Publication Date 01/11/2010         Volume. 2 No. 10   
Information to Pharmacists

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Pharma-Goss for November 2010

Rollo Manning

articles by this author...

Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin.
Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

Nurse practitioner prescribing PBS misunderstood

In a sense the PBAC has passed the buck on Nurse Practitioner prescribing to the Advisory Committee on Medicines Scheduling (ACMS) or the Secretary of the Department of Health and Ageing.
At present there is no way a NP can prescribe anything more than Schedule Three medicines under the provisions of the Standard for the Uniform Scheduling of Medicines and Poisons (SUSMP).
In some jurisdictions there is in place a select list of medicines that has been approved by the Chief Health/Medical Officer for NP prescribing.
Such a list has existed in the NT for 23 years and is widely used for prescribing PBS medicines by nurses and Aboriginal health workers in remote locations that are listed in the Gazettal Notice that describes the action.
These “prescriptions” can then be dispensed by the practitioner using the special provisions of supply under Section 100 of the National Health Act for PBS to remote Aboriginal Health Services.

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Then SUSMP makes it quite clear in the following definition of Schedule Four:

Schedule 4. Prescription Only Medicine…Substances, the use or supply of which should be by or on the order of persons permitted by State or Territory legislation to prescribe and should be available from a pharmacist on prescription.

The discussion on the “Medical Observer” website illustrates the lack of understanding by doctors to the legal consequences of NPs being able to prescribe PBS – no mention of State/Territory law preventing the action.

See some of the discussion at:

http://www.medicalobserver.com.au/news/extent-of-nurse-practitioners-pbs-access-revealed?hash=e44971949b7f2bfc42e2dcff58b46aa5-d15a67670e0e82d8ce6424899da84efb

The high cost of PBS needs reigning in – How?

Well here is a suggestion.

Delete from the list all medicines that can be bought at a supermarket or over the counter at a pharmacy for a price less than what it is costing the PBS from taxpayer’s revenue.

The classic example in Paracetamol Tablets 500mgm 100.

Cost the PBS $8.42

Cost at discount pharmacy or internet pharmacy for $1.99.

Mylanta-P is another example where it can be bought over the counter or over the Internet for $5.39 or $5.99 from a pharmacy but it costs the taxpayer $15.72.

Bearing in mind that $6.42 of the price to taxpayer is in dispensing fee and $1.02 is for safety net recording this is not a bad deal for pharmacy – but no good to the consumer or taxpayer.

The PBS should be culled of such products and don’t worry about the cry that will go out for pensioners – that is a detail – maybe shopping vouchers from the doctor funded by the PBS and redeemable at Colesworth et al.

The generic mismatch in Australia

And while on the PBS and pricing a lot is heard about how the Australian rate of generic dispensing is well down on comparable developed world countries. Is it any wonder when a collusive arrangement exists with the buyer of the medicines – the Government through the PBS – and the industry leaders protecting their patch?

Let’s look at Amoxycillin Caps 500 mgm 20

There are nine different brands of the product all costing the taxpayer $10.65.

What a coincidence that each has the same return price and therefore wholesaler and presumably declared manufacturers cost price.

What happened to competition or is it time for the PBS to start seeking contracts from manufacturers who would then select the cheapest to last for a (say) four year term of arrangement.

Quote of the Month

A great many worries can be diminished by realizing the unimportance of the matter which is causing anxiety.

Bertrand Russell
(1872-1970, British philosopher, mathematician, essayist)

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