s Countdown Pharmacy (Woolworths NZ) - A Preliminary Analysis | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Countdown Pharmacy (Woolworths NZ) - A Preliminary Analysis

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

In November 2005, Australian supermarket giant Woolworths Ltd purchased Progressive Enterprises Ltd, a New Zealand company that was previously owned by Perth-based Foodland Associated Ltd (FAL).
This marked the second attempt that Woolworths had tried to enter the New Zealand market.
Progressive Enterprises was capitalised through its Woolworths owner, for its initial expansion, and since 2005 has accumulated 150 supermarkets under three different brands- 70 under Countdown; 52 under Woolworths and 28 under Foodtown.
After extensive surveys and testing the Foodtown and Woolworths brands are to be gradually phased out and replaced by a revitalized, new generation Countdown brand.

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The re-branding, will take up to five years and will see the company's stores receive a new modern identity.
The new logo - which also replaces the current Countdown identity – is meant to symbolise a new beginning for the New Zealand supermarket business.
The Countdown brand was chosen, rather than Foodtown or Woolworths, due to its popularity with customers and the geographically wide spread across the whole of New Zealand.
Part of the new beginning involves the incorporation of a pharmacy within each new generation Countdown supermarket.
Countdown Managing Director, Dave Chambers, said:

 “Countdown Pharmacy was an exciting new venture for the company, and would be a natural extension to the great range of health and beauty products that our customers are increasingly buying.
“Countdown Pharmacy has been developed to bring customers the convenience and value of Countdown supermarkets to a pharmacy offering. Each Countdown Pharmacy will be operated by trained and registered professional pharmacists.
"Our customers have already embraced the concept of buying health and medical products in supermarkets, so the move to offer prescription and pharmacy-only products is another way we’re offering that one-stop-shop in a retail environment," Mr Chambers said.

There are currently plans to launch Countdown Pharmacy at two supermarkets in 2012 subject to regulatory approvals. The stores include the new Countdown in Newtown, Wellington and Countdown Rangitikei Street, Palmerston North. There are plans for more Countdown Pharmacies to open in other stores in the coming year and $1 billion has been allocated for Countdown over the next five years

Newton CD with logo

This artist's impression is of Countdown Newtown, a flagship store planned for Adelaide Road in Wellington. The 4400 sqm store will feature an enhanced design suitable for this important Wellington site

Countdown Pharmacy Business Manager Jeremy Armes said the full-service pharmacy model will be operated as a ’store within a store’ by a full-time pharmacist, featuring a private consultation room and a full range of prescription and pharmacy-only medicines.

"We’re anticipating having our Countdown Pharmacies open in-line with extended supermarket hours, with 9am to 8pm, seven days a week as a minimum. Supermarkets are central to communities across New Zealand and with people’s lives getting busier, Countdown Pharmacy is in a unique position to offer Kiwi customers convenient trading hours in the safe environment of a supermarket," said Mr Armes.

Countdown will leverage its buying and distribution skills to deliver leading medicine brands at low prices to kiwi households. Mr Armes said Countdown Pharmacy would also deliver increased competition in the New Zealand pharmacy market. "As a retail provider, we work hard to reduce costs and provide value for our customers, and Countdown Pharmacy won’t be any different," Mr Armes said.
Also, there are no location rules and pharmacies may set up in or adjacent to doctor surgeries or within supermarkets. 
As Countdown pharmacies are set up it may initially displace other pharmacy operators in the local area because of a net increase in pharmacy numbers and a concentration of some pharmacy sales in the Countdown environment.

As a management consultant I have been personally involved in a variation of the NZ model here in Australia.
That particular business model was located within a K-Mart environment in western Sydney. It had a noticeably low prescription count segmented into oral contraceptives, chronic treatment drugs e.g. digoxin, and practically no acute care drugs.
Within the K-Mart store it was geographically located in the centre and had no direct street access.
It was also characterised by not having a seated waiting area for patients.
All customers/patients had to exit through the K-Mart checkouts and the pharmacy lease had clauses restraining the sale of various products and sizes of products that were possibly invalid under the Trade Practices Act, but not tested at that time.
I advised my client that under those existing conditions there was no real future for a pharmacy in a K-Mart environment.
It will be interesting to see whether Countdown pharmacies will have a separate street access as I believe that factor will be important in terms of attracting overall scripts and the content of prescriptions (higher acute care drugs). It will also need a seated waiting area, and it has already advised that a private interview room will form part of the pharmacy.

Under NZ legislation a registered pharmacists my own a majority share of up to five pharmacies (as a sole trader or incorporated). Countdown has had at least seven years to take advantage, but has taken its time because of obvious complexities of management involved.
The rules also say that a non-pharmacist such as Countdown can own up to 49% of a pharmacy without restriction on the number of pharmacies.
However, if the non-pharmacist is the landlord or someone who holds an agreement to manage the business, problems may intrude for the pharmacist irrespective of what voting shares are held.
Further pharmacist restrictions may also occur in the ownership of fixtures and fittings leases and ownership of stock.
Care will need to be exercised as to how future funds will be recruited for the pharmacies given that traditional wholesalers will not be involved in guarantees, leaving Woolworths as maybe the only guarantor through one of their many finance alliances.
Pharmacists could find themselves in a complex legal battle depending on what agreements have been signed.
But apart from all the potential hazards of a Woolworths domination in all areas of activity, the model could work very well if all providers of products and services were truly independent of each other.

At the very least the lease of the area occupied should be free and uncluttered of any restraints on stock held, stock sizes or waive any rights that are contained in legislation involving trade practices.
A shareholders agreement needs to be in place to protect who can enter or leave through disposal/acquisition of shares.
A Service Agreement should delineate how the pharmacy will operate in the Countdown environment.
For example, one irritating occurrence that happened regularly in the K-Mart model was that managers and senior staff continually harassed the pharmacy management and their staff in terms of display space. As there were no visible boundaries, you often ended up with a K-Mart stock promotion inhibiting the movement of pharmacy patients and customers. Often, there were some very vocally strong conversations.

The advent of Woolworths owning and/or controlling pharmacies in NZ has not stimulated much debate from the Guild down to the coalface, so it seems that the pharmacy model that will be progressively developed is actually embraced.
Compared to the thoughts of Australian pharmacists,(many of whom see the NZ development as a “clinical trial”, providing ammunition and argument for another attempt by Woolworths on the Australian  pharmacy scene once again).

Some idea of where Woolworths will take their NZ pharmacy model can be gleaned from their efforts in Australia between 2003 and 2010 when an attempt for direct pharmacy ownership was in full swing.

A search of the Australian trade marks register identified three trade names for a Woolworths identified trade name:
* Pharmacist @ Woolworths
* Pharmacist at Woolworths
* Woolworths Pharmacy

The first two names were registered in November 2003 and eventually cancelled on the 17 June 2010. Ownership of these names was vested in Woolworths Ltd.

The third name (Woolworths Pharmacy) had registration lodged on the 18 June 2006 and cancelled on the 17 June 2008.
This registration was not in the name of Woolworths and appears to be someone else trying to cash in on the name in some way.

The Woolworths registered names covered the following classes:
Class: 3
Soaps, perfumery, essential oils, cosmetics (including, without limitation, lipsticks, eye make-up, nail polish and false fingernails), deodorants, toiletries, dentifrices, toothpaste, mouthwashes, hair preparations including shampoos and conditioners and hair sprays; sunscreens

Class: 5
Pharmaceutical and medical preparations, pharmaceuticals, vitamins, minerals and/or herbal supplements, sanitary preparations for medical purposes, dietetic substances adapted for medical use, food for babies, plasters, materials for dressings, disinfectants; absorbent sticks and applicators consisting of or predominantly of cotton

Class: 9
Cameras and films in this class; sunglasses and optical frames in this class; electrical apparatus and instruments, batteries

Class: 10
Medical, pharmaceutical and dental products, apparatus and instruments, bandages

Class: 16
Tissues, toilet paper, nappies consisting of or predominantly of paper or paper products; photographic albums and folders in this class, photographs, photograph stands

Class: 35
Wholesale and retail services (including, without limitation, of pharmaceutical and medical products) provided by pharmacists and by way of pharmacies and chemists

Class: 44
Medical and pharmacy advice and services

The range of activities proposed by Woolworths is fairly normal across the spectrum of retail pharmacy activity but extended into wholesaling as well.

The service agreement structured for Countdown pharmacies will probably try to specify exclusive purchasing by the pharmacy of products held by a Countdown wholesaler that may have further extension into manufacturing e.g. generic drugs and OTC private label drug products.
There would be no impediment preventing Woolworths from entering the generic market and generating sales for their trademarked drugs for PBS supply in Australia or through the government agency PHARMAC in New Zealand.

Given the renowned political clout of Woolworths and their now ability to influence and virtually own/control a majority share of the NZ market, how long can Australian pharmacists hold on to control of their market, given all the “hits” that pharmacy has been absorbing through direct supply by manufacturers, and manipulation of the Poisons Schedules, down to the support of free atorvastatin promotions by some pharmacy groups?
Will we see another “harmonisation” experience (as seems to be frequently happening under the TGA radar), through the direct importation of the NZ model to Australia?
All Woolworths branded or manufactured drugs are already “harmonised” to flow to Australia without restriction.

Ironically, Woolworths in New Zealand may eventually dominate drug distribution and the prices paid by government for any subsidised scheme.
The Australian government should therefore consider playing fair with Australian wholesalers by supporting their claim for all drug suppliers to the PBS to come under the CSO agreement otherwise drug prices here in Australia will begin to rise.

Politicians should not rely on a future Woolworths ability to keep pressure on Australian prices downwards.
That is not their history.

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