standing in a pharmacy waiting for a script to be filled, and I was struck by a sign announcing a $5 fee for blood pressure checks, a service that has previously been free. I can imagine that this was not an easy decision for the owners of the pharmacy to make, but I understand that these are the choices many pharmacies are facing in light of the government's announcement to implement 60-day dispensing for community pharmacies.

No part of our health ecosystem is more important than the other. It takes a community of dedicated health professionals to diagnose, treat and manage an individual's health, or sometimes many health conditions, and our community pharmacists, particularly in regions like northern Tasmania, play a key role in health management. From Elyse in Scottsdale, Jason in Youngtown, Rhys in Summerhill, Dianne in Ravenswood, Borys in Bridport to lvo and Helen in Riverside, northern Tasmanians are fortunate to have caring pharmacists who are dedicated to the health and wellbeing of their patients. But we can't expect pharmacists to do their job, to keep their doors open to the community and to continue to employ locals in their businesses on goodwill and dedication to the job alone.

I understand the hurt and frustration felt by our community pharmacists, who felt demonised by some of the comments made when the dispensing changes were first announced. Playing our healthcare sectors off against each other is a no-win situation, as is attacking pharmacy owners for their genuine concerns about how the proposed changes would impact them financially. Everybody loses if a community pharmacist can no longer afford to be in business. In order for pharmacists to do their job to the best of their ability, any government should seek to find ways to better equip pharmacists to do their job while also delivering better outcomes for patients. From what I have seen of the government's announcement so far, the 60-day dispensing change doesn't achieve either of these goals.

Let me be clear that I strongly support affordable access to medicines, particularly as an elected representative from Tasmania, a state that is, unfortunately, overrepresented in chronic disease. Additionally, living in an electorate with significant issues of accessibility to health care in some areas and challenges in affording necessary health care, I do understand the need to provide cheaper medicines and have advocated for such, particularly as the cost of living continues to impact many in my community.

However, I do have some concerns about whether Labor's proposed changes will actually deliver cheaper medicines in the long term, and there are serious questions over what impact the changes will have on pharmacists and patients in both the short and long terms, particularly at a time when we are facing a national medicine shortage and as it has become very clear that there was very little meaningful consultation undertaken with community pharmacists about the proposed change.

We now know that a letter from the Office of Impact Analysis has revealed that the impact of the Government's change to 60-day dispensing was not properly assessed to the standard of 'good practice'. Furthermore, the government failed to meet the criteria for good practice due to a lack of public consultation, particularly on the potential impacts for small businesses and pharmacies in rural and remote areas. It was also found to be lacking a detailed evaluation plan outlining how Labor is going to monitor the impact of the policy on community pharmacies once it is implemented.

Whilst I'm dumbfounded by the lack of consultation, the findings are of no surprise to me after engaging with numerous community pharmacists in my community who don't feel as though their concerns have been listened to. I'd like to read an email extract from one passionate local pharmacist in my electorate about the value of community pharmacists and the damage this proposed change would bring: 'Pharmacists didn't close during COVID. We triage patients for free. We bandage up people for free. We deliver medications for free. We hug the bereaved. We give social advice to the marginalised. We pack medication packs for under cost. We deliver subsidised diabetes products for $1. The list goes on. This will all change under this announcement. People will hoard medication. Drugs will run out of stock, worse than the present out of stock. At the end of the day there'll be young pharmacists going broke, and the profession will struggle to attract new talent, who will be too scared to take on the risk of ownership if government makes changes contrary to the agreements in place. I love my job. I love my profession. I love the customers in the community I serve,' he said.

We all want to see cheaper medicines, but the government must clearly demonstrate that our community pharmacists will not be adversely impacted by the proposal. Otherwise, we will all lose.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

Community pharmacies are a very important part of our towns and villages in Gilmore. They are there when you need them, and we have seen that first-hand through many natural disasters: the Black Summer bushfires, multiple floods and storms, and of course COVID-19. Community pharmacies, pharmacists and pharmacy workers really play—and, importantly, will continue to play—an extremely important role in our communities. They are where people go to get their medication and some advice, where people pop in to buy some essentials, to have their vaccination and more. There is great opportunity for an increase in scope for pharmacists so that pharmacists can utilise their skills even more. In a changing world, just like many businesses in my local area, this is what many businesses have had to do to survive—and that was without a government subsidy.

In 2018 the clinical experts at the independent Pharmaceutical Benefits Advisory Committee recommended moving to 60-day dispensing. Instead, it was not implemented, costing Australians billions in lost savings and resulting in people paying much more for their medicines than they should have. But multiple-month dispensing is nothing new. It happens in many countries around the world, like New Zealand, the UK, France and Canada, and has worked for years. This will halve the cost of medicines for millions of Australians, and in Gilmore around 50,000 people will benefit from cheaper medicines. If this system was introduced in 2018 it would have saved patients billions of dollars. Think about that. That is taxpayers' money—taxpayers' money that has gone to keeping medicine prices higher unnecessarily.

In Gilmore, incomes are not high. People are facing tough times, and people need sensible cost-of-living relief. This government is making the decision to make medicines cheaper for six million Australians. In my electorate, where there has long been a GP crisis due to the previous government's cuts to Medicare, our cheaper medicines policy will, importantly, help free up GP appointments for those who need them most and help ease pressure on our local hospitals' emergency departments as well as free up time for more GP support for nursing home residents.

I have looked at this policy from every angle. I've listened to local views of pharmacists, GPs and patients. And I'm completely satisfied that there is no logical reason that we should not move to 60-day dispensing. But don't take my word for it. I recently received a letter signed by peak medical and consumer health organisations supporting our cheaper medicines policy, including the Consumers Health Forum, the Rural Doctors Association, the AMA, the Royal Australian College of General Practitioners, Breast Cancer Network Australia, the Heart Foundation, Asthma Australia, Diabetes Australia, and the Lung Foundation, as well as groups like the Council of the Ageing and the National Aboriginal Community Controlled Health Organisation, and many others. These represent patients in Gilmore with chronic conditions that will benefit from cheaper medicines. This is what Dr Dominic Frawley, a Nowra GP, had to say:

Patients will be able to get the same quality of care while reducing unnecessary visits to the doctor and pharmacist. This will take some pressure off appointments in general practice—making it easier for my patients to see me when the need arises. The new government is offering some genuine support to GPs and their patients, after many years of cost-cutting. That's better for me and my patients.

Isn't better health care for people what it's about?

I have been deeply disappointed that some local pharmacists, and pharmacists around Australia, have been deliberately misleading and harassing consumers with a vicious scare campaign. I have never, ever seen such atrocious, despicable behaviour—in particular, scaring and lying to vulnerable patients. Medicine shortages will not be worsened due to this initiative, nor will it directly lead to medicines going into chronic shortage. The PBAC has said the 325 medicines for chronic conditions are safe for 60-day dispensing. I understand that local pharmacist owners are concerned about their profits, but this is good health policy, and the fact that the government is putting every dollar of the $1.2 billion saved back into community pharmacy is a good thing.

My message to local pharmacists today is, in the best interests of local pharmacies and pharmacy workers, encourage the Pharmacy Guild to return to the negotiating table so that the pharmacy sector is involved in constructive discussions about the reinvestment of funding back into community pharmacy. That would be in everyone's best interests. I look forward to cheaper medicines starting on 1 September and providing much-needed cost-of-living relief for people in Gilmore.

Garth Hamilton (Groom, Liberal National Party) Share this | Link to this | Hansard source

I think the previous speaker, the member for Gilmore, laid out much of why this has become such a contentious issue. We hear the concerns raised by local pharmacists described as a 'vicious scare campaign'. There are two sides of that: dismissing these concerns out of hand as a vicious scare campaign, and hectoring the guild to come back into the consultation process. You can't do both of those two things.

Let's be very clear: I have no doubt that the government has the intention of reducing costs of living by taking these steps. I'm not going to pretend they're out there trying to cause harm to family businesses. I think their intentions are to do good. The issue is that, with politicians, intentions aren't really what matter; it's consequences. One of the ways we tried to assuage the issues that came through was through that consultation process. What came up time and time again when I spoke to my local pharmacies, trying to understand what their issues were with this policy, was that there had been no consultation getting all the way through.

An opposition m ember interjecting

I hear, 'That's rubbish.' Once again we're getting dismissal from a government that, on one hand, wants to dismiss these concerns but, on the other hand, says, 'Come back to the table with us.' We had no consultation, and what that produced was a very poor policy.

I don't think it's right to catastrophise these things. I have raised consistently that one of the issues I hear from my small regional and rural pharmacies—these are people who are the only medical professionals after hours. If you are hurt or need attention, people have been going to the pharmacies for exactly that in places like Goombungee, Oakey and Pittsworth for years. They are established parts of the community. That's the role they play within our health service. I'm not saying it's the right role—I think there's a lot of work to be done there—but that is the role that they play. They have raised genuine concerns around what a change to their cash flow would look like and how it would impact their business.

Since this issue has bubbled into life and we've had all the conversations we've had—some quite angry—the consultation process has been for the government to talk to Chemist Warehouse. Now, I have nothing against Chemist Warehouse—good on them; they're a big player—but they're a big fish in this pool. They represent between eight and 10 per cent of the pharmacies in Australia. There is no way the impact on one of their businesses will be in any way similar to that on the Oakey Pharmacy. When I speak to Nathan Jervis, an example of many small pharmacies, a family-owned company, the impact is in the hundreds of thousands of dollars. This is a pharmacy that operates in that hub-and-spoke model. They are a small town. They play a significant role, but they are already having to look at what the consequences of this will be. It looks like questions on staffing. It looks like questions on opening hours. And we look at the services that they may have to cut back on. At the moment they provide free delivery throughout their community. At the moment they provide cheap Webster-paks. They've got a great relationship with the aged-care facility out at Oakey. They also provide free delivery, particularly to the Indigenous community in our area. They support sports clubs and community events.

I'm not talking about a business. I'm not concerned about a particular business. This isn't about someone who has a financial or economic issue only. I'm talking about a family-run business that is a crucial part of the community. If you take away that business, it's not the business that fails; it's the family that fails and it's that little bit of community that falls down further. And these small regional towns have witnessed this constant drain over generations, away and out of these towns, and they have seen how hard it can be to get projects off the, generate employment and keep these places going ground in these towns.

The impact of reducing those services in that town will be felt. It's not going to be a landslide or calamitous. It's going to be town by town getting a little bit worse and a little bit worse. I think that's the issue at play here. Whatever their intentions are—I say again that I don't think the government is trying to hurt these small businesses—they've not listened. They've not gone out and spoken to them. The impacts on these small businesses will be considerably different to the impacts on giant national companies like Chemist Warehouse. To pretend otherwise is absolutely ridiculous. To demonise the guild—if you don't want to talk to the guild, talk to the Pharmaceutical Society. If there's an opportunity to talk, these people will absolutely do it. I think you'll get a very different answer from what we've been getting.

Shayne Neumann (Blair, Australian Labor Party) Share this | Link to this | Hansard source

I wish to thank the local pharmacies in my electorate and in urban Ipswich as well as the country towns for the work they do, the employment they provide and the contribution they make with local organisations, including sport organisations.

I'm pleased to speak on this motion because it gives me an opportunity to call out some of the exaggerated claims and scaremongering around the Albanese Labor government's plan to allow Australians to buy two month's worth of medicine for the price of a single prescription. This policy is supported by so many health organisations: Consumers Health Forum, the Heart Foundation, the Lung Foundation, the Breast Cancer Network, the Rural Doctors Association, the AMA and so many others. The reality is our cheaper medicines policy will help around six million people: patients with chronic health conditions who require regular drug treatment for the rest of their lives, halving their medicine costs and saving $1.6 billion over four years, with fewer visits to the GP and the pharmacist. It builds on the changes that we've made in terms of the costs of prescription medicines from the beginning of this year.

Unfortunately the Pharmacy Guild, which represents the interests of too many pharmacies and now the opposition, are trying to mislead Australians with a dishonest scare campaign. The suggestion in the motion that the government has not consulted with, or listened to, the concerns of community pharmacists is simply not true. The Pharmacy Guild were briefed early, and in detail, by the government on the increased dispensing policy which is the basis of a recommendation of the independent expert Pharmaceutical Benefits Advisory Committee, the PBAC. That body is made up of clinical experts, including from the pharmacies sector. Moreover, the changes were first recommended back in 2018. So for the Pharmacy Guild to now claim that the prospects of the proposal being implemented were not known to them is simply disingenuous. They weren't letting on to their members about this prospect.

The PBAC has now reconsidered the issue and recommended hundreds more—in fact up to 300 more of the most common medicines used by Australians. The majority of these are currently in good supply or have a readily available alternative. It's disappointing that the Pharmacy Guild has chosen to break their non-disclosure agreement with the government prior to the announcement of their reasons and deal themselves out of the policy implementation discussions. The invitation remains for them to be engaged in a constructive process.

I've met with many local pharmacists in my electorate. I had a Zoom meeting with up to 31 people. I had meetings in my electorate office in Ipswich and also down here in Canberra. I'll continue to engage with them, as will the Minister for Health and Aged Care and other government members because we know how important local community pharmacies and the role they play in our local communities are.

Secondly, the motion calls for the government to guarantee this change will not harm the viability of community pharmacies. Don't get me wrong. We acknowledge there will be some impact on individual pharmacies, including in regional and rural areas. But that's why the government is reinvesting money back into the community pharmacy sector. The government recognises that rural and regional pharmacies face particular challenges; that's why we've doubled the rural pharmacy maintenance allowance ahead of the introduction of the policy. This provides a significant boost to small and regional pharmacies, with some pharmacies set to receive more than $90,000 under the subsidy.

It's worth noting the Australian pharmacy sector receives a lot of government support already. On the whole it is highly profitable, well regulated and highly protected. For example, the total industry revenue was estimated to be nearly $26 billion this year, with an industrywide profit margin of well over eight per cent. The benchmark the Pharmacy Guild has been using is a highly selective use by the Pharmacy Guild. It's an inaccurate description of the profitability of the sector, relying on that figure that I refer to based on the turnover of pharmacies earning more than $3.5 million a year. That's not the preferred benchmark of the ATO, by the way, which is the cost of sales, not the expenses divided by annual turnover, which the Pharmacy Guild tends to use. If you look at that, it goes from the actual eight per cent to nearly 38 per cent profitability, which is commensurate with what a legal practice, an accounting practice or some other professional practice might earn.

The argument also that somehow this will result in drugs not being available or not being dispensed is simply nonsense, quite frankly. The PBAC considered this whole issue on 5 May, and the chair of the PBAC, Andrew Wilson, confirmed that 60-day dispensing will not cause medicine shortages, and it's simply rubbish to say otherwise. RMIT has said that, Macquarie University has said, and a whole range of other people have said that as well.

Russell Broadbent (Monash, Liberal Party) Share this | Link to this | Hansard source

I have actually seen figures—private figures given to me—from a pharmacist who runs three or four pharmacies in my area and others. I have seen what these changes will do to their bottom line. I have seen that he is arguing to me that it will cost jobs in his businesses. I have seen what others have argued to me, from Phillip Island to San Remo and down to Grantville—all the way through my regional areas. They are saying to me that these changes will force them to close the very small pharmacies that they've got in local communities, especially in country and regional areas.

This is really important to me, because sometimes the only health care provided in districts and electorates like mine is through the local pharmacist. That's the only way people are able to get some medical information, benefit or whatever their need may be before they have to go on quite a trip to get to a hospital or a GP. Because of that interaction every month, the pharmacist gets to see the person involved. It's very similar to aged care. If gastroenteritis goes through an aged-care community and the doctor only comes once a week, if Mrs Jones isn't diagnosed as having gastro, she can be so dehydrated by the time the doctor does come that it may be too late for her in that situation. You can't expect the tea lady taking the morning tea around to particular clients in the aged-care setting to diagnose why somebody may not be eating or taking their cup of tea. It's not up to them.

When pharmacists are seeing clients once a month rather than every two months, they actually get a chance to assess how the medicines are going, whether they need to attend a doctor for more attention or whether they have deteriorated in the last month. If we leave that for two months, that's six times a year. This system has worked so very well, especially for country communities, that we encourage pharmacists to go out and create these smaller unit pharmacies in more remote locations so that we can have our small communities getting the same sort of service you'd get in a larger community with one, two or three pharmacies. These changes have been put to me by genuine pharmacists coming to me with their issues. I've spoken to them, and they have said to me, 'This will be the result of these government changes.'

I'm not a protector of minority groups of doctors or pharmacists or any group. I'm not. But I like to listen to their genuine concerns, and I like to know that information I'm being given is factual. So when someone gives me the actual books of their chemist shop, and says: 'Here they are. You're a former retailer; you work it out. Here are all the lines, and this is what's going to happen to those lines, and, therefore, some of the things we're doing for free and some of the things we're doing on the cheap, we won't be able to do anymore because we have to keep viability within the business somehow.' And they say: 'I know that I am going to lose a number of valued staff members that I've had for a long time. They're going to lose their jobs because there won't be the work for them to do within the pharmacy.' Even the Prime Minister's own pharmacist said, 'These changes will break me.'

The pharmacies that I deal with are family businesses. They're small businesses in country towns. They are the pharmacists and they are highly regarded within their community. They're highly regarded by me. I'd like to see the government really go and consult with the pharmacists and the pharmacies guild, and see if they can come up with some reasonable changes to this legislation they're putting forward.

David Smith (Bean, Australian Labor Party) Share this | Link to this | Hansard source

Firstly, I'd like to recognise Dan Lalor, Canberra Hospital's chief pharmacist, for his recognition in the King's Birthday Honours last week.

In a previous life, I represented both hospital and community pharmacists, and it was a real privilege. Across the country our community pharmacists do an enormous amount of work in our local communities. They were at the frontline during the COVID pandemic, during the Canberra bushfires, and every day they work with their patients to ensure they're getting their medicines and that they're being cared for. People rightly perceive pharmacists as highly reliable advisers on many personal health matters; trustworthy, independent sources of healthcare products; and steadfast partners of the medical profession and other allied health professions. This has been clearly shown in national and international literature on consumers' views and experiences of consumer pharmacy practice. It accords with my own experience.

My local pharmacists are critical for health care delivery in Bean, and I want to thank them, on the record, for all they do. I want to thank them for supporting my constituents with their vaccinations, their blister packs and their basic medical needs, right through to their outreach in our aged and disability care communities. I also want to thank my local pharmacists for spending their valuable time meeting and briefing me on our government's changes on dispensing and the government's reinvestment into community pharmacy.

The policy intent of 60-day dispensing is sound. We all want people visiting the doctor less often, saving time and money on dispensing and having more funds reinvested into our community pharmacy network. As many people would know, the government is driving this policy intent by delivering cheaper medicines through 60-day dispensing for more than six million Australians. This will halve the cost of medicines for millions of Australians, including pensioners, many of whom who have been living with chronic conditions for years. It's worth noting that in January of this year, Labor cut the price of more than 2,000 brands of medicine, delivering $130 million back into the pockets of hardworking Australians. Introducing 60-day prescribing for stable, ongoing conditions isn't a new idea. It was a recommendation of the clinical experts at the independent Pharmaceutical Benefits Advisory Committee back in 2018.

The government is committed to supporting better access to health care for all Australians, including through critical services provided by pharmacists. Every single dollar that will be saved by the government from lower dispensing fees paid to pharmacies will be reinvested back into community pharmacy practice, funding the services that will directly benefit patients.

From 1 January, Australians eligible for the National Immunisation Program will be able to get their vaccine from their pharmacy for free. The government will pay the pharmacy per vaccine administered. NIP is an uncapped program, and, in fact, demand is likely to increase over time as more vaccines are added to the NIP and the Australian population grows.

The PBS Opioid Dependence Treatment Program will broaden access to treatments in community pharmacies from 1 July 2023. These programs alone will mean nearly $500 million will be invested by the Albanese government into community pharmacies over five years.

The government is also investing $350 million to community pharmacy outreach into aged-care facilities to ensure older Australians are managing their medications. In addition to this, more than $650 million in funding for community pharmacy programs will ensure patients can access critical medication management and Dose Administration Aids programs through community pharmacy.

That said, I've been made aware, through my meetings and correspondence with my community pharmacies, of some of the many implementation challenges and the cost impacts of the changes to 60-day dispensing. I'm concerned that it's critical that our local pharmacists who want to keep doing their valuable work need that support in terms of doing that service as these changes transition through.

I note the government continues to work with all parts of the pharmacy sector on the implementation of this policy. This includes an invitation to the Pharmacy Guild to engage in constructive discussions with the government on the implementation policy and the significant reinvestment of funding in the pharmacy sector. These ongoing discussions are important. I'd urge all parties to continue to work together. I'll continue to engage with my local pharmacy community, but I support these proposed changes to 60-day dispensing.

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

Tonight, I rise to speak on this matter of private business, Mr Wallace's motion on community pharmacies. This issue has led to a huge uplift of correspondence to my electorate office and communication with pharmacies right across my electorate. There are a few issues with the way this was done. There was a lack of consultation in the first place, and that has led to the situation we are now in. Even the Office of Impact Analysis has stressed that the report was lacking a reasonable level of consultation.

I heard during question time in the House that this particular policy was formulated some years ago and it's just been sitting there. There's a reason it's just been sitting there, and that is because it's just not good for regional pharmacies.

I've been contacted by some of my larger pharmacists—for instance, out at Broken Hill—and some of my smaller ones. I'll give you a good example: the pharmacy at Walgett. Walgett has a 45 per cent Indigenous population, and that's part of the irony of this debate we're having in this House at the moment. On one hand, we're hearing wonderful speeches about the government and other people's great care for our Indigenous brothers and sisters, but, on the other hand, they're implementing policies that are impacting on those very communities and the people that provide those services. Walgett is a long way from the next town. A lot of the Indigenous population of Walgett do rely on the Walgett Pharmacy for the services they provide—blister packs to aged care, to people who are having services delivered at home—and the potential closure of a business such as that would be devastating.

The other pharmacy I've spoken about is Gilgandra Pharmacy. Emma Robertson, the pharmacist there, has done an incredible job in building that business so that they are providing a broad range of services. Indeed, I had my flu shot there last year—my flu shot or one of the COVID ones, I can't quite remember—but they are doing great work in that section. Emma is supporting some trainees so that we've got new pharmacists coming through. Emma employs several other pharmacists. She was telling me that it's going to be really difficult for her to maintain that level of service in the town of Gilgandra. We heard from the other side that the AMA are supportive of these changes. It's fine for the AMA. The taxpayers are paying for the changes to bulk-billing and other things like that, and fair enough. With these changes, it's expected the pharmacists will pay. There's been some detail in here about the work that the pharmacists are doing with addiction programs and some of the services they provide to community around methadone and other things. I'm being told by my local pharmacist that that is going to really impact on what they do.

I heard from members on the other side how profitable pharmacy is. But in some of my communities they're the primary provider of medical services. Even if they're not the only one, quite often they're the most constant provider, because in an era where we have fly-in fly-out locum doctors, and where every time a patient might go to a doctor at the clinic down the road there's a different face, the pharmacist generally is the constant. I've had pharmacists say to me that patients will come in with a script, and, while they might not have confidence in or a complete understanding of what the GP has told them, they go to the local pharmacist to get advice about their medication and the things they take.

This program is ill-conceived in its time, and I will agree with the member for Bean that there is still time for consultation to actually salvage something from this rushed announcement and make sure that those pharmacies can continue to provide the services right across Australia and particularly in regional Australia.

Bridget Archer (Bass, Liberal Party) Share this | Link to this | Hansard source

The time allotted for this debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.