There has been significant political banter and spin regarding the pros and cons of the federal government's 60-day double dispensing proposal.
It is a foregone conclusion that the scheme is acceptable from a medical standpoint, as medical advisors and the media have readily publicised. However, the question remains as to whether it makes sense financially.
Pharmacies would like you to believe that many will miss out, and that the concept is flawed with inequity. The government is leading us to believe that everyone will save, and no pharmacy or patient will be worse off.
The question is, where does the truth end and the political spin begin?
The following case studies may help our understanding of the financial distribution and impact of the proposal.
Patient One: a 45-year-old male electrician works in the coal mines. Patient One takes three medications a month that currently cost him $90 and $180 over two months. Under 60-day double dispensing, Patient One will now pay $90 for two months with no additional expenses. Patient One saves $540 a year.
Patient Two: a 75-year-old widow taking six medications a month. She has begun to lose her vision, so she cannot drive and has her medications put in a Webster-pak by her local pharmacy. She pays $522.80 a year for her medications as she hits the safety net threshold, and $5 a week ($260 a year) to have her medications packed (the true cost of which has been calculated at $20 a week). She will now, however, pay $15 for her pack and $5 for her delivery. Patient Two will now pay $1562.80 a year, an extra $780 (government caps on funding for Webster packed medications result in each pharmacy packing considerably more than they are actually paid for).
For decades, prescriptions have been the income stream from which free services at pharmacies are funded. When an efficiently run primary health outlet such as a pharmacy is stripped of 30 per cent of its income, income that has always provided services to those most in need, who will be most affected? Those who use the services: the elderly, rural and regional communities, those with mobility issues, those on low incomes and any Australian young or old who has ever walked into their community pharmacy with the expectation of receiving free medical advice.
So, who is this policy trying to help? Do general patients deserve to be the primary benefactors of 60-day double dispensing, when it means that concession and pensioner patients on many medications will pay more on the defunding of services? If the government is to help everyday Australians with increased costs of living, why is every Australian not being treated equally? Our votes are equal, why is our health not?
In January 2023, the PBS co-payment for medicines was reduced from $42.50 to $30 for general patients, but increased from $6.80 to $7.30 for concession patients. This immediately conferred savings to the entire general population, while increasing costs for the concessional population. This disparity looks to widen further under 60-day dispensing with many concession patients who reach the safety net unlikely to save at all. These are the people who most need the services provided by pharmacies.
From 2020 up until this point, community pharmacies have been praised and supported for their valuable role in patient care outside the doctors' rooms during COVID-19. Pharmacies stood proud, if not fearfully, with open doors and soon transformed into free health information hubs for every community across the country.
How can it be that the savings given to some patients are being taken directly from the pool of funds being used to offer free services to those who have the least and need help the most? This is a pivotal moment where the pharmacy sector is being forced into a user-pays model where those without will go without. It will widen that ever-increasing gap between the haves and have-nots.
Is this policy helping everyday Australians struggling with the rising cost of living? Or could it be a very clever political ploy to wrap up a 30 per cent cut to a primary health sector in a palatable way for the everyday voting Australian?
It looks like the spin is going to win.
Sarah Twohill is a career pharmacist of 14 years who works four days a week in Swansea. She does not own a pharmacy and is not affiliated with any group.
