Rural concession card holders may miss out on rapid antigen tests as small town pharmacists are caught between a government scheme that requires upfront investment in stock and wholesalers stipulating large minimum orders.
Under the government’s scheme announced last week, pharmacies have to pay for the tests first before being reimbursed only for the tests they use. Small pharmacies are also increasingly forced to pay for large numbers of orders stipulated by wholesalers.
Robert Smith, sole pharmacist and owner of Merriwa Pharmacy in NSW, said wholesalers were asking for very large-scale minimum orders in the realm of $10,000 worth of stock.
He said it was a lot of risk to carry for rural pharmacies servicing small populations who could become stuck with stock once the market gets flooded with tests.
Joanne Loftus, proprietor and sole pharmacist of Northampton Pharmacy in Western Australia – a town with a population under 1,000 – said the entire wholesaling system seemed to be set up to support larger pharmacies.
“The quantities that they’re wanting you to commit to are just way too big, they’re ridiculous,” she said.
Smith said the risk is exacerbated because the details of who will need them and the numbers of how many he will need to order was unclear.
Although the program is due to commence from 24 January, Smith is looking at delivery in mid-to-late February and is worried about his business not being able to absorb the loss if the government policy changes, “as we’ve seen with government policy changing very frequently”.
Katie Stott is the coordinator of the Rural Pharmacy Network and manages the only pharmacy in the Tasmanian town of Dover, servicing a catchment area of 2-3000, together with her husband Fred Hellqvist. Stott said because of the way the concessional RATs scheme has been set up, itwas likely to create an inequitable situation.
According to Stott, because RATs have not been listed under the pharmaceutical benefits scheme, it is not essential for wholesalers under their community service obligation to ensure timely access to those medicines for all pharmacies in Australia.
A spokesperson from the Pharmacy Guild of Australia told the Guardian that “participation is not compulsory, and pharmacies will make their own decisions to participate subject to their ability to source RAT kits to be able to provide to eligible patients”.
“People work in health professions in rural communities, they live amongst their patients and don’t want to let them down,” said Smith. “They want them to have access but there’s only a certain amount of risk they can carry.”
Stott said “we’ve got concessional patients in our communities and if it’s not possible for us to obtain the stock at a reasonable price, then our communities will miss out because we won’t be able to make it viable”.
She believed “the [Pharmacy] Guild has a role to play in ensuring the rollout is equitable”.
For Loftus, the nearest pharmacy besides hers is 55km away in Geraldton and the need for patients who are eligible for the scheme – including elderly patients and people with comorbidities – to have to travel is “something you don’t want your most vulnerable patients to have to deal with”.
Similarly, for many of Stott’s customers, the drive to the nearest pharmacy would be over an hour and not an option for the elderly. Rural pharmacies also often have limited public transport options available.
A Department of Health spokesperson told Guardian Australia that “specific decisions in respect of stocking, supply and purchasing arrangements (including pricing and terms of trade) are a matter between the pharmacy and the wholesale distributor”.
“The Department of Health has worked closely with the pharmacy profession including the Pharmacy Guild of Australia, the National Pharmaceutical Services Association representing wholesalers, and individual pharmacy banner groups to design and implement the program with a clear focus on ensuring that there are large numbers of pharmacies participating in the program across metro, rural and regional Australia.”
“The commonwealth will work with stakeholders to monitor program uptake in the initial weeks, including access in rural areas,” the spokesperson said.
Stott said “the government is reimbursing all pharmacies at the same rate so obviously if you can get a better deal it makes it more viable to deliver. This favours the banners and large groups”.
There is also concern that those who can afford the bulk deals will be prioritised when it comes to distribution, which is already being seen according to Prof Trent Twomey, the national president of the Pharmacy Guild.
Stott added that small rural pharmacies are “used to this situation … You’re right down the bottom of the chain”.
According to her, the pattern of larger clients being prioritised over smaller rural pharmacies was already occurring at the beginning of the pandemic when numerous rural pharmacies experienced difficulties re-stocking essential PBS medications.
“This is why we have no faith,” she said.
Loftus agreed that rural pharmacies are at “the lower end of the scale all the time”.
“We’ve already got workplace shortages, we’re already high cost of freight, high cost of everything to keep your business running. And it’s all just geared up towards major franchises. I feel as though it’s not about public health,” Loftus said.
