Nicola Roxon (Gellibrand, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

I rise today to also speak briefly about the National Health Amendment (Pharmaceutical Benefits) Bill 2007. The bill has two purposes. Firstly, it amends the National Health Act 1953 and the Health Insurance Act 1973 to allow authorised optometrists to prescribe certain ophthalmic eye medicines under the Pharmaceutical Benefits Scheme and the Repatriation Pharmaceutical Benefits Scheme. Secondly, the bill amends the National Health Act 1953 to clarify the intent in relation to the supply of pharmaceutical benefits by approved pharmacists. Labor will be supporting the passage of this legislation through the parliament. Given my and the minister’s other commitments today, I will deal with these issues very briefly.

Let me turn firstly to the extension of the limited prescribing rights to optometrists or, more precisely, the benefits that there will be to consumers that will flow from this change. Those prescribing rights already exist, but the arrangements will enable consumers not to go to a GP or, at least, to receive the benefit from their pharmacist when purchasing these products. Under the current arrangements, only medical practitioners and participating dental practitioners can prescribe pharmaceutical benefits. As the minister has pointed out, this means that patients who need eye medicines are obliged to follow a visit to an optometrist with a visit to a GP for a prescription if they wish to receive subsidised medicines under the PBS. This bill will change that to allow for authorised optometrists to come within the ambit of those provisions that have applied only, in the past, to medical and dental practitioners, and it will allow authorised optometrists to prescribe certain medicines under the PBS and RBPS. I do want to emphasise that this ability has been there already and that this is not giving optometrists new prescribing rights but is removing the inconvenience to patients or the cost to consumers—something that Labor is prepared to support.

Optometrists who are authorised to prescribe certain medicines under relevant state or territory legislation will now be able to apply to the Secretary of the Department of Health and Ageing to be given the authority to prescribe from a limited list of eye medicines under the PBS. According to the explanatory memorandum, the minister may determine any criteria that must be satisfied first before an optometrist is approved, and any conditions that might attach to that approval.

It is clear that the PBS will apply only for certain ophthalmic preparations. This change will not only provide convenience and cheaper medications; in rural and regional areas where GP workforce shortages are acute it will achieve a more efficient deployment of the health workforce and will potentially reduce some Medicare costs.

I want to note that the Optometrists Association of Australia have advised of their strong support for this change, arguing that it will improve access to subsidised medicines for people who cannot afford to pay the full price or for people who live in remote and rural areas. I note that, whilst the optometrists have no concern about this enabling legislation, they are frustrated about restrictions on which medicines will be available for optometrists to prescribe. The Royal Australian and New Zealand College of Ophthalmologists has advised that the college is not, in principle, concerned about these changes to the legislative framework under this bill; however, it does remain concerned that optometrists who are not medically qualified should have access to the full range of legal drugs. The college believes its concerns will be addressed via regulations, which, as we understand it, are not yet available.

We know that some doctors are opposed to this change because they fear it is a sign of increased role substitution to come in the future. The AMA, for example, has previously raised concerns regarding optometrists performing ophthalmological diagnosis and more interventions from a very restricted knowledge base. They are concerned that this will encourage role substitution and potentially sideline the role of GPs and specialists. Whilst we take on board these concerns, these prescribing rights for optometrists have been in existence for a long time. What is changing through this legislation is that patients who previously did not have their prescriptions covered by the PBS will have that, and this change will mean less dual handling or lower costs to patients. We do not agree that any risk exists for patients. In fact, the benefit to patients in terms of both cost and convenience is the reason we support this bill. Obviously, arguments are yet to be had about what will be included in the regulations, and we need to ensure that high standards of appropriate care are maintained while giving maximum benefits of convenience and access to cheaper medicines for the public.

I think, for the benefit of the chamber, I do not really need to go through with these other comments that the minister has covered in his speech. I can indicate that Labor supports the government’s decision to proceed with these changes, despite the resistance of some doctors, on the basis that they will provide a better outcome for patients in terms of convenience and cost, which must be our focus in this House.

Turning briefly now to the second object of the bill, schedule 2 of the bill amends the National Health Act 1953 to clarify the intent in relation to the supply of pharmaceutical benefits at or from approved premises by approved pharmacists. While neither the explanatory memorandum nor the second reading speech nor the minister’s comments today make any specific mention of a recent Federal Court decision or of concerns about the court’s interpretations of section 90 of the National Health Act, it appears that the amendments in schedule 2 are intended to address what is effectively a loophole that was created in relation to the supply of medicines by pharmacists. Whilst we support these changes, it would be helpful if the government could be a little more transparent in its legislative intentions. The rationale for these amendments really only became apparent when we were advised that the amendments are in reaction to the recent Federal Court decision of Holtzberger v the Secretary of the Department of Health, where the term ‘at or from’ in section 90 was interpreted as referring to a supply at or from the premises in question, indicating that the supply of pharmaceutical benefits need not necessarily occur at the approved premises. The department no doubt would be concerned about this interpretation and those concerns have been addressed with provisions that are in this other part of the bill.

I turn to the changes, which we support. I would remind the House that the purpose of the location rules which will be protected by closing this loophole is to ensure widespread community access to pharmaceutical services and to ensure the continued viability of existing pharmacies’ objectives, which Labor strongly support. Once approved, pharmacists must also comply with a range of other conditions in order to continue to be able to supply pharmaceutical benefits—and obviously these sorts of loopholes can threaten those sorts of conditions. For example, a pharmacist can only supply benefits from a pharmacy that he or she is operating and may not supply to anyone any pharmaceutical benefit that attracts a Commonwealth contribution for free or for a price less than the relevant patient contribution. The amendments in schedule 2 will tighten the conditions applying to pharmacists who are approved to supply medicines for which benefits will be paid by the Commonwealth under the PBS. While the government’s explanation for these changes has been a tad ambiguous, we support the pharmacy location rules and legislation which seeks to clarify the intention of the act in relation to those, and the supply of pharmaceutical benefits is supported by Labor. We commend the bill to the House.

Question agreed to.

Bill read a second time.

Ordered that the bill be reported to the House without amendment.

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