s HMR Moratorium – Killing Jobs in Pharmacy | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

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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News Flash

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

Comments: 1

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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
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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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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HMR Moratorium – Killing Jobs in Pharmacy

Joseph Conway

articles by this author...

Joe Conway is an Irish born pharmacist who qualified in the UK in 1998.
After completing a residency in a hospital in London, he embarked on a 3 year locum stint that involved working all over the UK, Ireland, and Australia in over 350 pharmacies of all varieties (hospitals large and small, community, even a prison pharmacy).In 2002, Joe emigrated to Australia and worked in the Private Hospital sector gradually moving in to management positions with Slade Pharmacy where he developed a keen interest in Oncology services. In 2006, Joe took up a position setting up a Pharmacy service to a newly built Day Hospital in Frankston, Victoria. The Pharmacy now conducts over 40 clinical trials.
Joe is currently studying for a Master of Biostatistics to help him progress in the area of clinical trials, and think outside the square (or at least be left-field).

It’s no secret that the Pharmacy Guild has called for a moratorium on HMRs until the alleged abuse of a tiny minority of Independent Pharmacists potentially rorting the system is investigated and the system is changed to reduce the possibility of such rorting.
They say that this is necessary as the budget for HMR’s has been overrun and any potential rorting could put the viability of future pharmacy-centric programs at risk too.
The Guild want payments stopped so that the business rules behind HMR’s are “tightened” to stop this apparent rorting.
If there is actually rorting going on, then I think that it’s in all pharmacists’ interest to “fix” this issue.
I for one have nothing against tightening the rules to stop pharmacists “Warehousing” HMRs?
This is great.

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What I have an issue with is the method of choice by the Pharmacy Guild to deal with this as yet unproven rorting of the system.
It’s like blowing up a house because one room has might have mould in it?
I think that this action has jeopardized the futures of all Independent Pharmacists whose income source has now dried up and could strengthen the positions of the Members of the Guild – Pharmacy Business Owners who can still claim for pharmacy-centric services such as Medscheck.
This could reduce the overall pie for pharmacist positions and ultimately may end with more pharmacist under-employment and even pharmacist unemployment as current HMR pharmacists get disenfranchised with doing HMR’s , return to dispensing more often as at least the Guild is not going to call for any moratoriums that would directly affect its members. This may leave fewer positions in Community pharmacies for future pharmacist graduates.

Is the Budget for HMR’s sufficient?

I think that HMR’s were underfunded in the 5CPA.
Across the five years of the 5CPA, a mere $52.11 million was allocated for HMRs.
Compare this relatively small HMR pool amount to the Rural Pharmacy Maintenance allowance ($70 mill), PPI and accreditation payments to owners ($75 mill), clinical interventions ($97mill), DAAs ($137 mill), Guild admin fee 1%? ($150 million over 5 years).
I have roughly estimated that in the 2012/13 financial year, Community pharmacy owners stand to gain $235 million from the price difference on Atorvastatin alone (See Appendix).
The approximate $10.42 million allocated for HMRs in the 2012/13 financial year is chickenfeed compared to the money made from generic discounts on drugs such as Atorvastin, Pantoprazole, Rabeprazole, Clopidogrel, Olanzapine, Quetipine, etc...
Money could have been transferred from other areas to make HMR’s work if the Guild really wanted them to?
The HMR represents a tiny part of the overall PBS spend and according to many it more than pays for itself and is money better spent on improving patients health than other money spent on PBS.
Drugs get listed according to the strict criteria of Clinical trials.
However, when a drug gets listed, there can be a form of “creep” where drugs get used on patients not quite fitting the strict criteria in clinical trials and potentially may not work as well. Where is the quality assurance to help reduce “Creep”?
I think that HMR’s should be integral to ensuring that PBS-subsidized medication is utilized properly. Considering that the PBS costs taxpayers around $9-10 Billion (not a fixed amount) approximately per year a small percentage saving is a high dollar value.
If widespread HMR’s resulted in a 1% saving to the total PBS spend, that would represent a saving of $100 million.
The current HMR budget is $52.11/5year = $10.42 million per year.
If this was increased to say $30 million a year, and there was a confirmed 1% saving to the PBS budget, taxpayers would be still ahead in their investment in pharmacists.
This could also provide jobs for pharmacists as experienced pharmacists would have an inducement to provide HMR’s and the dispensary jobs that they vacate would provide jobs for early career pharmacists who would be a viable avenue for career progression in the field of Clinical pharmacy in the Community. The pie for pharmacist jobs would be increased? Also, your success in this area would be more reliant on your ability to write decent HMRs than your business acumen and personal wealth.

Do HMRs really need to be done in patient’s home?

Not always I think.
What if a patient has a history of deviant sexual behaviour or violence?
Some people may feel uncomfortable with a pharmacist entering their house and are capable of bringing a bag with their medication to a neutral place – often a Pharmacy or a Doctor’s surgery. Sometimes, we have to trust the power of the individual to want to help themselves. I think that a new type of review may need to be developed for patients who are not covered under HMR’s and RMMR’s. Maybe HMR’s need to be renamed so that they can be performed outside the home for proscribed reasons…

But the funding from the 5CPA was on behalf of pharmacy Owners?

It has been argued that there is a natural stepwise process from dispensing to HMR’s referral from within the pharmacy. This has dispensing of medication as the core trigger for positive clinical pharmacy interventions into patients’ lives.
Most patients receive their medication at a pharmacy and the dispensing process is the one time that a patient has to come to see a pharmacist.
It appears to be the Guild’s view that this point is integral to identifying potential problem patients and there is a natural stepwise referral system stemming from this to fund pharmacist intervention.
First, there is a Clinical Intervention – a small piece of advice that has a positive contribution to QUM. This works for most people, but if during a clinical intervention, it appears that there might be other problems, then, a Medscheck within the pharmacy can be performed.
If during this Medscheck, further problems are identified and it’s suspected that there might be other medication issues, then the patient is referred to their GP with a recommendation to refer for a HMR where a pharmacist visits the home to provide a more thorough review than a Medscheck.
If a patient has had a HMR during the previous 12 months, then a Medscheck will not be funded by Governmnet.
Pharmacy Owners argue that their process has been compromised by the Direct referral from GPs.
There have been reports of patients signing forms in a Medical Centre and a Medscheck like review performed and claimed as a HMR.
It has been said that such patients barely even remember the review and the pharmacist completing the Medscheck then doesn’t get paid for their service which must surely be infuriating for pharmacy owners.
However, the dispensing process is not the only point for identifying problem patients.
Many patients see their GP and then don’t bother to get their medication dispensed for many reasons. They may not have one set pharmacy. GP’s have much more medical information pertaining to patients that the dispensing pharmacist is not privy to. There has to be a system stemming from the Doctor-Patient visit so that GP’s can refer a patient to an accredited pharmacist for a Medication review.
The problem is to marry the pharmacy centric referral process with the GP referral process.
The HMR moratorium has compromised the GP referral process and isolates us as a profession from the rest of the healthcare team…

Success as an Independent Contractor is dependent of your ability as a Clinical Pharmacist whereas Medchecks don’t have the same inbuilt quality assurance systems:

When a GP refers to a pharmacist for a HMR and gets a “Rubbish” HMR back, then they are less likely to refer to that pharmacist again.
If the Pharmacist does a high quality review, then they will find success.
The GP may refer more patients to that pharmacist and tell his/her GP friends about this HMR pharmacist.
The better you are at reviews, the more success you can get.
Many HMR pharmacists are senior pharmacists with a wealth of experience working at the coalface in a Community Pharmacy or on the wards in a hospital.

Compare this with Medschecks.
These are no substitute for a proper Medical review. In many pharmacies, early career pharmacists are involved in the data collection for these.
There is less quality assurance to ensure the quality of these in-pharmacy reviews and this type of review is something that 80 or 90 percent of pharmacists do anyway.
The Guild has cleverly gotten its members who are owners to benefit rather than providing that extra funding to increase wages and respect for pharmacists.
It’s doesn’t matter whether the GP thinks that a particular Medscheck is useless as they are in no position to determine which pharmacist is doing the review on their patients.
This is a major flaw with the Medscheck system.
If you are good at them, there is little in the system to ensure personal success and the incentive is there to use cheap labour (i.e. Interns and less experienced staff) rather than more expensive experienced pharmacists.
There is a potential conflict of interest in Medschecks too.
An Independent Pharmacy contractor providing an independent of pharmacy review could provide an unbiased recommendation to stop a profitable drug like Atorvastatin generic whilst with a Medscheck review, there may be more incentive to keep a patient on the profitable Atorvastatin and instead try to upsell the patient something like Co enzyme Q10.
Is this best for patients?
Medschecks have flaws in their design too I think.

Another way to deal with potential rogue operators? 

Did the Guild really need to call for HMR moratorium?
I don’t see why the Guild feels the need to “Save” Independent contractors from themselves.
This appears as if someone in a backroom somewhere (in a Guild office) has made the decision that they know what is best for the HMR direct referral industry.
I think that someone thinking that they know what’s best for another group of people (i.e. saving people from themselves) is bad policy.
Individuals are capable of making their own choices and taking the consequences of such actions. Couldn’t the rest of the profession have been notified through an appropriate medium (e.g. APLF) to deal with a potential problem facing pharmacy?
The Guild could have led from the front.
If this is truly what they intended why then is the Guild not calling for an audit of the program?
It would be easy to develop a list of HMR providers who have recently been performing significantly more medication reviews than the average and are performing them outside of patients' homes (assuming they aren't lying on the claim forms as well).
They could, at the same time product a list of doctors who are claiming for HMRs above average, since the review must be initiated by a GP.
The data is there for this to be done but perhaps the Guild would prefer not to do this.
If the Guild produced this data and showed it to the rest of pharmacy, they could have led from the front to fix this problem if it exists. Instead of leadership, we got a bad decision inflicted onto the rest of the profession which could compromise future independent pharmacist job prospects…

Why weren’t Independent HMR providers allowed to be full members of the Guild?

These people were pharmacy businesses just like any other pharmacy business in Australia.
From afar, I see it as madness that such pharmacist business people weren’t allowed to be full members of the PGA.
There would have been a mutual benefit.
Independent Pharmacist practitioners have to abide by business rules and the Guild could have provided a platform and products for them to do this.
Also, with ever increasing numbers of graduates, the Guild is going to represent an ever decreasing percentage of total pharmacists in the coming years.
This has to reduce the political clout of the Guild and increase the power of the PSA.
Moving forward, the Guild will have to bow down more often to the wills of the PSA and in time the PSA could be seen as more representative of pharmacy by Government.
Allowing Independent Contractors to become full Guild members would have helped alleviate the creeping power of the PSA relative to the Guild and maintain the PGA political stronghold on pharmacy. There are many pharmacy businesses in Australia who don’t want to become a “Crazy Clerks Chemist”. They can’t.
You can’t have 5,500 Discount Chemists in Australia.
Many current Pharmacy Owners (with years of business knowledge) could have seen independent contracted pharmacy reviews in Medical Centres as a viable future business and in time a significant proportion of the patients consuming PBS subsidized medication could have yearly reviews.
This would have provided jobs and opportunities in pharmacy pharmacists who wonder what they will do when most of dispensing becomes increasingly automated.
The action of the Guild recklessly calling for a HMR moratorium which might have significantly compromised these pharmacist businesses and makes the likelihood of Independent Pharmacist operators becoming full Guild members even more remote. Is this a missed opportunity for the PGA?

What to do now?

I think that the data needs to be produced to prove that there are rogue operators.
We live in a Capitalist society and ultimately we need some innovation on the ground in order to find the best methods of delivering patient review in the Community.
Everything cannot be controlled if we are to get the best solutions.
We need the proof if it exists that HMR’s help to reduce the overall PBS spend.
We need proof that a Government investment in this program more than pays for itself.
The days of sitting in a dispensary and converting people to the most profitable brand of a medication and being paid generously to do this are coming to an end with price disclosure.
We as a profession need to plan for an age when dispensing is not as lucrative as it once was.
To do this, we need to change.
Change is scary as there is always a risk that you will fail. However, if you fail to change and wait too long, then you may fail anyway.
I think that it’s essential that all pharmacy organisations work together to get HMR’s funded as soon as possible and hopefully before the end of February 2013.
Any longer than this and the future prospects of Pharmacists working collaboratively in the area of pharmacy reviews will have taken a fatal hit and there will be fewer jobs for pharmacists in the future than there otherwise would have been…

Appendix: How I conservatively calculated that Australians are paying $235 million extra for Atorvastatin ($42,000 per pharmacy) in the 2012/13 financial year:

I would say that the average pharmacy in the current system could make $42,000 in difference between the price paid for Atorvastatin by the pharmacy and price used to pay us by Medicare for the current financial year. How I estimate this:

There were about 10.8 million scripts for Atorvastatin dispensed last financial year according to PBS stats.

If you assume that this will decrease by 10% in the 12 months from July 2012 (due to increased Crestor usage?), this might become about 9.82 million scripts for the current financial year.

Let’s assume that the average script costs approximately the average of a 40mg and a 20mg (pretty sure figure would be closer to 40mg though).

Assume price for July-November 2012 (5 months) inclusive is ($55+$39)/2 = $47 per script approx.

Assume price for December-June 2013 (7 months) inclusive is ($41.60+$29.55)/2 = $35.58 per script approx.

Number of scripts dispensed from July-Nov 12 = 9,800,000X(5/12) = 4.08million scripts

Number of scripts dispensed from Dec 12 to June 13 =9.8-4.08 = 5.72million scripts

Assume average substitution rate across all pharmacies is 70% to pharmacy preferred generic brand

Assume average discount of 85% off list price at time of supply for pharmacy preferred brand. Any pharmacy can assess Ranbaxy 90%++ discounts, but the pharmacy buying process has inefficiencies I think.

Actual discount when substitution rate factored in = 70% of 85% = 0.7X0.85 = 0.595 = 59.5%. Pharmacies are paying 100% for Lipitor brand.

Apply this % to list price for the two periods

July-Nov12 = $47 X0.595 = $27.97 difference per Atorvastatin script in price between average paid by pharmacy and average list price (not including dispensing fees and mark-up)

Dec12-June13 = $35.58X0.595 = $21.18 difference in price between average paid by pharmacy and average list price (not including dispensing fees and mark-up)

Multiple each by predicted number of scripts dispensed in each period

July-Nov12 = $27.97X4,080,000 scripts = $114,117,600 difference between what pharmacy pays and claims

Dec12-June13 = $21.18X5,720,000 = $121,149,600 difference between what pharmacy pays and claims

Add these two together to get a total figure

$114,117,600 + $121,149,600 = $235,267,200 difference between what pharmacy pays and claims predicted for current year

Divide this figure by about 5,600 pharmacies

$235,267,200/5,600 = $42,012 per pharmacy conservative estimate. The average pharmacy is pocketing a difference of $42,000 on Atorvastatin alone – not insignificant. That’s $800 per week alone in price difference on one drug. If the effective discount was 90% as in NZ, then you can see that Australians are spending a lot of money on this drug alone.

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