Jan McLucas (Queensland, Australian Labor Party, Shadow Minister for Aged Care, Disabilities and Carers) Share this | Hansard source

I seek leave to incorporate my speech in the second reading debate. I have checked that with the government.

Leave granted.

The speech read as follows—

The amendments in this bill are the result of the Fourth Pharmacy Agreement between the Commonwealth and the Pharmacy Guild of Australia which commenced on 1 December 2005 and will terminate on 30 June 2010. The Agreement provides for new pharmacy location arrangements to commence on 1 July 2006, and this bill gives effect to some of the issues around those arrangements.

Specifically this bill will:

(1)

Extend the operation of the Australian Community Pharmacy Authority until 30 June 1 2010. The Authority’s role is to consider applications made by pharmacists for approval to supply benefits under the PBS, to determine if such applications comply with the Pharmacy Location Rules and to make recommendations to the Secretary of the Department of Health and Ageing as to whether such applications should be approved.

(2)

Increase the membership of the Authority from five to six members by including a consumer representative, appointed by the Minister.

(3)

Provide the Minister with a new discretionary power to overrule a decision of the Secretary, made in accordance with the Pharmacy Location Rules, if that decision will have the unintended or unforeseen consequence of leaving a community without reasonable access to pharmacy services. Affected parties may seek a review of any decision made by the Minister under this power under the Administrative Decisions (Judicial Review) Act 1977.

(4)

Provide for the processes associated with this discretionary power, such as how an applicant may make a request to the Minister for consideration of the Secretary’s decision.

(5)

Clarify the ability of the Secretary to approve more than one pharmacist to supply PBS benefits from a particular premise.

(6)

Provide that the Secretary can approve a pharmacist’s application to expand or contract their premises without prior recommendation by the Australian Community Pharmacy Authority.

The actual changes in Pharmacy Location Rules will:

• Permit co-location of pharmacies with large medical centres that operate extended hours;
• Allow location of pharmacies in small shopping centres;
• Allow the relocation of an additional pharmacy to one-pharmacy rural towns and one-pharmacy high growth areas without regard to the usual distance criteria;
• Remove the requirement that a specified number of commercial establishments are open and trading before an approved pharmacy can relocate to a shopping centre; and
• Provide greater flexibility for pharmacies located in private hospitals by allowing establishment of satellite dispensaries for hospital in-patients.

These changes do not require legislation but are exercised through a set of regulations authorised by Ministerial Determinations under Section 99L of the National Health Act 1953.

The Changes to the Rules will have a number of benefits, especially in rural and remote areas and growing suburban areas.

• Co-location of pharmacies with medical centres will assist in providing access to pharmacy services for acute medication needs, at the time of medical consultation.
• Location of pharmacies within small shopping centres recognises the retailing trend for smaller centres with larger supermarkets. The existing requirement for large shopping centres (with at least 30 commercial establishments) has limited access to pharmacy services in many retail developments.
• Not all of the required commercial establishments in a shopping centre need to be open and trading at the time of application approval. In some cases, this requirement has delayed access to pharmacy services in new shopping centres.
• Rules for relocation of an additional pharmacy to single-pharmacy rural towns and high growth urban areas will mean a second pharmacy can be approved in these communities.

For these reasons Labor will support this bill.

I do note however that there is nothing in this bill that will ensure that Aboriginal and Torres Strait Islander people have better access to PBS medicines and pharmacy services. This is despite the fact that PBS spending per capita on Indigenous people is only one third of that on the non-Indigenous population. Once again, the health of our Indigenous population has been forgotten and I think that this is a serious oversight.

Labor is also very concerned that the Howard Government is failing to properly manage the PBS, and that is why I have moved this second reading amendment today.

In finally reaching agreement on the Fourth Pharmacy Agreement and the new Pharmacy Location Rules, the Howard Government and the Minister for Health, Tony Abbott have hardly covered themselves in glory.

Despite the importance of pharmacy services to all Australians, and despite the fact that the Agreement covers some 22% of PBS spending, negotiations were protracted, sometimes acrimonious, and always hidden behind closed doors.

The Health Minister was alternatively belligerent or cowed. Several times he used changes to the Pharmacy Location Rules as a threat. That’s why this is the third time in less than 12 months that the Parliament has been required to act on these Rules.

In May 2005, Parliament voted, with Labor support, to extend the current provisions with respect to the Pharmacy Location Rules to 31 December 2005 through a provision in the Health Legislation Amendment (Australian Community Pharmacy Authority) Bill 2005. Then in October 2005, these provisions were further extended until 30 June 2006 through passage of the Health Legislation Amendment Bill 2005.

On both occasions, the Government’s stated reason for the extension was to allow time for the Government to consider the findings and recommendations of the Joint Review of Pharmacy Location Rules, which were received in June 2005. However at the same time fierce and protracted negotiations were underway with the Pharmacy Guild of Australia over the Fourth Pharmacy Agreement and it was clear that pharmacy location issues, linked to the ability of pharmacies in supermarkets to dispense PBS medicines, were being used by the Howard Government as heavy-handed negotiating tools.

Labor has said that it does not support the location of pharmacies within supermarkets. Labor has previously stated, when the above bills were considered last year, that it could support extension of the Pharmacy Location Rules as finally agreed in the Fourth Pharmacy Agreement.

Labor is therefore relieved that finally we have a sensible agreement that both benefits pharmacy and the Australian consumer – especially those who are elderly, frail, sick and unable to travel long distances to get their prescriptions filled and receive important pharmacy services.

However the Health Minister Tony Abbott has failed to tell the Australian public the real story about the impact of the Howard Government’s policies on the Pharmaceutical Benefits Scheme and on the affordability of essential medicines.

Since the introduction of the 21% increase on PBS co-payments last January and the 12.5% cuts in generics in the middle of the year, the growth rate for PBS spending has now fallen to 1% and it is expected to drop even lower. The growth in prescription numbers (a good measure of whether people can afford to get their prescriptions filled) is already in negative territory.

The Government’s own figures show clearly that fewer prescriptions are being filled in some crucial categories - for cardiovascular conditions, for anaemia and blood clotting problems, for hormone replacement therapy needed because of thyroid, pituitary or pancreatic problems, and for mental illness, epilepsy, Parkinson’s Disease and Alzheimer’s Disease.

This is only good news if you put budget savings ahead of health outcomes. The Health Minister and the Treasurer consistently confuse PBS sustainability with cost cutting, and never look at the impact on the overall health system and the ability of patients to afford their needed medicines.

The Minister’s office has tried to say that the fall in prescriptions is not serious because it does not include drugs dispensed through the highly specialised and high cost schemes – an analysis of the data shows that explanation is wrong. The Department of Health and Ageing has tried to say it is because Vioxx was taken off the PBS – again wrong. There is a clear an unambiguous decline in PBS growth rates regardless of the Vioxx effect.

Furthermore, these comments are in direct contrast to what the Treasury has officially stated in its Mid Year Economic and Fiscal Outlook (MYEFO) paper.

This paper now states that the growth in PBS expenditure in 2005-06 will be 2.2 percent less than the budget projection of 7.4 percent.

The MYEFO states that this will see a windfall for the government of $283 million – and there is every chance that it will actually be more than this as growth rates head well below those projected by Treasury.

It is obvious that rising out-of-pocket costs due to increased co-payments, special patient co-payments and therapeutic and brand premiums are hitting the sickest and neediest Australians, meaning that too often they must chose between buying their medicines or the other necessities of life. And the impact of changes to the PBS safety net and the new 20-day rule is yet to kick in.

As patients will have to pay more out-of-pocket before they hit the thresholds for the PBS safety net, and the 20-day rule makes it increasingly difficult for some patients to get their PBS costs to count towards the safety net, we can only expect things to get worse.

In particular the 20-day rule is having a major impact on patients in rural and remote locations who only visit town infrequently and elderly patients who rely on others to get their prescriptions filled and delivered.

This is not just confusing and troublesome for patients. It is making life difficult for busy doctors and pharmacists. In proposing this policy the Government has failed to recognise that there are many legitimate reasons for patients to acquire their medications within 20 days.

But the Government doesn’t care, and the Minister for Health doesn’t want to know.

In the meantime the Treasurer, the Minister for Finance and the Minister for Industry push on with their plans for more PBS budget savings. They are either oblivious to the consequences or they don’t care.

The Minister for Health is not included in these budget decisions. His lack of involvement and lack of concern places him in clear dereliction of his duty to protect the health of all Australians.

Labor has consistently called on the Government to monitor the impact of these PBS cost cutting measures to ensure that there are not adverse consequences which will see a blow out in hospital costs and more expensive medical procedures.

Again today, I call on the Minister for Health and the Treasurer to look at the full impact of their short sighted and short term policies to cut the PBS. These are not the way to make the PBS and our health care system as a whole sustainable into the future.

Question agreed to.

Bill read a second time.