Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Don't you just hate it when you turn out to be right about the wrong thing? This thought came to me recently when my son, currently a pre-registration intern in a community pharmacy, told me about two letters the pharmacy had received during the week, one from a private health fund, the second from a major third party accident insurer. Both letters concerned changes to payment to pharmacists for prescriptions.

The health fund will no longer pay pharmacists a 75 percent mark up + $7 dispensing fee for medications covered under the scheme, reducing the mark up to 40 percent with a slightly increased dispensing fee.
The insurance company has gone even further, reducing its payment schedule to that offered by the PBS, ie $4.62 dispensing fee and 10 percent mark up on cost.

I recall a number of arguments I have had over the years with younger pharmacists about the gradual erosion of income from PBS dispensing as successive governments targeted the scheme.
As a "pharmacy dinosaur" I remember the time when a pharmacist could actually make a living from his/her profession without resorting to production line dispensing of ridiculous numbers of scripts each day.
The pharmacist was able to take the time to interact with patients to listen to concerns, advise and counsel on the appropriate use of their medicines.
"Too good to last" I thought and was, unfortunately, correct.
Each Budget Night we heard that, "shock, horror", the cost of the PBS was rising and that steps had to be taken to reduce expenditure.
Co-payments rose regularly and then it was unilaterally decided that a mark-up of 33 percent was much too high and would be reduced to 20 percent then 10 percent as now.

Community pharmacy responded to these changes by improving output and by becoming more efficient. Remember that Australian pharmacists led the world in applying computer technology to their dispensing business.
Note that I say business and not profession, this came much later.

This has resulted in a generation of younger pharmacists who think that $4.62 + 10 percent (or less) mark-up is appropriate for applying their skills to dispensing.
BUT ONLY FOR PBS PRESCRIPTIONS!!
For some reason, known only to those propounding the theory, a totally different process seems to be involved in dispensing private scripts where a larger fee and mark-up applies.
My argument has always been that dispensing a script is dispensing a script is dispensing a script and that consistent standards and values should apply.
What is a fair remuneration - $4.62 + 10 percent or $7 + 70 percent? I always stated, quite vehemently at times, that if pharmacy is willing to accept low fees for PBS scripts sooner or later private payers would question higher rates to them.
Guess what?
The penny has dropped with HBF and Zurich Insurance who have decided that, as the pharmacy profession is willing to undervalue itself to the government, they will try to screw it also.
In a similar vein, I have been reading with interest discussions about the remuneration available to consultant pharmacists for medication reviews.
$140 per review might sound reasonable but remember that even the simplest one is likely to take two or more hours of pharmacist time.
The doctor who refers the patient for the review receives over $100 for about half an hour's work, so look at the pharmacist's fee in perspective.
We pharmacists bemoan the lack of remuneration for intellectual input but we continue to sell ourselves short.
We have given away information away for so many years that we have created the impression that pharmacists' advice has no value.
Why is it that the public is willing to pay for advice from complementary medicine practitioners but not from pharmacists?
In my time in community pharmacy I often spent time advising customers not to purchase some unnecessary medication without being able to request payment for my time.
At the end of such a session I often thought to myself, "I would love to see your face if I said, 'That was a 20 minute consultation - $15 please'".
Probably would have caused a riot in the pharmacy, despite the legitimacy of such a request -an accredited consultant pharmacist exercising expertise in his chosen field.
The perception of the pharmacist as a free source of medical information is deeply ingrained in the public's psyche and until we deal with this pharmacists will always be "second class health professionals".
I know - we always rate very well in the "most trusted profession" surveys but that is possibly because we are cheap and easy to access.
Just remember that, in my "real job", I often receive calls querying whether or not a patient has been overcharged for medications by the pharmacist so I wonder if this trust factor quite as powerful as we think.
Why don't we make use of the media to increase awareness of the benefit that the public can gain by making use of a pharmacist's knowledge of health matters rather than highlighting what products are available?
Returning to my original point, as long as pharmacy continues to undervalue itself it is always going to find others willing to help!
As a fragmented group, pharmacists are relatively easy to target, a weakness exploited by larger, more cohesive, sectors over many years.
My fear is that we are now too far along the path to be able to return to the situation where pharmacy again can survive as a purely health care orientated profession.
I hope I'm wrong.