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Thursday, 1 March 2012
Page: 1383


Senator EGGLESTON (Western Australia) (13:11): I am interested in this legislation, having been a medical general practitioner for a long time. The National Health Amendment (Fifth Community Pharmacy Agreement) Bill 2012 contains the continued dispensing initiative, as Senator Connie Fierravanti-Wells has just said, and the medication chart initiative, as included in the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild of Australia. As has also been said, the bill makes amendments to conditions for authority required, or S4, medications. These tend to be very expensive medications for which the government sets specific preconditions for their provision under the Pharmaceutical Benefits Scheme at a lower price than their real price. I think it is probably a good thing that there are these amendments to authority for S4 medications.

The coalition in the past have provided policy certainty and stability for community pharmacies and we support in principle the fifth agreement, but there are some issues which arise from this bill. One of the more controversial ones is the continued dispensing provision, which will allow pharmacists to provide pharmaceuticals without a prescription at all. It has not been specified what the eligible pharmaceutical items are and what conditions apply to the facility allowing pharmacists to provide pharmaceutical items without prescription. However, the government has indicated that the provisions will apply to two well-tolerated medications: oral contraceptives and cholesterol-lowering drugs. I suppose it is very important at times for people to be able to obtain a resupply of their oral contraceptives without a prescription, and cholesterol-lowering drugs are now very commonly used, as many people in our society have problems with cholesterol and it is important for them to be able to continue their treatment if they have high cholesterol. This provision will certainly assist this to occur, but we believe there is a need for clear conditions and protocols for the provision of medications without prescription because, as always, issues of patient safety have to be considered. The department's consultation paper does provide conditions and protocols for the operation of this practice, which is known as continued dispensing. Among the conditions and protocols are the following. Firstly, continued dispensing will apply where a patient has run out or is about to run out of an essential continuous therapy medicine and does not have a valid prescription available. Secondly, the patient must be able to demonstrate that they have been prescribed the medicine for at least a six-month period and that they have been taking the medicine prior to their seeking a further supply without prescription. I suppose that this implies that the patient is going back to the same pharmacy from which they have received their medication in the past and that the chemist can verify from their own records that the patient is on this medication and then supply an ongoing amount of the medication or, if the person happens to be in a location away from their home town or suburb, ring the chemist which usually supplies the medications. I think that that is a very good provision because it means that, if people travel and have not brought a repeat prescription with them but do need ongoing medication, they will be able to get it. That is a very practical measure.

There are certain categories of drugs which are supplied on authority only, and these are often very expensive or very powerful drugs. Supply of increased maximum quantities of an authority drug will not be permitted. I think that that is a very serious sensible provision also. It means that the supply will be limited to what is on the prescription for a six-month period, which is usually the period for a prescription, and that patients will not overdose on authority approval medications because they will have to go back through a doctor to get a new authority prescription in order to have access to authority drugs. These drugs are often very expensive to the government to provide even though they are supplied to the patients at the price of a usual prescription. The provision also means that people will not be able to come back repeatedly and seek to have medications supplied without prescription but will have to go back to their medical practitioner in the interim and obtain a new prescription. It is a very sensible provision also because it means that people will be reassessed by their doctors, which reduces the possibility of patients overdosing on medications through being able to access drugs without having a medical practitioner reassess them.

The AMA, I believe, has some reservations about these proposals, but I understand that the department has advised that the dispensing pharmacist must provide written communication to the most recent prescriber advising that he or she has supplied the medicines to the consumer within 24 hours of having done so. That provides some protection of the patient by the responsible professionals in that the patient's GP, consultant physician or surgeon will know that they have received additional quantities of these medications and, if the doctor concerned thinks that that is not appropriate, they can call the patient and say, 'I think you'd better come in and have a talk about this, and we'll work out what you need,' and can counsel the patient about not obtaining drugs without prescriptions lest they develop side effects and do themselves harm.

The second initiative in the bill allows for the supplying and claiming of pharmaceuticals on the basis of a standard medical chart in residential aged-care facilities. I think that that is a very good idea, and it is widely supported because it is expected to reduce the administrative burden in aged-care facilities and to improve patient safety. It means that patients in aged-care facilities will be able to have an ongoing supply of their medication according to what their standard medical chart says they are eligible for and should be receiving. The Australian Commission on Safety and Quality in Health Care has commenced the development of these standardised charts, and I understand that they will be consulting further on it during the coming year.

I have been informed that the coalition supports the bill but is proposing some amendments to ensure that the government meets its stated commitments, that the objectives of the bill are realised and that patient care is maintained within ethical boundaries. We have heard that the legislation will be reviewed after two years, when PBS statistics are available. This will provide a lot of insight into how the continued dispensing provisions are working, although this fact is not referred to in the legislation. I think that these provisions mean in general that people who need medications will be able to obtain them when they are in situations where they have run out of their medications, that their treatment will continue and that they will not be disadvantaged by having travelled to distant places and found that they do not have the medication which they need. For example, the legislation could be applicable to the circumstances of people with quite serious conditions such as high blood pressure—the half-life of the medication for which in the person's body is fairly short—where once the medication has been metabolised its effect is no longer there and the person's blood pressure goes up again, a fact which might have undesirable consequences.

Overall, I think that this legislation contains a sensible set of provisions; but I hope that it is carefully monitored, especially during its early years.

Question agreed to.

Bill read a second time.