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A newspaper headline recently caught my eye, that stated that there were millions of dollars being wasted, because items dispensed as Pharmaceutical Benefits could have been procured at a cheaper price, by purchasing the same medication at a supermarket.
It was a cynical piece of reporting, and one that puts you on guard as to the real purpose of "planting" such an article. Paracetamol was the only drug mentioned.
Was it the supermarket lobby trying to promote the concept of "it's always cheaper in a supermarket", or was it the Federal Government signaling some major changes in the Pharmaceutical Benefits Scheme?

However, on balance, it is more likely to flag a shift in PBS expenditure, with drugs like paracetamol being removed from the PBS list, and patients being asked to fund their own purchases.
As we all know, the Federal Government negotiates prices for PBS items, so if it was concerned at the costs being generated from the current brands on the list, it is quite capable of adding new brands or manipulating prices, to suit its purposes.

Removing paracetamol from the PBS list not only derives savings in the cost of the actual drug, it will have an effect on the number of times a patient may visit a GP, particularly if they are a pensioner or concessional patient.
Safety net costs might also reduce as paracetamol represents a considerable number of prescriptions accumulating for the extra subsidies available for safety net patients.
I was interested to note that a PGA posting to Auspharmlist expressed similar sentiments, and these comments are shown below in italics.

'From: "Stephen Armstrong"

Paracetamol and the PBS

A report in the Sydney Daily Telegraph of April 22, 2003, states that "taxpayers are paying $32.77 for pensioner prescriptions of paracetamol under the Pharmaceutical Benefits Scheme, when the tablets can bepurchased $29 cheaper at supermarkets".

To arrive at those figures, the $25.05 Medicare rebate for a visit to the doctor to obtain a prescription has been added to the cost of 100 paracetamol tablets. The result has then been compared to the lowest cost of 24 tablets in a supermarket.

The figures assume that every single prescription requires a separate doctor's visit. This is not the case.

The report in the newspaper says: "Pensioners would be better off if they bought the drug at a supermarket".

The PBS price for paracetamol is $7.63 for 100 tablets. Supermarkets can sell packs of 24 (maximum) for around $2, so 96 tablets would cost around $8. The maximum a pensioner or veteran pays is $3.70. And they have a safety net that gives them their PBS medications free after 52
scripts.
No way would they be better off!

Following the newspaper's logic, veterans and pensioners should diagnose and dose themselves and doctors should stick to prescribing higher-cost medications.

The real issue is the Quality use of Medicine.
Pharmacists provide advice about the correct use of paracetamol, a medication that can be fatal if used incorrectly.

A pharmacist will advise consumers about the dangers of misuse and warn of possible adverse interactions with other medications - advice that is not available at supermarket checkouts.'

The above comment was found after this article was completed, so please forgive if some comments that follow appear to be a duplication.......................

Leaving the economic argument aside, what would really concern most pharmacists, if such a move was contemplated, would be the number of patients left without professional supervision, as they were encouraged to purchase from supermarkets, on the basis of price.

The irony of this situation is that one of the cheapest supermarket brands (Herron) has now been taken over by an Australian pharmaceutical company (Sigma), and is already available on pharmacy shelves at competitive prices.

All the above thoughts led me to further speculate why the federal government has not opted to formalise pharmacy "counter prescribing" as part of the PBS.
We are often told that community pharmacists are underutilised and have an excellent track record in the field of counter prescribing.
Why then has the federal government not looked upon this traditional activity of community pharmacists as a means of reducing the PBS costs?
This at least would offer a "middle of the road approach" when the cost of a supervised GP generated prescription is compared to a totally unsupervised service offered by a supermarket.

It is not so long ago that the British National Health Service was considering counter prescribing for its own National Health Service.
Negotiations between the Royal Pharmaceutical Society and the UK government were proceeding down this track, until it was quietly dropped from the agenda, with pharmacist prescribing being limited to a supplementary role for a small number of illnesses, performed by a limited number of pharmacists (generally located in NHS Trusts).
What has now happened in the UK is that there is a general swing away from the independent prescribing by community pharmacists towards a secondary prescribing role by hospital or practice-based pharmacists. This has had the effect of limiting consumer convenience access to pharmacist services, which was not the desired outcome.

One of the side effects of this process is that the secondary prescribing process requires a great deal of training and ongoing revalidation for little reward and minimal patient benefit.
If independent counter prescribing had been supported, there would have been minimal requirements for training, plus relief of pressure on GP surgeries, resulting in an expanding convenience service for the general public.

Many pharmacists see prescribing roles as the next professional advance in cognitive services.

Some see it as an extension of the counter prescribing role to enable pharmacists to give symptomatic treatment for illness.
Others see it only in the therapeutic area, where the role is supportive and supplementary (more suited to consultant pharmacists).

There is no reason why both pathways should not be pursued with patients and the profession being clear winners.
Handled correctly, the government would also be a winner, with reduced global payments, as would GP's, as they would generate an expanded capacity, to better target health projects.

With the increasing pressure to deregulate more potent medicines, and reduce PBS drug costs, why isn't the government looking towards a pharmacist generated solution?
Adding to the package of services, provided by consultant and traditional pharmacists, must enhance professional prospects for individuals, and a more fluid (but safer) marketplace for the distribution of drugs.