Tuesday, 20 June 2023
Matters of Urgency
Senator Ruston has submitted a proposal under standing order 75 today, as shown at item 12 on today's order of business:
Pursuant to standing order 75, I give notice that today I propose to move "That, in the opinion of the Senate, the following is a matter of urgency:
"The failure of the Albanese Labor Government to consult with the community pharmacy sector, particularly small and rural and regional pharmacies, prior to the announcement of their 60 day dispensing policy, which may see hundreds of community pharmacies closed, thousands of jobs lost and free access to critical primary healthcare ripped away from vulnerable Australians."
Is the proposal supported?
More than the number of senators required by the standing orders having risen in their places—
With the concurrence of the Senate, the clerks will set the clock in line with the informal arrangements made by the whips.
That, in the opinion of the Senate, the following is a matter of urgency:
The failure of the Albanese Labor Government to consult with the community pharmacy sector, particularly small and rural and regional pharmacies, prior to the announcement of their 60 day dispensing policy, which may see hundreds of community pharmacies closed, thousands of jobs lost and free access to critical primary healthcare ripped away from vulnerable Australians.
Today, I stand in support of the motion that I've moved in this place in relation to the failure of the Albanese government to consult properly—or even at all—on a very important new measure that's going to have a very significant impact on the lives of many Australians, most particularly vulnerable Australians and those that live in rural, regional and remote communities. We're calling out the government because it doesn't consult. We're calling out the government because it doesn't do its homework and it doesn't do the detail. And we're calling out the government because it does not consider the secondary effects of these announcements. They're all headline and no substance.
First of all, I want to put on the record very, very clearly that the opposition has always supported and continues to support Australians having access to affordable medications. But the government's failure to consult has been borne out time and time again since this ill-conceived policy was put into the public domain back in April. It was a great headline, but the consequences of this policy were completely ignored in the policy's development. First of all, we know that there was no real consultation when it came to the development of the impact analysis. We have a letter from the Department of the Prime Minister and Cabinet and the Office of Impact Analysis about this proposal, and I want to put this on the public record:
To have been assessed as 'good practice' under the Guide, the IA—
would have benefited from more recent public consultations on potential stakeholder impacts, particularly for small businesses and pharmacies in rural and remote areas. Moreover, where stakeholder impacts are difficult to ascertain at this point in time … the IA would have benefited from a more detailed evaluation plan that outlines metrics and data required to monitor the impacts on stakeholders following implementation.
It's a very damning letter about the basis of the impact assessment that was undertaken by the government. I have to say I reckon a 12-year-old could have written a better impact assessment than the one we've got here. But most damning in the assessment is on page 28, where the government's own impact assessment on its 60-day dispensing policy says, 'The community pharmacy sector will be significantly impacted by this proposal,' and some pharmacies may even experience cash flow and purchase problems for stock. This is their impact assessment, but they still decided to go ahead with it. There was no regard for the knock-on impacts, but, most distressingly, there was no modelling done. No modelling was done. The Minister for Finance, who was representing the minister for health at estimates, actually admitted to the fact that there had not been any modelling done.
We now find out through the work of the Pharmacy Guild—and it's not just the Pharmacy Guild, to those opposite who will probably try and discredit the Pharmacy Guild; it's also the Australian Patients Association, Painaustralia, the National Pharmaceutical Services Association and the Pharmaceutical Society of Australia—whose name has gone onto a very credible document that has been written by an eminent economist, Henry Ergas, that the very people who were most likely to be the most negatively impacted by this are elderly people with chronic health conditions and regional Australians. They are the ones who are going to suffer. We've found out that 665 pharmacies are likely to close, but potentially another 900 will be at risk of closing, and some 20,000 Australians who currently work in the pharmacy sector are likely to lose their jobs.
Time and time again we have asked this government to guarantee that no Australian patient will be worse off either financially or with regard to access to pharmacy by this measure. It's no wonder they've never given us a straight answer; they've just run around the subject because they know that not only will the pharmacy sector be significantly negatively impacted by this but many patients will be negatively impacted as well. I think one of the most distressing things is just how many secondary impacts are likely to result from this: pharmacy closures, reduced hours and reduced services. Services that were previously provided for free will now have a charge. How is this government going to enable shortages to be addressed? What about wastage? That's before we get to pharmacy viability.
We've got a situation here where a government has rushed to a headline policy. They have had no regard for the potential impacts. The possibility that this particular policy is going to have significant negative impacts on many millions of Australians has been completely disregarded, despite the fact that the impact assessment clearly outlines it and subsequent evaluation has highlighted it, and there has been no consultation at all— (Time expired)
The government says that pharmacies are running a scare campaign—that pharmacists want to 'clip the ticket'. That's just not true. I've spent the past few weeks talking to my local pharmacists in Tassie, and some of them have been in tears. They're scared. At worst, they're looking down the barrel of a policy that will see a lot of them close their doors, and, at best, the policy will see some small-business pharmacies cutting services, cutting staff and reducing opening hours.
This is what they've told me. Rhys told me about the long shifts his staff did during COVID. When the 60-day dispensing policy comes into effect, he'll have to look his staff in the eye and say, 'Thanks very much for all your hard work and all your efforts, but I'm going to have to let you go.' Maree says health minister Mark Butler should visit her pharmacy in East Devonport to see what pharmacies actually do. She said that the minister needs to see the vital services they offer for free to people that need them and how much staff care about their customers. Luciana told me that the loss of income risks the late-night service she provides. She says it absolutely breaks her heart that she won't be able to offer her customers the support they need. Everywhere I go at home I'm reminded of just how much our communities rely on these pharmacies. In areas like Dover, New Norfolk and Westbury, shutting a pharmacy would be shutting a healthcare lifeline.
The minister need to go back to the table on this policy. The government should increase the dispensing fee for pharmacists in the community pharmacy agreement to cover the revenue lost by this policy. The government say they are investing $1.2 billion back into pharmacies, but when the cost of these cuts is around $3.5 billion something doesn't add up. I want people to have cheaper medicine, but ripping the guts out of community pharmacies isn't the way to do it.
The Greens have always supported cheaper medicines. In a cost-of-living crisis where people are literally making choices between paying rent, paying for their medicines, paying their bills or putting food on the table, the Greens have been supportive of measures that will ease these cost-of-living pressures. The government has informed the community that the purpose of the proposed changes to the PBS is to make it easier and cheaper for people to access the medicines that they need. Making it easier and cheaper for people to access medicines that they need is obviously something the Greens support. We believe in the depths of our souls in the importance of the public healthcare system, of a universal healthcare system that covers everything from your teeth to your brain—every part of your body—free at the point of use for all.
As part of our consideration of 60-day dispensing, I have spoken with pharmacists all over the country and heard many concerns about the impact that they feel these measures may have on the local pharmacies they run and also on community members who rely on community pharmacies. After hearing these pieces of feedback from people, I would very much agree that the Albanese government has not consulted effectively with community pharmacists on how these changes will impact on them. I have heard that there will be significant impacts. It's my view that a way forward would be for the government to bring forward the negotiation of the community pharmacy agreement and start talking with pharmacists now to minimise any adverse impacts from this measure.
One of the concerns raised by pharmacists is on the impact of reduced dispensing fees. We are encouraging the government to find a way forward on this, for the minister to consider the doubling of dispensing fees until a new pharmacy agreement has been finalised or to commit to reimbursing any losses at a community pharmacy that can be proven as an unintended impact of the 60-day dispensing measure.
The Greens will not be supporting this urgency motion today, but I do want to reiterate—and I want to speak directly to the minister in this statement—that this should not be taken as a final position of the Greens in relation to the proposed regulation. The Greens party room will continue to negotiate to ensure that these regulations do not have unintended consequences and that they actually achieve their intended goal. (Time expired)
I, too, rise to highlight the government's failure to consult in relation to a policy that has the potential to destroy lives and livelihoods in Tasmania and across Australia. The Albanese Labor government's change to 60-day dispensing for some medicines could cripple our community pharmacists. In a poor attempt to save consumers money in a cost-of-living crisis, the Albanese government announced its 60-day dispensing reforms in the days before the May 2023 budget. While this announcement was greeted with much fanfare from those on the other side of this chamber, there were many who were not celebrating.
As has been stated earlier, the coalition strongly supports affordable access to medicines for all Australians. In fact, in government, we committed to lowering the cost of medicines, and approved more than 2,900 new or amended listings on the Pharmaceutical Benefits Scheme, at an overall investment of around $16½ billion. However, we do not support affordable medicines at the expense of pharmacists. Within hours of this announcement, I had received emails from community pharmacists who feared for their futures and the futures of the businesses that they had worked hard to build, in communities around my home state of Tasmania. These emails multiplied in my inbox, as pharmacists in incredible distress called my electorate office and dropped in to voice their concern. When I arranged to meet with two pharmacists, as part of a Senate tour with my Tasmanian Liberal colleagues, we were met by 12 from the state's north and north-west, all of whom were desperate to share how these changes would impact them.
Community pharmacies in rural and regional areas will be disproportionately impacted by the changes to 60-day dispensing—so much so, that many will be forced to reduce their opening hours, cut the services they offer, or even close altogether. Without pharmacies and bulk-billing or permanent GPs, small rural and regional towns, like so many in Tasmania, are at risk of becoming healthcare deserts. This will mean that many more people will present to emergency departments because they can't access the local healthcare services that they need, which we all know is not going to save anyone money in the long run.
Pharmacists see their patients significantly more than doctors, especially older customers, who regularly seek advice around medicines and symptoms they're experiencing and need ongoing monitoring for chronic conditions. This proposal will cost pharmacy owners thousands of dollars, with a likely 30 per cent drop from their bottom line. One pharmacist calculated that this policy would cost them $104,000 annually, while, for others, it was up to $500,000 per annum. That's a lot of money for a small business.
These pharmacists told us that they would be forced to charge for services they currently provide at no or minimal cost to patients. These are important services, like preparing Webster-paks; reviewing medications, often in the patients' homes; servicing aged-care facilities and nursing homes; doing home delivery for those who can't make it to the pharmacy; filling prescription requests; and doing blood pressure checks, triage and doctor referrals. The 60-day dispensing plan could also drive up the cost of other pharmacy items, as pharmacists try to recoup the funds they have lost as a result of this policy.
Those opposite will tell you that they are reinvesting into community pharmacies, but we need to read the fine print on that promise. For example, doubling the regional pharmacy maintenance program won't help the thousands of pharmacies that are already ineligible for it, and not all pharmacists are geared for vaccination services.
The 60-day dispensing policy is billed as a cost-saving measure, but it is a measure that will be introduced at the expense of pharmacists, their patients and the wider community. And, in many cases, it won't actually save money for the people who need it the most, because, once they've reached the safety net, their medications are often provided free.
So who is really benefiting from this poorly-thought-out plan? The government, who are banking the savings and making pharmacists wear the pain. So something promoted as a saving for consumers risks the viability of our local community pharmacies, leaving us with community pharmacies running on skeleton staff, opening fewer hours and offering fewer services to customers who they've served in their local community for many years. It does not make good business sense. The government's failure to consult, prior to their grandstanding announcement in the lead-up to the budget, will result in poorer service provision to our rural and regional communities.
The coalition does support cheaper access to medicines, but not at the expense of small business. This is just another clear example of the consequences of this Labor government's policy brain-snaps have never been properly considered or consulted on.
I rise to oppose the motion moved by Senator Ruston. This motion is nothing more than a scare campaign against the Albanese Labor government's cheaper medicines policy, which will halve the cost of more than 300 medicines for millions of Australians. From 1 September, everyone with a Medicare card will be able to save up to $180 a year if their medicine is eligible for 60-day dispensing. This policy has been enthusiastically welcomed by health organisations, including the Consumers Health Forum, the Heart Foundation, the Lung Foundation, the Breast Cancer Network, the rural Doctors Association, the AMA and the RACGP.
Many countries, including New Zealand, Canada, France, Germany, Ireland and Norway, have well-established dispensing quantity policies of up to three months, one month more than what we are proposing. Despite this, the 'no-alition' still say no—no to cheaper medicines, no to cost-of-living relief and no to what's best for Australians. Let's not forget that this policy was first recommended to the former government, in 2018, by the Pharmaceutical Benefits Advisory Committee. And what did the former government do? Absolutely nothing, which cost Australians hundreds of millions of dollars in lost savings. Fast forward to 2023, and instead of supporting our plan for cheaper medicines they jump on a scare campaign, claiming the pharmacists will lose their jobs and pharmacies will close.
Let's set the record straight. Australian pharmacies do so much more than just dispense medicine. The Albanese government is supporting our trusted pharmacists to play an integral and even more central role in the health care of Australians, not to mention the fact that every dollar the government saves through 60-day dispensing will be reinvested into community pharmacies.
This $1.2 billion reinvestment includes increasing the budget for community pharmacy programs under the Seventh Community Pharmacy Agreement, introducing nationally consistent pharmacy payments for opioid dependence treatment services, subsidising community pharmacies to provide vaccines on the national immunisation program and increasing support for aged-care residents through community pharmacy programs. The government has also taken steps to alleviate the pressure on pharmacies by implementing the policy in three tranches, giving pharmacists adequate time to transition to the new dispensing arrangements.
In recognition of the vital role of pharmacies in our regions, I am also pleased that the government will introduce targeted programs to ensure rural and regional pharmacies can successfully adjust to the changes. Those opposite would like you to believe that this policy is bad for the regions, yet the National Rural Health Alliance has endorsed the policy, saying it will reduce the cost, travel and time for rural and remote people to pick up repeats or new medications.
As part of the package of reinvestment, the government is also doubling the total budget for the Regional Pharmacy Maintenance Allowance. There are currently over 1,000 pharmacies in regional, rural and remote Australia that access this allowance, and, under the increase, Australia's most rural pharmacies may be eligible for almost $100,000 in government assistance.
Senator Ruston has also claimed there has been a lack of consultation with pharmacists. Firstly, it's a bit rich, coming from those opposite, moving a motion about lack of consultation when they don't even want First Nations people to have a voice. Secondly, it's completely untrue. The Albanese government has worked and continues to work with all parts of the pharmacy sector on the implementation of this policy. I have met with numerous pharmacists in my home state of WA. I have listened to their concerns and I recognise their vital contribution to the health of our community. I will also be hosting an online forum next Tuesday for the pharmacists who have contacted my office.
I can assure you that we will continue to engage constructively with all stakeholders, because what we want is for Australians to have access to cheaper medicines while ensuring pharmacists feel valued for the work that they do. While those opposite focus on scare campaigns, we will continue to focus on delivering real solutions.
tor CAROL BROWN (—) (): I'd like to, firstly, congratulate Senator Payman on what was an excellent contribution and also congratulate her on the work that she's doing in her great state of Western Australia. It's not as good as Tasmania but you can't have everything! This MPI that we are discussing today is about the Albanese government halving the cost of medicines for around six million Australians. The government supports affordable medicines, and the opposition, through this motion, is more interested in scare campaigns. The Albanese government understands that many Australians are doing it tough. That is why we are determined to take the pressure off household budgets wherever we can and that is why we're making medicines cheaper for millions of Australians. On 1 January, for the first time in the 75-year history of the PBS, the general co-payment was reduced from $42.50 to $30. In the first three months of this year, 5.1 million prescriptions have been cheaper, saving Australians more than $58 million. For Tasmanians, that is over 185,000 cheaper scripts and over $2 million saved. That is money that's in your pockets to help ease the cost-of-living pressures.
In this budget, we've gone further. The budget includes a measure that will allow millions of Australians to buy two months worth of medicine—for the price of a single prescription—for hundreds of common conditions. From 1 September this year, with a staged implementation, general patients will be able to save up to $180 a year if their medicine is able to be prescribed for 60 days—$180 a year. After a decade of inaction by the previous government, Labor is making medicines cheaper for Australians, and that's why this policy has been welcomed. Let's have a look at some of the organisations that have welcomed this policy: Arthritis Australia, Diabetes Australia, the Heart Foundation, the Australian College of Rural and Remote Medicine, the National Rural Health Alliance, the Rural Doctors Association, the Council on the Ageing and the Breast Cancer Network.
The Australian Medical Association says this policy is 'a win for patients' that 'should lead to better medicine adherence and ultimately better health outcomes, with reduced pressure on the health system'—not like what is being peddled here in this motion. The president of the College of General Practitioners said:
This change has been recommended because it is in the best interests of patients, and I am pleased that the Government has heeded the expert advice.
The policy has been welcomed by the Consumers Health Forum, who have said that the policy 'shows the government is listening' to health consumers and that 'every dollar saved at the pharmacy is money that can be spent on groceries or rent'. There we have it. We have the AMA, the College of General Practitioners, the Consumers Health Forum and so many other organisations welcoming this policy. We know that making medicines cheaper is good for the hip pockets of Australians, but it's also good for their health. That's not me saying it; the AMA is saying it and other organisations are saying it. In Tasmania, I know that these changes will make a significant difference to so many.
I must say that I find it incredibly concerning that Senator Payman has compared industry consultation with the Voice to Parliament. Is she honestly suggesting that for consultation to be true and proper we need to constitutionally enshrine organisations to be able to consult with them? It was a farcical comparison, absolutely farcical, and it's exactly what we see from this government, time and time again—particularly when it comes to policies that impact rural and regional Australia most significantly. The decision to change the current dispensing policy without proper consultation with the very people who it's going to impact the most, being community pharmacies, is just the last in a long line of disastrous decisions for our regional communities.
Let me say from the outset that I am absolutely all for cheaper medicines. That's why I'm very proud of the record that the Liberals and Nationals had in government of approving PBS medicines on the Pharmaceutical Benefits Scheme, saving literally thousands of dollars from the pockets of our sick Australians. But we did that with no impact—zero impact—on the bottom line of community pharmacies. The government makes big noises about saving patients $180 a year on their medicines through this policy. What about the $180,000 a year, per pharmacy, that will be stripped from their business bottom lines? That's money they use to pay rent, utilities and staff.
Respected economist Henry Ergas has estimated that about $4.5 billion will taken from community pharmacies. That puts at risk 665 pharmacies and as many as 20,000 jobs. In regional areas, like where I live, pharmacies are often the first and only medical support in a country town. Across Australia, there are 320 towns that don't have a doctor but they do have a pharmacy. And I ask: what will the savings mean to the people of those towns if they lose their pharmacy and they have to get in the car and drive a two-hour round trip just to get their scripts filled? It makes a mockery of the $180 a year the government claims will be saved.
I met recently with Port Macquarie pharmacist Judy Plunkett, who told me of the services her pharmacy provides. It's not just filling scripts; she takes blood pressure; she helps to set up CPAP machines for people with sleep apnoea; she give vaccinations; she goes into the aged-care homes and delivers and dispenses their pharmaceuticals; and she fills Webster-paks for her aged clients. A lot of these services she does for free because she can afford it, and that's because of her business bottom line. But she won't be able to afford it if $180,000 a year is stripped from her. And the Capital Chemist in Braidwood, which currently employs eight staff and is open for extended operating hours, will not be able to continue to service that community at the same level if they lose $180,000 per year. We know already, because we've been told , that the banks are circling the pharmacists because they're seeing the impact that this bad policy will have. The Albanese government must confront the fact that the changes will drastically affect Australians' ability to access health care through pharmacies, particularly in regional areas.
We are, of course, supportive of the intention to reduce the cost of medicines on Australians, but we must ensure that people have access and equity of access. It's so that I can access a pharmacy in Deniliquin just like someone living in Chatswood or on the North Shore can access their pharmacy. There is absolutely no point in having two months worth of dispensing if the pharmacist in your town closes down.