SSRIs and heart meds on double dispensing list as Guild objects

Confirming that 60-day dispensing was on the way this morning, Health Minister Mark Butler took some shots at pharmacy lobby groups.

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The Health Minister has announced that 60-day dispensing will be one item GPs can count on come budget night, but not all stakeholders are feeling joyous.

Doubling the maximum quantity of medicines that can be dispensed off a single script was first floated by the PBAC in 2018, but then-Health Minister Greg Hunt chose not to act on the recommendation.

Doctors’ groups began a renewed push for the measure earlier this year, but the Pharmacy Guild of Australia has remained staunchly opposed.

Reacting to the news today, Guild president Professor Trent Twomey reportedly said Health Minister Mark Butler “doesn’t seem to give a shit” about the potential consequences for community pharmacy.

Last week, rumours circulated among pharmacy groups that double dispensing had been included as an item in draft budget papers; the Guild even held an emergency webinar on the topic.

Speaking at a press conference this morning, Mr Butler not only confirmed those rumours but revealed that a total of 325 medicines would be subject to extended dispensing.

While the original 2018 PBAC recommendation only deemed around 150 medicines to be suitable for extended dispensing, an updated list from December 2022 included 320 medicines.

The final list of medicines has not been released at time of writing, but it’s understood to closely resemble the December 2022 list.

Among the 320 medicines deemed fit for extended supply are common SSRIs like sertraline, escitalopram and citalopram, as well as PPI medicines pantoprazole, esomeprazole and omeprazole.

Several metformin formulations have also been included on the double-dispensing list.

Atorvastatin and rosuvastatin, Australia’s top two most-prescribed medicines, are currently available under the 12-month repeat measure but were found suitable for amendment in accordance with the PBAC recommendations for increased dispensed quantities.

Other heart medicines on the list include perindopril, as well as various candestartan, telmisartan, erbesartan, ramipril and amlodipine formulations.

Both the RACGP and the AMA welcomed Mr Butler’s announcement.

“[This advantages] people with chronic, stable medical conditions,” RACGP president Dr Nicole Higgins told The Medical Republic.

“Having bigger pack sizes and longer scripts does not take away the need for regular review … but what this does is it frees up those low value care appointments that are just for prescriptions.”

AMA vice president Dr Danielle McMullen said the announcement will ease cost of living pressures for patients, with an estimated saving of $180 per patient per year.

“What this change will mean is [that patients] can go to the pharmacy every two months, and for pensioners, it means it will halve the cost of their medications, which is fantastic news,” she told Sunrise.

Pharmacists, though, are not celebrating the news, given that the dispensing fees they collect every time a patient fills a script will effectively be halved.

The Pharmacy Guild – which represents pharmacy owners – has been particularly vocal, arguing that extended dispensing will create medicine shortages.

“I don’t want to see a Hunger Games stand-off in any community in Australia where some patients get double the medicine they need, while others get nothing,” Professor Twomey said.

Mr Butler said that suggestions that up to 40% of the medicines included in the PBAC double dispensing list were already in shortage – claims which members of the media attributed to the Guild – were misguided.

“I advise people to take advice around medicine supply and shortages from our medicines authorities rather than the pharmacy lobby group,” the Health Minister said.

“The actual truth is: of the 325 medicines that I have announced today, only seven of them are experiencing supply shortages.”

He also encouraged people to “think about this for more than a few minutes” and recognise that the measure will not change the number of tablets dispensed in any given period of time.

There’s also the fact that new minimum stockholding requirements will be in place from July, meaning that manufacturers of some PBS medicines will be required to hold a minimum four months’ worth of stock onshore in Australia.

The measure is designed to create buffers in the event of a supply disruption, preventing severe shortages.

Mr Butler also said that double dispensing would be phased in over the next 18 months, lessening the burden on pharmacists.

“It is important to stress that not every patient on these medicines is going to rock up to their pharmacy with a new 60-day script at the same time,” he said.

“Patients will come off their existing scripts at different times.”

He also pledged to reinvest the savings made from double dispensing back into funding community pharmacy programs.

If the number of scripts filled is negatively affected, the government would also be forced to increase the pharmacist dispensing fee, as per the seventh Community Pharmacy Agreement.

Even with these guarantees, the Guild is not satisfied.

Dr Higgins said she had sighted an email to Guild members with a suggested script to send to their local MP.

She called the letter “offensive” and “emotive” and said that it implied larger pack sizes will contribute to overdoses of adults and children.

To be fair, that line of rhetoric is not entirely dissimilar to the RACGP’s own warnings on the dangers of pharmacist-led prescribing.

“At a time when [it] has recorded record profits and consumer spending in retail pharmacies, it’s time that the Pharmacy Guild puts patients ahead of profits,” Dr Higgins said.