Nola Marino (Forrest, Liberal Party, Shadow Assistant Minister for Education) Share this | Link to this | Hansard source

I'm pleased to speak on the National Health Amendment (Technical Changes to Averaging Price Disclosure Threshold and Other Matters) Bill 2024 because, in part, it reflects on the importance of the stockholding requirements. We've seen severe medicine shortages occur under the Labor government's watch. The recent shortage of saline IV fluids in Australia has posed a serious risk to a lot of our healthcare system. Saline IV bags are absolutely critical to the emergency health care provided to patients in Australian hospitals, but doctors in every hospital around our nation are being told to ration the amount they use for patients. This is not okay. The government has been aware of this, and Minister Gallagher admitted that the government has been aware of this impending shortage for over a year. This is a real problem in Australia.

The government had more than 12 months' notice of this impending shortage, but no other country has had the same issues. The problems in rural and regional areas, where we live and work, are even worse. I spoke to Rowan Lowe, who's not only a pharmacist in Donnybrook, a small regional community in my electorate, but also the national pharmacist of the year for 2024. I asked him about the shortages in rural and regional areas, and he said they are impacting our regional patients. These are Rowan's own words. He said:

One of the biggest issues that we still experience on a weekly basis is that prescribers are not communicated with medication shortages and then send the patient off with a prescription that they are unable to fill. The Pharmacy then has to reach out to the prescriber, the patient has to wait longer for their medication and if the prescriber does not get back to us in time that wait time can be extended due to the order cut off times.

He said:

We had an example last week of a patient being discharged from Busselton hospital with critical pain medication post surgery … the prescriber was contacted 3 times and did not call back, the patient was in pain for 24 hours until myself as the Pharmacist went directly to the local GP clinic and used my relationship with the GP to source some alternative pain medication for the patient. There needs to be a more up-to-date resource for all prescribers to access that shows the stock availability in their regional areas.

He went on to say:

Local GPs are currently experiencing high workloads and long wait times for appointments, therefore trying to follow up with them regarding medication shortages is becoming more difficult with the patients being the ones who are being disadvantaged the most. If we were able to have some point of truth that was live and up-to-date—

that would be a real bonus for these pharmacists and for the patients. He said:

Current medication shortages that impact patients and some may be WA based—

but—

Amoxicillin … patients are having to be switched to—

a different dosage—

which means double the volume, decrease compliance with children and also longer wait times while we call the prescriber to have the changes approved

That's what Rowan said. He said:

Ezetimibe—the combination product … went Out of stock and that has seen the individual products … now also go out of stock. We are then having to send patients back to their GP for a review as to what path to take with their treatment which is taking up more GP appointments that are currently hard to come by.

He spoke of Duodart:

Duodart … has been unavailable for almost 2 months and is used for benign prostatic hyperplasia (BPH). Not life critical but for many males can create social implications and fears when they are not able to obtain.

The individual drugs in this medication are not available on the PBS so we are unable to switch and patients just go without treatment due to cost.

Rowan went on to say:

Ozempic—this is a well known shortage however has become easier … but again now has been put on restrictions from the wholesaler in which we are only able to order 1 pen per week to cover our 40 diabetic patients per month that are currently on the medication.

The release of the new Wegovy is theoretically meant to ease the pressure on Ozempic however we do not see this occurring as the price of Wegovy is so much higher than Ozempic so we still see patients wanting Ozempic over Wegovy.

This is what's happening in regional Australia.

He spoke about Vyvanse:

… this medication has had supply issues for the majority of 2024 and the complexity around seeking alternative treatments is extremely complicated as the medication is a schedule 8 and prescribed through specialists who are often the most difficult to get in contact with.

This is happening in my South West. He went on:

Again patients then having to go without medication decreasing compliance. Also increasing significantly the workloads on Pharmacy teams to manage these patients, stock supply and be a middleman for communication between the specialist and the patient.

He also spoke about Ordine liquid:

… the medication is often used for Palliative care and is now discontinued—

shortages and being discontinued. He then spoke of hormone replacement therapy:

… this is a continual issue in the industry and one that we see the highest rates of non-compliance due to unavailability of patients having to use products that are not effective because it is the best option available.

He said:

Ordering of stock is often also a logistic issue in regional areas …

We see a lack of understanding in this place of what actually happens in the regions. Rowan said:

… if we receive a prescription for a medication at 1:05pm on a friday we are not able to have that medication delivered in store till the following Tuesday as we are a regional area.

No wonder people in the regions have a lesser health outcome. Rowan said:

That is a 96 hour wait for a medication which for me is unacceptable.

He's the pharmacist. He said:

To help our patient base we chose to hold a higher stock on hand value which comes at a cost to the business, cashflow and me as the owner, all to help service our community, something that Metro businesses do not have to think about.

Also being in WA we experience higher number of stock outs and longer stock outs than other states within Australia, another reason why we hold higher stock values and I know that the wholesalers also hold higher stock values in WA.

If a product is out of stock, particularly popular items, we may have to send that patient into Bunbury which is an hour return trip when they are sick or unwell to source a medication.

That's in the South West of WA. He said:

In our store in Dongara WA the same situation occurs and we may need to send a patient on a 2 hour return trip for the same reason. These examples also add to cost of living pressures with patients then having to add the cost of fuel to sourcing medication and being regional those drives can be much further than in metro areas.

This is the reality for those of us who live and work in regional Australia. It is not acceptable. Rowan said:

This situation is extremely common and as much as we move mountains to ensure that our patients don't have to drive or wait 96 hours more often than not it has to occur.

Rowan is the Pharmacist of the Year. He is an exceptional pharmacist. He goes above and beyond in what he provides to his patients and his people. Rowan went on to say:

We also see that Pharmacists acting in full scope in regional areas as a great solution to parts of this issue, as Pharmacists would be authorised to make therapeutic substitutions. This would alleviate the pressure on the Pharmacy to contact the GP, patients having to wait for the GP to return a call as often they cannot talk as they are in an appointment—

GPs are very busy in regional areas—

and the pharmacist would have full visibility of what is available at wholesalers.

He went on to say:

Medication misadventure is another issue that occurs as often a drug might not be out of stock, however stock might be extremely low and each Pharmacy is having to grab whichever brand it can find to ensure that their patients will have continuity of supply.

They are the comments that I got from Rowan Lowe, who is, as I said, the Australian Pharmacist of the Year and has a practice in Donnybrook in my electorate. Rowan went on to say:

This is a daily issue, and we have to be very cautious as we are always having to 'brand swap' due to stock availability and this drives confusion for the patient and often a patient then takes 2 brands of the same medication. Often in WA we are not completely out of stock but we are often having to 'brand swap'.

What that says to me is that not only is this making the challenge for pharmacists in rural and regional Australia and the more remote parts more and more difficult but the government has a job to do in this space. To actually have those medications available for those pharmacists to be able to dispense when the GP writes out a prescription is surely not too much to ask? As we all know, the health outcomes for people in regional and more remote Australia are far worse than what we see in cities. Surely this is one of the contributing factors? But, unfortunately, what we see here is not enough focus on rural and regional Australia and its needs compared to others in the metro areas. This is very practical example. Should anyone from the government or from the department want to talk to Rowan about what's happening for practical purposes on the ground, I really encourage you to do so. It should be the job of all of us in this place to make sure that it doesn't matter where you live in this country. Your postcode should not be determinant of the health outcomes that you have access to and the medications that you have access to. But that's what we've got. Here's the evidence I'm calling on the government and anyone from the department to take me up on this offer to talk to Rowan and perhaps some other rural and regional pharmacists, not people based in Canberra or based in a city. Why not talk to the pharmacists who have to live and work with this day in and day out? How do you think they feel when they cannot dispense and actually hand over the counter what the local people need?

You need to remember that our pharmacists live and work with us as families. When we walk in their doors, they know our history and they know what we are predisposed to. We rely on them as part of—and, often, the only—medical treatment. Because of changes that the government has made, we've seen a flight of GPs out of regional and remote areas. There aren't GPs in every community like there were because overseas trained doctors can now practice in outer metro. So we rely, then, on our pharmacists. If there is a pharmacist in our community, they are the ones we rely on. But they need the medications to be able to dispense. Irrespective of where that prescription comes from and wherever that GP is that prescribed it, we need them to be able to access those medications.

In my contribution to this, I'd just like to finish by encouraging people to talk to Rowan. I know he would be very happy to talk to anyone in the government or from the department to give a practical view on what is actually happening to pharmacists and the issue for patients and our people in rural and regional Australia. I refuse to accept that it's okay for people who live in rural, regional are more remote parts of Australia to not be able to access the medications they need compared to others. That is not okay by any standard.

Question agreed to.

Bill read a second time.

Ordered that this bill be reported to the House without amendment.