Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Link to this | Hansard source

The bill contains the continued dispensing initiative and the medication chart initiative, as included in the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild. It also makes amendments to conditions for authority required medications. The most recent pharmacy agreement, signed in 2010, will provide $15.4 billion over a five-year period for community pharmacy.

The coalition provided policy certainty and stability for community pharmacy when it was in government, and the coalition supports, in principle, the fifth agreement, but will consider all legislative changes presented to parliament.

The continued dispensing provision will allow pharmacists to supply pharmaceuticals without a prescription. The eligible pharmaceutical items and the conditions of supply are not specified in the bill, and will be determined by legislative instrument. It was stated in the department's consultation paper and the previous health minister's second reading speech that the measure will apply to oral hormonal contraceptives and lipid modifying agents—cholesterol-lowering drugs. These groups were chosen because they are claimed to be well-tolerated and have a good safety profile.

The consultation paper provides conditions and parameters for the operation of continued dispensing including: continued dispensing will apply where a patient has run out, or is about to run out, of an essential continuous therapy medicine and does not have a valid prescription available; or where the patient must be able to demonstrate that they have been prescribed the medicine for at least six months, and that they have been taking the medicine immediately prior; or supply of increased maximum quantities based on an authority approval will not be permitted where supply cannot be utilised for consecutive occasions and there can be no switching of medicines within the same class. The department has clarified that patients must not have received the medicine by continued dispensing within the last 12 months. The department also states that the pharmacist must provide, within 24 hours, written communication to the most recent prescriber advising of the supply of the medicine to the consumer.

The targeting of this provision to two well-tolerated medications, in combination with clear conditions and protocols, should assist in addressing any issues regarding patient safety. The coalition is concerned, however, that this detail is not in the legislation. While it would be preferable to have a copy of the draft legislative instruments, the office of the Minister for Health has confirmed that details of the consultation paper, including the pharmaceutical groups affected, will be specified in the instruments to be tabled. Any future changes to eligible pharmaceuticals and conditions would have to be done by legislative instrument and would therefore be subject to parliamentary scrutiny and disallowance. The coalition will carefully consider any future changes in close consultation with all stakeholders, including the medical profession.

The proposed continued dispensing initiative is intended to complement existing emergency supply provisions. Former health minister Nicola Roxon gave an undertaking that a review would be conducted after two years. PBS statistics that are published annually should also contain information on the continued dispensing provisions. This is not reflected in the legislation. This is a government that does not have a good history on keeping to its word; hence, the coalition proposed amendments in the House, which I am pleased to say have been supported, to ensure the government meets its commitments. The coalition's amend­ments are consistent with the government's stated intent and will be facilitated by recording requirements contained in the guidelines for pharmacists for continued dispensing.

More broadly, the Rudd-Gillard Labor government's actions on pharmaceutical policy have seriously jeopardised timely access to subsidised medicines for Australian patients. Until last year, a health minister could list medicines costing less than $10 million in a given year on the Pharmaceutical Benefits Scheme. Cabinet considered medicines over $10 million. Almost without exception, previous governments listed according to the advice of the independent Pharmaceutical Benefits Advisory Committee.

In February 2011 the government indefinitely deferred the listing of seven new medicines and a vaccine recommended by the PBAC due to the Commonwealth's 'fiscal circumstances'. This occurred just months after Minister Roxon had signed a memorandum of understanding with Medicines Australia to provide policy stability in return for $1.9 billion in savings to the PBS. Minister Roxon promised that the MOU would provide 'policy predictability to the industry for the next four years, cut red tape and speed up the addition of new medicines to the PBS'. The government eventually agreed in September last year to list medicines deferred in February However, the government's announcement did not provide any greater certainty for the PBS listing process and in the process caused a lot of angst for a lot of patients. That was very clear from the Senate inquiry into those deferrals. We received some very telling and poignant evidence in Melbourne to that effect.

The Gillard government on 30 September last year announced that there would be further 'deferrals into the future' for new medicines subsidised through the PBS. It is still not clear which patients will be denied access to their medicines and on what grounds. The uncertainty means companies may reconsider attempting the process to list new medicines in Australia, let alone having the impact on patients that I referred to earlier.

The second initiative in the bill will allow for the supply and claiming of pharmaceuticals based on a standardised medical chart in residential aged-care facilities. This measure has broad support, with the claim it will reduce the administrative burden in aged-care facilities and improve patient safety. The Australian Commission on Safety and Quality in Health Care has commenced development of a standardised chart, and further consultation is due to occur during 2012.

The coalition does not oppose this bill, but our amendments will ensure the govern­ment's commitments will be honoured. The coalition's amendments ensure that a review is conducted of continued dispensing and is publicly available after two years. They will also ensure annual statistics are published on pharmaceutical items supplied under this initiative. The coalition will examine in detail future legislative instruments, particu­larly in relation to continued dispensing, to ensure there is genuine parliamentary scrutiny of this measure. Given that the government agreed to the coalition's amendments in the House, the coalition will not be opposing this bill.

Alan Eggleston (WA, Liberal Party) Share this | Link to this | Hansard source

I am interested in this legislation, having been a medical general practitioner for a long time. The National Health Amendment (Fifth Community Pharmacy Agreement) Bill 2012 contains the continued dispensing initiative, as Senator Connie Fierravanti-Wells has just said, and the medication chart initiative, as included in the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild of Australia. As has also been said, the bill makes amendments to conditions for authority required, or S4, medications. These tend to be very expensive medications for which the government sets specific preconditions for their provision under the Pharmaceutical Benefits Scheme at a lower price than their real price. I think it is probably a good thing that there are these amendments to authority for S4 medications.

The coalition in the past have provided policy certainty and stability for community pharmacies and we support in principle the fifth agreement, but there are some issues which arise from this bill. One of the more controversial ones is the continued dispensing provision, which will allow pharmacists to provide pharmaceuticals without a prescription at all. It has not been specified what the eligible pharmaceutical items are and what conditions apply to the facility allowing pharmacists to provide pharmaceutical items without prescription. However, the government has indicated that the provisions will apply to two well-tolerated medications: oral contraceptives and cholesterol-lowering drugs. I suppose it is very important at times for people to be able to obtain a resupply of their oral contraceptives without a prescription, and cholesterol-lowering drugs are now very commonly used, as many people in our society have problems with cholesterol and it is important for them to be able to continue their treatment if they have high cholesterol. This provision will certainly assist this to occur, but we believe there is a need for clear conditions and protocols for the provision of medications without prescription because, as always, issues of patient safety have to be considered. The department's consultation paper does provide conditions and protocols for the operation of this practice, which is known as continued dispensing. Among the conditions and protocols are the following. Firstly, continued dispensing will apply where a patient has run out or is about to run out of an essential continuous therapy medicine and does not have a valid prescription available. Secondly, the patient must be able to demonstrate that they have been prescribed the medicine for at least a six-month period and that they have been taking the medicine prior to their seeking a further supply without prescription. I suppose that this implies that the patient is going back to the same pharmacy from which they have received their medication in the past and that the chemist can verify from their own records that the patient is on this medication and then supply an ongoing amount of the medication or, if the person happens to be in a location away from their home town or suburb, ring the chemist which usually supplies the medications. I think that that is a very good provision because it means that, if people travel and have not brought a repeat prescription with them but do need ongoing medication, they will be able to get it. That is a very practical measure.

There are certain categories of drugs which are supplied on authority only, and these are often very expensive or very powerful drugs. Supply of increased maximum quantities of an authority drug will not be permitted. I think that that is a very serious sensible provision also. It means that the supply will be limited to what is on the prescription for a six-month period, which is usually the period for a prescription, and that patients will not overdose on authority approval medications because they will have to go back through a doctor to get a new authority prescription in order to have access to authority drugs. These drugs are often very expensive to the government to provide even though they are supplied to the patients at the price of a usual prescription. The provision also means that people will not be able to come back repeatedly and seek to have medications supplied without prescription but will have to go back to their medical practitioner in the interim and obtain a new prescription. It is a very sensible provision also because it means that people will be reassessed by their doctors, which reduces the possibility of patients overdosing on medications through being able to access drugs without having a medical practitioner reassess them.

The AMA, I believe, has some reservations about these proposals, but I understand that the department has advised that the dispensing pharmacist must provide written communication to the most recent prescriber advising that he or she has supplied the medicines to the consumer within 24 hours of having done so. That provides some protection of the patient by the responsible professionals in that the patient's GP, consultant physician or surgeon will know that they have received additional quantities of these medications and, if the doctor concerned thinks that that is not appropriate, they can call the patient and say, 'I think you'd better come in and have a talk about this, and we'll work out what you need,' and can counsel the patient about not obtaining drugs without prescriptions lest they develop side effects and do themselves harm.

The second initiative in the bill allows for the supplying and claiming of pharmaceuticals on the basis of a standard medical chart in residential aged-care facilities. I think that that is a very good idea, and it is widely supported because it is expected to reduce the administrative burden in aged-care facilities and to improve patient safety. It means that patients in aged-care facilities will be able to have an ongoing supply of their medication according to what their standard medical chart says they are eligible for and should be receiving. The Australian Commission on Safety and Quality in Health Care has commenced the development of these standardised charts, and I understand that they will be consulting further on it during the coming year.

I have been informed that the coalition supports the bill but is proposing some amendments to ensure that the government meets its stated commitments, that the objectives of the bill are realised and that patient care is maintained within ethical boundaries. We have heard that the legislation will be reviewed after two years, when PBS statistics are available. This will provide a lot of insight into how the continued dispensing provisions are working, although this fact is not referred to in the legislation. I think that these provisions mean in general that people who need medications will be able to obtain them when they are in situations where they have run out of their medications, that their treatment will continue and that they will not be disadvantaged by having travelled to distant places and found that they do not have the medication which they need. For example, the legislation could be applicable to the circumstances of people with quite serious conditions such as high blood pressure—the half-life of the medication for which in the person's body is fairly short—where once the medication has been metabolised its effect is no longer there and the person's blood pressure goes up again, a fact which might have undesirable consequences.

Overall, I think that this legislation contains a sensible set of provisions; but I hope that it is carefully monitored, especially during its early years.

Question agreed to.

Bill read a second time.