The pharmacists’ lobby wants all its members to be able to prescribe autonomously, but has no model for how they would be remunerated for the extra work and responsibility.
The Pharmacy Board’s discussion paper on pharmacist prescribing makes no mention of extra payments. But it has generated plenty of heat in response, including arguments from the RACGP and the AMA that combining the jobs of prescribing and dispensing will lead to an unacceptable conflict of interest.
Because community pharmacists are also business owners who make money from what they dispense, it is argued they will already be biased towards prescribing something rather than nothing. (This doesn’t apply to salaried hospital pharmacists).
But this doesn’t factor in the extra time a pharmacist will spend on a consultation, as well as the costs of further education, regulation and presumably professional indemnity.
Pharmacy Guild of Australia spokesman Greg Turnbull told The Medical Republic: “We haven’t made remuneration part of our submission because that’s not the territory of the Pharmacy Board. Our focus is on benefits to patients through allowing pharmacists to practice at their full scope, as they do in some other comparable countries.”
Pharmacists are currently paid an indexed dispensing fee of around $7 per ready-prepared prescription; an administration, handling and infrastructure fee tiered according to the PBS price, from about $4 up to a maximum of about $72; $2 to prepare a medication on the spot; a dangerous drug fee of $3; a premium-free dispensing incentive of about $2; and up to about $6 for under co-payment prescriptions.
TMR can think of three ways community pharmacists might be further reimbursed for prescribing duties.
They could charge per script, getting nothing for their time if they feel medication is not indicated; they could charge for a consultation, regardless of whether they end up prescribing anything or not; or they could spread their costs around by lifting prices on other things they sell.
The first model, in which a pharmacist is only recompensed if they prescribe and dispense something, would exacerbate the conflict-of-interest problem and might encourage overprescribing; the second might also encourage overprescribing, since consumers may resent paying a fee for no apparent service; and a general price rise might be resented by customers or go unnoticed, depending on its size.
Mr Turnbull said these were “good questions … but there are no firm answers yet”.
“Bear in mind that community pharmacists already utilise their skills and medicine knowledge to dispense Schedule 3 pharmacist-only medicines without a prescription, and without separate remuneration.
“Obviously if additional skills training and time are required there should be commensurate remuneration, but the form and source of that is unclear.”
Following an inquiry, the Queensland government agreed to trial pharmacist prescribing across the state, limited to repeat prescriptions for the contraceptive pill and antibiotics for urinary tract infections.
A Queensland Health spokesman could not say whether extra remuneration would be part of the trial, which is under development.
“It is very early in the process and all factors relevant to the trial are being considered,” he said.