#pharmacy guild

Read more at http://medisecure.com.au/scripts-may-not-be-required-to-buy-oral-contraceptives-from-pharmacies/

In 2014, Green Cross Health (a New Zealand pharmacy banner group) sought approval from the New Zealand Medicines and Medical Devices Safety Authority, Medsafe, to allow pharmacists to sell oral contraceptives over the counter. Medsafe turned down the proposal, saying more input was required from doctors.  Now Green Cross Health and a pharmaceutical company made a second attempt and requested Medsafe to reconsider the proposal at its May meeting.

It argues there is an unmet demand for oral contraceptives, with increasing demand for the morning-after pill at pharmacies. Its proposal includes training pharmacists to ask patients the right questions in a face-to-face consultation and checking for any contraindicating health conditions before selling the drugs over the counter.

Across the Tasman Sea in Australia, a proposal was submitted to the Therapeutic Goods Administration (TGA) in November 2014 to move oral contraceptives to Schedule 3 medicines. This proposal would require patients to fill in a simple questionnaire on any family history of hypertension, heart problems or stroke. The pharmacist would also need to conduct a blood pressure test on the patients to make sure they are suitable for the medication. Each visit is limited to a 3-6 months supply of oral contraceptives.

Dr Brian Morton, chair of the Australian Medical Association (AMA) Council of General Practice, described the proposal as a completely inappropriate expansion of pharmacists’ scope of practice. He questioned whether pharmacies would be an appropriate environment to ask women questions on their suitability for contraception and doubted pharmacists have the training or skills to interpret the relevant information.

“It will lead to fragmentation of care, lack of continuity of care. You will end up with the patient never coming to see the doctor and [missing out on] mammograms, breast self-examination, Pap smears, blood pressure checks, and all those things related to lifestyle won’t be checked,” he says.

Apart from being strongly opposed by the AMA, the proposal also did not have the support of the Pharmacy Guild of Australia, which said as a general rule, this is not something they would support.

TGA is expected to announce the outcome of this proposal on July 23 on its website.

Read more at http://medisecure.com.au/harper-review-and-pharmacy-guild-on-deregulation/

On 4 Dec 2013, PM Tony Abbott and the Minister for Small Business, Bruce Bills, announced a panel to review Australia’s competition policy (Ref). This review is dubbed Harper Review after its chairman Professor Ian Harper, an Emeritus Professor at the University of Melbourne and a director at Deloitte Access Economics (Ref). The Final Report, released on 31 Mar 2015, made 56 recommendations to the Federal government. If implemented, these changes would initiate the biggest shake up in the competition regime in over 22 years, revolutionising the way business is conducted.

The recommendations are designed to dismantle regulations that restrict retail trading hours and operational licenses in certain industries and to usher Australia into the 21st century. Traditional bricks and mortar shop fronts face unprecedented competition from cross-border, online stores utilising disruptive technologies and operating 24/7. The ultimate objective is to promote competition and in turn improve outcomes for consumers with lower prices and better service.

Some of these recommendations are controversial and would have profound consequences for particular industries. These include:

Deregulation of trading hours, leaving Christmas Day, Good Friday and Anzac Day morning, the only three days a year closed for retail.

Removal of restrictions on parallel importing, allowing goods such as second-hand cars, books and software, that could be purchased overseas at much lower prices, to be sold here.

Opening up of the tightly protected taxi industry to ride sharing service providers under the online-based Uber model. The increase in supply may lead to at least a 15-20% drop in taxi fares, making them more affordable to low-income earners.

Introduction of specific “effects test” to assess anti-competitive conduct.

The taxi industry and parts of the small business community, whose interests are affected, are outraged by the review’s recommendations. Small retailers claim it is costly and unprofitable to open longer hours and will struggle to compete with large supermarket chains, which will be handed even more market power. They say this will eventually lead to the demise of the small corner store.

  Proposed Deregulation of the Pharmacy Industry

The strongest response came from the Pharmacy Guild of Australia, whom Fairfax Media described in a recent article as “the most powerful lobby group you have never heard of”.

Currently there are many state and federal restrictions on the operation of pharmacies:

State laws require pharmacies to be owned by registered pharmacists and impose limits on the number of outlets they can own.

Complex federal laws (written in a 56-page handbook) govern where pharmacies can be located. For example, a new pharmacy cannot be opened within 1.5km (metropolitan areas) or 10km (country towns) from an existing pharmacy, effectively closing the door for new entrants. Pharmacies cannot be located either within or directly accessible from a supermarket. A pharmacist has to apply to the Federal Government for approval to open a new pharmacy or to move/expand an existing pharmacy.

The Harper Review recommended the scrapping of pharmacy location and ownership rules, finding these restrictions were imposing costs on consumers, limiting choice and thwarting the ability of providers to meet consumer preferences.

The location rules are part of the 5CPA (Fifth Community Pharmacy Agreement), a 5-year agreement between the Pharmacy Guild and the Federal Government, due to expire on 30th June 2015. The review suggested relaxation of the location rules as part of the 6CPA, the next agreement currently being negotiated, as the first step towards their complete removal.

  Consequences of Deregulation

The likely consequences include:

More pharmacies, particularly in affluent or densely populated areas.

Pharmacies in supermarkets, owned by Coles and Woolworths etc. or by independent pharmacists renting space to take advantage of the foot traffic.

More pharmacies staying open outside standard business hours.

Lower prices for non-PBS medicines and other products, as shown by a 10-30% drop in prices in the UK after supermarkets were allowed to sell medications (Ref).

Limited impact on prices for PBS drugs. Currently, prices are determined mainly by government subsidies. However, for off-patent drugs, retail chains may be able to negotiate better prices with suppliers and pass the savings on to customers.

  The Winners and Losers

The winners would likely be:

Consumers who would benefit from lower prices for some drugs and greater choice on where and when they obtained their medications, though pharmacy groups have suggested the quality of service would deteriorate.

Pharmacy chains such as Chemist Warehouse, which would find it easier to grow without the existing rules that thwart their ambitions for expansion.

Supermarkets, which would gain a new, lucrative and stable revenue stream.

The losers are most likely:

Smaller pharmacies with their margins squeezed by competition.

Pharmaceutical suppliers/wholesalers as the entry of the supermarket giants may use their enormous purchasing power to demand lower prices.

  The Supporters

Adam Stankevicius, CEO of The Consumers Health Forum, says the Government should bring in a new, more flexible system over the next two years. He said the current system is geared towards pharmacies making profits, not the consumers. The location rule protects existing pharmacies from competitors wanting to establish themselves nearby. This in turn keeps young pharmacists out of the industry, as they cannot compete with established businesses. He said even if pharmacies set up next to each other, they could offer different services or specialize in particular areas such as providing services to an aged care home or a disability service. He said a new pharmacy would more likely to remain open longer and attend to after-hours customers (Ref).

The Pharmacy Guild represents 4000 pharmacy owners. Another 20,000 pharmacists, so-called “employee pharmacists“, are locked out of pharmacy ownership. They are represented by Professional Pharmacists Australia, which supports a review of the location rules (Ref a, b).

The Business Council of Australia welcomed many of the report’s recommendations but was concerned about the Effects Test (Ref).

The Australian National Retailers Association (ANRA), which represents big retailers such as Woolworths and Coles, supports removing restrictions on retail trading hours, pharmacy ownership and parallel imports but is against the Effects Test (Ref a, b).

Alan Kirkland from consumer group Choice said the competition law failed to keep up with developments in technology and consumer markets. He is worried that big business will lobby against the recommendations, predicting that there will be very powerful forces opposed to some of these changes. He was concerned about the recommendations in expanding competition in the welfare sector, believing this should require a lot more community consultation (Ref).

The Opponents

The Australian Retailers’ Association called for protection of small businesses against being forced out of business by the two major supermarket chains (Ref). Master Grocers Australia (MGA), which represents the independent supermarket sector, is opposing the deregulation of trading hours as this would deliver even more market share to the Coles and Woolworths duopoly (Ref).

Grant Kardachi, national president of the Pharmaceutical Society of Australia, said the proposed changes could impact the quality of patient care. “The worst case scenario is if pharmacies are owned by non-pharmacists, that profitability could well become the target and consumer needs and outcomes may well be compromised,” he said (Ref).

The Pharmacy Guild argues the current pharmacy model is a tried, tested and trusted model, working well for patients and taxpayers, and continuing to enjoy strong public and bipartisan support. It is underpinned by a multi-billion dollar investment in local pharmacies by pharmacists who have put their livelihoods in these small businesses.

The location rules ensure consumers have timely and equitable access to Pharmaceutical Benefits Scheme medicines no matter where they live, rather than having pharmacies clustered around affluent suburbs. The ownership rules ensure that local pharmacies are owned by registered pharmacists, who are health care professionals, frequently putting their patients before profits.

The Pharmacy Guild president George Tambassis argued against big supermarkets being allowed to open pharmacies. “We don’t believe Coles and Woolies are interested in the health care of the Australian public. They are interested in selling tobacco and alcohol, interested in profit. We are interested in looking after people’s health care.” he said (Ref).  Abolishing the ownership rule would lead to major supermarket chains securing high level of market dominance in the pharmacy sector like what they had already achieved in grocery retailing (Ref).

The Pharmacy Guild commissioned several independent studies. A geospatial analysis of pharmacy distribution in Australia showed pharmacies are more accessible to consumers than banks, supermarkets and general medical practices. For example, 87% of Australians live within 2.5km of at least one pharmacy. Consumer surveys showed 89% of consumers highly trust their local pharmacists and 64% support pharmacists’ ownership of their own business. A cost-benefit analysis showed deregulation of the pharmacy sector would result in a $700 million loss in consumer benefits per year. Hence, these studies demonstrate that pharmacies are delivering high levels of access, choice, competition, equity and quality for consumers (Ref).

The Pharmacy Guild Executive director David Quilty criticised the panel for putting ideology before evidence that shows the current model was superior. “There is no evidence that a deregulated alternative model would deliver superior outcomes for patients or taxpayers,” he said. “On the contrary, all the evidence indicates that the alternative would likely result in worse outcomes both for consumers and taxpayers, and carry significant risk. Australia’s 5450 community pharmacies, currently struggling under the pressures of price disclosure, need certainty and stability – not a constant push to abolish a system that’s working.” (Ref)

  Political Factors

What are the chances the recommendations on pharmacy deregulation will be implemented?

There were various reviews on reform in the pharmacy sector, dating at least as far back as 2000.  The most recent one took place last year when the Commission of Audit recommended removal of the location and ownership rules. So far no government has adopted the measures.

This is probably due to the legendary lobbying power of the Pharmacy Guild. It has demonstrated its ability to make use of the high levels of public trust in pharmacists and to mobilize its thousands of members nationally to fight changes that threaten pharmacist interests (Ref).

Having suffered serious setbacks in the brawl with doctors over a Medicare co-payment, Liberal Party MPs said they do not expect the Abbott Government to support pharmacy deregulation, fiercely opposed by the politically powerful Pharmacy Guild. A Liberal politician said:  “Abbott has absolutely no appetite for this whatsoever. They don’t have to twist Tony’s arm.”

The Pharmacy Guild reminded PM Tony Abbott of what he said at the Guild’s annual dinner in November last year. He said: “I do not want to go for something which is untried and unproven against something which is tried and proven, and I never want to promote theory over practice. How do you know that I respect the place of community pharmacy in our economy and in our society Because the last time there was a serious push to threaten the place of community pharmacy in our society, I stood up against it.” (Ref)

The Pharmacy Guild also has a key ally – independent senator Nick Xenophon who has vowed to block any deregulation of Community Pharmacies to ensure they remain viable and able to meet the increasing health needs of all Australians. He said: “Pharmacists have to run a business with very little price-setting ability for prescription drugs. As many as 10 per cent of Community Pharmacies are known to be only marginally financially viable”. (Ref)