Kon Sclavos (Pharmacy Guild) - National Press Club Address

LuckyLisfranc · Jul 25, 2008

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Interesting speech, and some important points to consider as we move towards a greater prescribing role...makes you wonder what our leadership is doing?

National President Kos Sclavos - National Press Club Presentation

Thank you very much Ken, and thanks to the National Press Club. Welcome ladies and gentlemen. I would also like to recognise the support of today’s sponsor, the National Australia Bank.

I would like to take this opportunity to thank the people who are present here today or watching on television – including my pharmacist colleagues, pharmacy assistants, other health industry stakeholders and health consumers.

All of these people take a keen interest, and play an active role in our health system and world class Pharmaceutical Benefits Scheme or PBS as I will refer to it today. Medicines benefit all Australians in our quest to live longer, happier and more productive lives.

The Pharmacy Guild of Australia or Guild, as we are known, is the national peak body representing community pharmacy. Our members are the pharmacy owners of Australia’s pharmacy network of almost 5000 community pharmacies in varied locations including private hospitals, medical centres, shopping centres, the suburbs, to pharmacies in the most remote parts of Australia.

Naturally, I am a community pharmacy owner, and I live in the Prime Minister’s electorate of Griffith in Brisbane, I know Prime Minister Rudd well and as his fellow Queenslander, might I also say, “I am here to help”.

Those who know me know that I am very passionate about community pharmacy and public health. As a result of adversity, I know what it is like to be on the patient’s side of the health care system. I think this has made me a better pharmacist. In 2003, our beloved son Stanley passed away at age 10, after a three year battle with leukaemia. Leukaemia is one of many health conditions where the support of a pharmacist is paramount offering support with chemotherapy medications, the significant side effects and all medicine related issues. Sadly the hospital system, with its limited resources, did not provide us that assistance.

My wife Effie, also a pharmacist and I were asked an overwhelming number of questions from other parents. A pharmacist – the medicines expert - should be there for everyone. I am driven today to ensure that pharmacy services are expanded – not contracted. The pharmacist is an essential part of the health system.

One of the most important things I want to talk about today is change. While I hope to use this opportunity to speak generally about the crucial role medicines and community pharmacy play, in the ongoing health and well being of all Australians, I want to focus also on how my profession is evolving to meet the changing needs of our communities. I want to make sure pharmacists remain, as they have always been, the most accessible of all health professionals. You don’t need an appointment to see your pharmacist.

I have discussed pharmacy’s direction and our plans, over many meetings with Prime Minister Kevin Rudd and Health Minister Nicola Roxon. The Guild always works cooperatively with the Government of the day. I need to place on the record our thanks for the confidence the Government have shown in Community Pharmacy in terms of their commitments and policy direction.

So in terms of change, there is no bigger structural change than the PBS reforms which will occur on 1st August. It heralds the biggest change in the 60 year history of the PBS Scheme. The Guild helped design these changes and they were passed through Federal Parliament last year. As custodians of the PBS, it will be the role of my pharmacist colleagues to explain these changes to our patients while the Federal government also wants pharmacists to explain to patients that generics are safe and effective and they can save you money. Most importantly, the changes to the scheme will ensure that the PBS continues to operate effectively and efficiently, and remains sustainable.

Firstly, for consumers on 1st August there will be an immediate reduction in price on 1045 medicines brands of safety net medicines. The decreases are from 20 cents to $4.65, with an average decrease of over $2.00. When you are taking lots of medicines, each and every month, even these few cents make a big difference.

Secondly, and more significantly, the changes will see some 99 drugs, representing hundreds of brands, being less expensive for the government with a 25 per cent price drop. Thirdly, moving forward, the reforms will introduce a high level of transparency to the industry, including a rigorous price disclosure mechanism, which will save the PBS – based on the Guild’s calculation – $6 billion over the next 10 years. This figure is twice the amount predicted by the Federal Government in 2006. This is because some 40% of the PBS will come off patent in 2012 and 2013 and the Guild has analysed the impact of these patent expiries.

Community pharmacy warmly welcomes the increased transparency that the PBS Reforms will establish, as they will put to rest once and for all, the misinformed – and sometimes mischievous – claims that pharmacists chase secret “discounts” on generic medicines. These claims are false because Australia in fact has the lowest generic substitution rate in the western world and the Government want pharmacists to promote an increased generics use. Again can I stress that generics are safe and effective and can save you money.

The Guild works with governments at all levels to create good health policy. We take our role as custodians of medicines very seriously. You can not create good policy unless you have excellent professional relationships with all stakeholders. You can not create good policy unless proposals are costed, and for this reason the Guild employs more health economists than any other health group. But good health policy is a balance of (1) hard edged economics, (2) compassion for the patients you serve, (3) a pragmatic approach to finding solutions, and (4) an ethical approach with consideration for social justice issues where bottom line profit and shareholder returns do not drive your thinking.

The Guild has some 300 staff across Australia with branches in all States and Territories. The Guild is signatory to scores of agreements with governments at all levels. When you are a signatory to an agreement, you can’t stand on the side line and complain about the Government of the day. The Guild works to present solutions to governments, and delivers those solutions through our network of pharmacies.

Some say that Medicare is the jewel in the Australian health system, but in my view, the PBS is that jewel. The Guild is very proud to have helped shape the PBS with government. In 1948 when the PBS started it was the Guild that was in discussions with then Prime Minister Ben Chifley.

The PBS delivers key outcomes that Medicare, quite frankly, can no longer claim it universally achieves. In terms of accessibility and affordability, the PBS is now the only product or service for which you pay the same price, on the overwhelming majority of life saving medicines, regardless of where across this vast nation you may reside.

For pensioners $5 is the cost of your PBS medicine no matter where you live. For general patients the price is $31.30. Because the total cost of the average PBS item is $41.54, tax payers subsidise the vast majority of medicines. This consistency of patient contributions to the price is extremely reassuring, as the last thing any patient wants to do when they are sick is to shop around for the cheapest medicine. For 84% of medicines on the PBS, the price is the same no matter which pharmacy you go to.

Compare that with the price of $100 worth of regular grocery items which even within the same supermarket chain – can differ up to 21%. What about the price of petrol? If that approach was allowed to be applied to pharmaceuticals, many millions of Australians would be seriously disadvantaged. It just wouldn’t be fair. The PBS is shaped by the five year Community Pharmacy Agreements that are negotiated between the Guild and the Federal Government. The agreements ensure that Australians have equitable access to medicines. Our current agreement is worth $35B. I have a saying
at the Guild – “Respect the M’s”. M’s stands for millions. In Canberra it is common to talk in terms of billions and millions – they roll off the tongue. However for every one cent of savings of the average price of a medicine that pharmacists can bring via a more efficient and effective PBS this saves the taxpayer $2.5M.

The Agreement we negotiate are about more than just the price of medicines- they cover how the scheme is delivered to patients including support schemes and professional pharmacy programs. We are accountable for all these issues, and how public funds are spent. By way of example we ensure that rural and regional pharmacies remain viable with specific additional payment support. Because of this targeted support, some economic rationalists would say this was anti-competitive. I disagree passionately with that argument because pharmacy services are now the only health services that have actually grown in rural and regional Australia. No other health profession can make that claim!

Over the last three years there has actually been – in essence – no rise in the number of PBS prescriptions dispensed by pharmacists. With the ageing population and new treatments this should not be expected. It is the Guild that implements various systems through IT and other methods to ensure there is minimal wastage and minimal abuse of the scheme. Thus far since 2005, in the current agreement, there have been some 39 million fewer prescriptions dispensed than predicted under the agreement and this represents a saving of $1.5 Billion. The custodian role of the Guild and the network of community pharmacies deliver great benefits to the community.

When patients take their medicines as prescribed, they stay healthy, avoiding unnecessary and more expensive hospital costs. Staying healthy means you are productive, productive means you work and when you work you pay taxes and that keeps Treasurer Wayne Swan happy. That is why the PBS should be seen as an investment.

When patients keep taking their medicines we say they are compliant. To support patient compliance with medicines, the Guild has developed a world first index that measures patients’ compliance to medicines. The system is called a MedsIndex score and compares the Doctor’s instructions with how the patient is going following those instructions. The score is out of 100 so if you have missed taking 50% of your doses you will have a score of 50.

The system was only launched in March this year, but has already been an outstanding success with tens of thousands of Australians benefiting. I can report today that baseline MedsIndex data shows the average compliance amongst high medication users is 76. That means people are missing one in four doses - and that is a concern. The great news I can report is that once patients know their score, and with the help and support of professional pharmacy programs, their score after two months improved to a score of 90. This new program over time will translate into substantial savings for the Australian health system.

Based on the patient’s score different pharmacy programs are triggered. A score of 70 or lower indicates serious compliance issues and the patient referred to their GP. These pharmacy programs have been developed with our sister organisation the Pharmaceutical Society of Australia and the Federal Government through the Department of Health and Ageing to help improve patient outcomes.

Dose Administration Aids is where pharmacists pack medicines into blister packs. This supports medication compliance and quality use of medicines. It makes it easier for patients to remember to take their medicines. By 2020 some 3 millions Australians will need to have their medicines packed by their pharmacist. The number one reason why patients end up prematurely in Nursing Homes is when they can not comply with taking their medicines on time. So Dose Administration Aids not only save nursing home costs, but they also help keep patients well.

Another common pharmacy service is a Home Medicines Review. Under this program the doctor recommends the service and the patient chooses their preferred pharmacy to coordinate the review. The pharmacist visits the patient’s home checking on things like where the medicines are stored and what over the counter medicines are being taken. The accredited pharmacist then makes a clinical assessment of the patient’s entire medication regimen and writes a report to the doctor recommending ways to help the patient to improve it. You pick up lots of areas for improvement on a patient home visit.

These programs operate in pharmacies where we have an independently assessed quality assurance system. The Quality Care Pharmacy Program as we call it places Australia as the first community pharmacy system in the world to be quality assured. We are proud of that achievement.

The National Primary Health Care Strategy announced last month by Health Minister Roxon will no doubt see an enhanced role for pharmacists and we are ready for that opportunity. There is currently much discussion about expanding the number of health professionals who can prescribe on the PBS and broadening the range of which health professionals can access Medicare for their services. I ask that you consider the following efficiencies that can be added by pharmacists and the network of community pharmacy, with no additional cost to Medicare.

Firstly a mere 20 medicines for chronic therapies conditions make up 45 million prescriptions each year or a massive 25% of claimed PBS items. For these medicines, once a doctor has initiated therapy, it is our view a pharmacist should be able to continue that therapy for up to 12 months. Currently when patients run out of prescriptions, a pharmacist must direct them back to the doctor to receive a new prescription, and when that happens there is another swipe of the Medicare Card. Some would view this change as pharmacist prescribing; but we see it as Medication Continuance.

We would overlay additional structured pharmacy programs in our Agreement which we can develop with the Pharmaceutical Society to assist patients with chronic conditions. The patient continues to see their doctor as regularly as the doctor requires, the doctor remains the key coordinator of care.

Secondly for some 380,000 Australians living in Nursing Homes or High Care Residential facilities where pharmacists pack their medicines into DAA, it is our view that pharmacists should be able to continue all medicines supply for six months whether or not there are repeats on the item or repeats available. Pharmacists are forever chasing up prescriptions and it is an administrative nightmare for Doctors. At present, every time a pharmacist needs a prescription, we go back to the Doctor. Our solution - another example of medication continuance.

Thirdly there are medicines, in our view, that should move from the Prescription Only category, to a new sub-category called Pharmacist Only Medicines Notifiable. This is what occurs now with pseudoephedrine sales. As the name suggests notifiable means relevant Government agencies may be notified of sales to monitor misuse.

Pharmacists have always done prescribing under this schedule of medicine. Using existing technology, sales can be monitored and reported, protocols set for each medicine, such as intervals in which patients can access medicines and perhaps some may require initial prescribing by Doctor. Products such as the contraceptive pill and low dose statins and products for minor ailments could come under this category.

The above three changes would see not one extra cent in remuneration go to pharmacists, so it would be a true added efficiency. This proposal equates to 4.4 million fewer Medicare Visits. The increased capacity for GP services is the equivalent of adding 450 full time GP places to the system.

Now back to those MBS rights to other Health Professionals and their PBS Prescribing rights. If every profession who has spoken to the Guild about wanting to get PBS Prescribing achieves that aim, there will be 7 other health professions adding to the current three. If that becomes the case the pharmacist will be even more important as the medicines coordinator, checking that what one health professional has prescribed does not interact with another.

Medicare is an uncapped scheme and I can see Treasury and Finance therefore wanting controls. This will be a long debate because all professionals need to be accountable for Medicare spending. The Guild is accountable for all Pharmacy spending in our agreement. This issue therefore will not be sorted out overnight but the solutions I have outlined today can be implemented quickly.

Moving on to another key issue- The Guild is also proud to support a number of programs designed to improve Indigenous health and bridge the heath gap. Let me name three quickly. The QUMAX program as it is known, aims to improve the health outcomes of Aboriginal and Torres Strait Islander peoples that attend participating Aboriginal Community Controlled Health Services in rural and urban areas of Australia. One key focus of the program is medication compliance.

Let me explain another key scheme. Through the Section 100 scheme, remote area Aboriginal Medical Services order medicines from their local community pharmacy, enabling these PBS medications to be provided to Aboriginal people as they present to these medical services. Remote community pharmacists then regularly visit these remote medical services and provide a range of services. This is a major breakthrough in service delivery and there has been a massive 350% increased use of PBS medicines. Previously the supply was through State or Territory hospitals.

Other Indigenous support programs we manage include scholarship programs that encourage Aboriginal and Torres Strait Islander peoples to pursue careers as pharmacists, or as pharmacy assistants. One such recipient is the 2008 Northern Territory Young Australian of the Year, Simone Liddy. Simone is currently completing her fourth year in a Bachelor of Pharmacy from Charles Darwin University, while working part-time in a pharmacy. She is a sports star as well, playing for the Northern Territory Pearls in the Australian Hockey League. Well done Simone and the Pharmacy Guild is proud to give Simone every support possible.

All of our pharmacy programs will be even more successful, if the Australian health system embraced an e-health model, where we use the technology to connect health professionals to each other, to connect Federal systems with State Government systems, to connect private and public systems.

In the particular area of e-health, no other health group has done more than the Guild and community pharmacy in terms of investing its own funds to support moves to the e-health model.

The Guild with Medicare Australia and software vendors implemented PBS On-line which is a system that in real time checks patient entitlements for PBS Benefits and now 98% of prescriptions go through the PBS On-line process. This figure was only 3% some three years ago. It saves the PBS tens of millions of dollars each year.

Our major challenge that we have set in our next 5 Year Agreement is to transform our health system to an electronic prescriptions model or e-prescribing in industry speak. The current paper system for prescriptions would disappear. E-heath in Australia has been categorised by big talk, big spend and little action. The Guild’s plan is to always ‘build one bit at a time’ and then move on to the next project. We need to know how many rescriptions are written and dispensed. About 12% of original prescriptions are never filled and 50% of repeats are never filled.

The Guild has set some key criteria that must be in place. One is that a ‘fill notification’ goes back to the prescriber every time the pharmacy fills the prescription. This is vitally important as we deal with the burden of chronic disease because with chronic therapy medicines the patient sees the doctor only once while visiting their pharmacist six times- for the original script and 5 repeats. Some medicines will soon have 12 repeats, as outlined in the May Federal budget, making reasons for implementing this scheme more compelling. That notification does not exist now. The Guild wants to use it to improve the health system.

We look at systems all over the world and adapt the best elements. Australian pharmacy is unique. There are other key differences with overseas pharmacy systems. In Australia we have two schedules of medicines that do not exist in places like the USA. Pharmacist Only Medicines are those that must be supplied by a pharmacist with appropriate recording and labelling. Pharmacy Medicines can be sold by pharmacists and trained Pharmacy Assistants. These trained professionals are available to answer questions and support patients. In contrast in the US an item is either a prescription only item or available anywhere … even in a gas station.

The difficulty with this approach is that basic ingredients, such as codeine in low doses, which is in painkiller tablets such as Mersyndol and Chemist Own pain tablets are available only on prescription in the US. If that system was here it would add $180 million in Medicare cost to the health system. That shows the value of the high service model of the Australian pharmacy system.

Relating to this issue in terms of e-health innovation, the Guild has developed a world class IT product called Project Stop which monitors pseudoephedrine sales. This ingredient used in cold and flu remedies is unfortunately also used to make methamphetamine which is the illicit drug “ice”.

How purchases are recorded into a nationwide online database. If that same person then goes to a nearby pharmacy shortly after, Project STOP will inform the next pharmacist. Drug runners used to go from pharmacy to pharmacy, now they can’t. Drug running through pharmacies has stopped overnight.

Some claimed the product should become prescription only but that would add $80 million to Medicare each year alone. The Guild’s own IT department developed Project STOP. We have worked closely with the Federal Attorney General’s office, Federal Police and State health and police departments to put in place the Project STOP system. This world class Australian system is now being sold to the US.

Now setting aside the outstanding developments in pharmacy professional services and ehealth innovations, I would now like to address one topic that comes up periodically - the suggestion by the supermarket operators that they should own and control pharmacies.

The most important concept to understand here is that medicines are not normal items of commerce. The US experience demonstrates that a supermarket model of pharmacy treats a medicine as a mere commodity. There is no focus on the patient, no focus on the patient’s compliance with their medicines, no focus on the efficient use of health resources. The supermarkets in Australia have one focus – to generate profits for their shareholders at any cost. It is at any cost and I ask you to consider the following evidence.

The biggest selling products in Supermarkets today, according to the 2007 AC Nielsen
Report:

Winfield Cigarettes nearly $1B in sales.
Coca-Cola,
Longbeach Cigarettes,
Peter Jackson Cigarettes,
Horizon Cigarettes,
Benson and Hedges Cigarettes,
Holiday Cigarettes. Do I need to go on?

Slogans like the “Fresh Food people” should be replaced with something more appropriate. Treasury should send the supermarkets a bill for $3 billion each year because that is the associated cost of these products on the health system, and the economy.

If the ethics of that business approach is not enough, consider that between Coles and Woolworths they sell alcohol worth more than the Federal government’s total investment in the PBS. The NSW Alcohol summit put out some data in 2003 on the cost of alcohol on the community. These are the annual costs- health and medical services - $225 million; road accidents - $1.8 billion; lost productivity in the workplace - $1.9 billion; alcohol related crime - $1.2 billion. Sure supermarkets are good at selling cigarettes and alcohol….. but health should be left to health professionals

We also need to consider that deregulation of pharmacy will lead to different scenarios of others owning pharmacies. I am sure many pharmaceutical companies would love to own pharmacies. Patients would get that company’s medicine brands whether the patient wanted them or not. That is not in the patient’s best interest.

In addition the corporatisation of medical practice including GP services has seen vertical integration of health services. The Federal Government has concerns with that process as various audits have exposed. Imagine if the doctor profited from what particular brand of medication they prescribed?

The Guild believes in the key principal that the prescribing and the dispensing functions should be separated. It provides checks and balances in the system. It provides protection to the public.

The Australian community pharmacy network is a delicately balanced system, involving many players and pharmacies provide the link to patients. In Australia we have a strong manufacturing presence in both branded and generic medicines. Australian made products are good for the country, good for the economy, and give confidence to patients.

These medicines are then distributed by three wholesalers who make daily deliveries of sometimes quite small quantities of pharmaceuticals. This guarantees the prompt supply to customers of over 3603 PBS medicine brands even including those which are rarely used.

The pharmacies complete the distribution system and also provide health-related education, professional care, advice and an increasing range of professional services reflecting the changing role of pharmacy. Pharmacists are supported by highly trained and dedicated professional pharmacy assistants. They form the front line ready to assist patients. Their high service levels are vital for a better health system. They play a key triage role and have been driving preventative health approach, way before this became a trendy term.

The Guild leads a proactive profession. We have 16 pharmacy schools across Australia delivering 1500 plus graduates all with at least 4 years of study at the university level. On top of that they then complete an intern year and the vast majority will work in community pharmacy. These pharmacists want to continue to work in a professional environment, they are ready to take on an increased role, and they do not want to work for supermarkets.

The Guild’s focus in the next few years will be to work with governments and industry to develop e-health solutions and in addition to help shape a modern health system. I have listed some of those innovative solutions today. The Guild will focus on one step at a time. That is our track record of success.

The one key ingredient for success is to maintain the trust and support of the public. The public is suspicious of on-line systems. The public is sometimes suspicious of government programs. The public does however trust their pharmacists and they trust the integrity of the community pharmacy model in Australia.

I am proud to lead the Pharmacy Guild and our profession. We thank the Australian public for their support. We will continue to be there for you. If you have any questions about the big changes that will occur on 1 August to the PBS system we are here to help. As we say in our advertising– ‘ask your pharmacist’.

Thank you.
Click to expand...

DaVinci · Jul 25, 2008

LuckyLisfranc said: ↑

Interesting speech, and some important points to consider as we move towards a greater prescribing role...makes you wonder what our leadership is doing?
Click to expand...

This is how they can eliminate the shortage of GP's in Australia:

Firstly a mere 20 medicines for chronic therapies conditions make up 45 million prescriptions each year or a massive 25% of claimed PBS items. For these medicines, once a doctor has initiated therapy, it is our view a pharmacist should be able to continue that therapy for up to 12 months. Currently when patients run out of prescriptions, a pharmacist must direct them back to the doctor to receive a new prescription, and when that happens there is another swipe of the Medicare Card. Some would view this change as pharmacist prescribing; but we see it as Medication Continuance....

Secondly for some 380,000 Australians living in Nursing Homes or High Care Residential facilities where pharmacists pack their medicines into DAA, it is our view that pharmacists should be able to continue all medicines supply for six months whether or not there are repeats on the item or repeats available. Pharmacists are forever chasing up prescriptions and it is an administrative nightmare for Doctors. At present, every time a pharmacist needs a prescription, we go back to the Doctor. Our solution - another example of medication continuance.

Thirdly there are medicines, in our view, that should move from the Prescription Only category, to a new sub-category called Pharmacist Only Medicines Notifiable. This is what occurs now with pseudoephedrine sales. As the name suggests notifiable means relevant Government agencies may be notified of sales to monitor misuse.

This proposal equates to 4.4 million fewer Medicare Visits. The increased capacity for GP services is the equivalent of adding 450 full time GP places to the system.

Now back to those MBS rights to other Health Professionals and their PBS Prescribing rights. If every profession who has spoken to the Guild about wanting to get PBS Prescribing achieves that aim, there will be 7 other health professions adding to the current three. If that becomes the case the pharmacist will be even more important as the medicines coordinator, checking that what one health professional has prescribed does not interact with another.
Click to expand...

LuckyLisfranc · Jul 25, 2008

there will be 7 other health professions adding to the current three
Click to expand...

I can think of the following who currently can prescribe,administer, or supply in some capacity, in at least some jursidictions:

Medicine
Dentistry
Nurse practitioners
Optometry
Podiatry
Paramedics/ambulance officers
??

The problem is there is no uniform drugs and poisons policy Australia wide, and we have a mixed bag of rules across the country, and I'm not sure anyone truly understands exactly who can do what with specific drugs.

For example, I cannot even find a reference in the WA drugs act to allow podiatrists in that state to use any restricted drug!

LL

ARB · Jul 25, 2008

Maybe the 7th profession could be Physiotherapy? (S4 analgesics, steroids?)

Tuckersm · Jul 28, 2008

LuckyLisfranc said: ↑

For example, I cannot even find a reference in the WA drugs act to allow podiatrists in that state to use any restricted drug!

LL
Click to expand...

It is because it is in the regulations, not the act.

Tuckersm · Jul 28, 2008

ARB said: ↑

Maybe the 7th profession could be Physiotherapy? (S4 analgesics, steroids?)
Click to expand...

It is. The APA is begining to put proposals together, and there has also been some interest from psycologists as well.

Kon Sclavos (Pharmacy Guild) - National Press Club Address

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Hong Kong needs Podiatrist

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Kon Sclavos (Pharmacy Guild) - National Press Club Address

LuckyLisfranc Well-Known Member

DaVinci Well-Known Member

LuckyLisfranc Well-Known Member

ARB Guest

Tuckersm Well-Known Member

Tuckersm Well-Known Member

Hong Kong needs Podiatrist

Syndesmosis Procedure for Hallux Valgus & Metatarsus Primus Adductus: My Hong Kong Chronicle

Looking For Hong Kong Pod

Hi all , any podiatry opportunities in Hong Kong?

Working in Hong Kong (hopefully)

Podiatrist Vacancy in HONG KONG

Job Vacancy in Hong Kong

Share This Page

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