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Wednesday, 23 November 2011
Page: 13573


Ms ROXON (GellibrandMinister for Health and Ageing) (12:01): I move:

That this bill be now read a second time.

The National Health Amendment (Fifth Community Pharmacy Agreement Initiatives) Bill 2011 will amend the National Health Act 1953 to implement two key initiatives in the Fifth Community Pharmacy Agreement.

These initiatives represent another important step in improving services for Australian health consumers, and will bring pharmacists even closer to the centre of the Gillard Labor government's health reform agenda.

A pillar of these reforms is the $15.4 billion, five-year Fifth Community Pharmacy Agreement, particularly the clear role within it for pharmacists to improve professional practice and patient care.

The initiatives implemented by the bill, Supply and Pharmaceutical Benefits Scheme Claiming from a Medication Chart in Residential Aged Care Facilities and Continued Dispensing of Pharmaceutical Benefits Scheme Medicines in Defined Circumstances, introduce more patient focused health services that will deliver better health outcomes.

In addition, the bill includes technical changes for prescribing certain quantities of pharmaceuticals.

The Fifth Community Pharmacy Agreement between the Australian government and the Pharmacy Guild of Australia was entered into on 1 July 2010.

Through the fifth agreement the Australian government has committed to ensuring that fair and adequate remuneration is provided to approved pharmacists for the supply of pharmaceutical benefits. This creates and maintains a stable environment for community pharmacy to remain viable and participate in delivering better care for all Australians.

Importantly, the fifth agreement also directly provides positive health outcomes for the Australian community through the efficient delivery of professional services and targeted community programs.

The two initiatives within this bill are scheduled to be implemented at the Commonwealth level by 1 July 2012. Amendments to state and territory government legislation will also be required to support the implementation of these initiatives and it is anticipated that this will occur through a staged progression of changes within the various jurisdictional frameworks.

They have both been the subject of wider consultation with consumer representatives, interested parties and professional organisations such as the Pharmaceutical Society of Australia and the Consumers Health Forum.

The government thanks all parties for their important input, particularly the Pharmaceutical Society, which helped to draft the protocols that will guide the continued dispensing initiative, should it be passed. This input is an example of the more inclusive nature of the fifth agreement, which is helping to ensure health consumers are the biggest beneficiaries.

Medication c harts

The Supply and Pharmaceutical Benefits Scheme Claiming from a Medication Chart in Residential Aged Care Facilities initiative will introduce the supply and claiming of PBS medicines, by approved suppliers under the National Health Act 1953, from an approved medication chart within residential aged-care facilities.

This initiative will allow the medication chart to be used in place of the PBS prescription form. This will eliminate the requirement for prescribers to write a separate PBS prescription as well as having to write on a medication chart. A pharmacist will be able to use this medication chart when supplying and claiming medicines for residents of aged-care facilities.

Medications included on the Repatriation Pharmaceutical Benefits Scheme will also be able to be prescribed, supplied and claimed in this manner where the person is a resident of an aged-care facility.

Enabling the supply and claiming of PBS medicines from a medication chart will improve patient safety by reducing risk of transcription error when writing a prescription from a medication chart entry.

A more streamlined process will also mean that more healthcare practitioners re-engage with aged-care facilities. Lessening the administrative burden on prescribers through the removal of administrative processes will allow more time to be spent on clinical care. Feedback received by the government indicated that the necessity for a prescriber to write the medication order on a prescription, as well as on a medication chart, makes some general practitioners reluctant to provide services to residents of aged-care facilities.

The medication chart will be designed to encourage prescribers to review the chart in its entirety each time a medicine is ordered. This will result in quality use of medicine benefits and ensure the resident gets the right medication at the right time.

This initiative will also address issues faced by prescribers, pharmacies and aged-care facilities regarding the ordering or prescribing, supply and PBS claiming of medicines within aged-care facilities, and improve the timeliness of medicine supply.

Pharmacies will be provided with timely notice of updates and changes to a resident's medication regimen, ensuring that the prescriber's most recent intentions for the resident's clinical care are promptly acted on.

The initiative will be supported by the development of a nationally standardised chart that incorporates all the necessary information to allow for the prescribing, supply and claiming of PBS medicines from the medication chart. Importantly the chart will also enable aged-care facility staff, such as nurses, to record administration of treatment to residents as well as act as a complete record of the resident's medication needs.

As part of the development of the initiative, standard fields for inclusion on a medication chart that can be utilised in electronic format will be developed. This will enable the chart to interface with other new initiatives being developed in the e-health space such as the personally controlled electronic health record.

Continued d ispensing

The second initiative to be enabled by this bill is the continued dispensing of PBS medicines in defined circumstances. This initiative will provide an additional mechanism for patients to access certain PBS medicines where a valid prescription is unavailable. The PBS is an Australian government initiative that provides affordable access for all Australian residents to effective and cost-effective medicines. Under part V (21)(1) of the National Health (Pharmaceutical Benefits) Regulations 1960, a pharmacist must not supply or claim for a pharmaceutical benefit unless the prescription is written in accordance with these regulations. The requirement for a written prescription is also included in respective state and territory legislation.

This can create problems when consumers are in need of a prescription medicine but have run out of the prescription, lost it, or are not able to see a GP. Currently, both Commonwealth and state and territory legislation require that a medicine will only be supplied on presentation of a prescription.

In an urgent case, a prescriber may communicate a prescription to a pharmacist personally by telephone or other means. The prescriber is then obliged to supply a PBS prescription, known as an 'owing' prescription, to the pharmacist within seven days.

Where it is not possible to contact the prescriber, most state or territory legislation allows for an 'emergency supply' of medicines without a prescription. The quantity supplied is generally limited to no more than that required for three days treatment or the smallest standard pack in which certain medication forms, for example liquids, are contained. PBS subsidies do not apply in the case of emergency supply and so the patient is required to pay the full price of the medicine.

This initiative will ensure optimal health outcomes for patients.

For consumers taking medication for the treatment of certain chronic conditions it means that their treatment will not be interrupted should they, for example, not be able to synchronise their medical appointments with their medication requirements. Patients will not bear the financial burden of paying the full cost of the medication, as is currently the case for 'emergency supply' situations.

From commencement, oral hormonal contraceptives, or the pill, for systemic use and lipid modifying agents, specifically the HMG CoA reductase inhibitors as listed in the Schedule of Pharmaceutical Benefits are in scope for this initiative. These two therapeutic groups have been chosen on the basis that they are relatively well tolerated medicines with a very good safety profile.

Professional protocols by the community pharmacist will apply, so that quality and patient safety will not be compromised. These protocols will assist the pharmacist in ensuring that a person on a stable medicine regimen is being given ongoing medication through the application of the quality use of medicines principles.

The protocol is expected to include how continued dispensing interacts with already existing emergency supply arrangements; a mandatory feedback loop to the prescriber that continued dispensing has occurred; communication to the patient about the medicines dispensed under this initiative, including the importance of regular review by the prescriber; and the limited and selective availability of supply under this initiative.

The continued dispensing initiative will introduce efficiencies for pharmacists and prescribers, lessening the administrative burden of having to chase 'owing prescriptions' and decreasing the wastage that occurs when an original pack of medication has to be broken to adhere to the limited emergency supply provisions under the current state or territory legislation.

The initiative will be implemented in the community pharmacy setting only.

A review will be conducted of this initiative two years following its implementation to assess the suitability and appropriateness of the current therapeutic categories as well as the impact the initiative has had on patient access to medicines.

Technical amendments

The technical changes proposed in the bill for prescribing certain quantities of pharmaceutical benefits are intended to enhance current policy, for example, by expanding use of the streamlined 'authority required' process. This continues the government's commitment to its 2010 policy, in accordance with requests from prescribers, for expansion of the criteria for streamlining 'authority required' medicines.

The bill also enhances current arrangements by providing for determination of rules about increasing prescribed quantities for some medicines. The binding rules would be consistent with current guidelines in the Schedule of Pharmaceutical Benefits.

Conclusion

The $15.4 billion, five-year Fifth Community Pharmacy Agreement is a central pillar of our health reform agenda.

Community pharmacists are a vital part of our primary healthcare system. They play an important role in the health care of their local communities, they are experts in medicines, and they are visited more often than GPs.

The initiatives contained within this bill are just two ways in which the Gillard Laborgovernment is supporting community pharmacy to provide better quality health outcomes to all Australians.

I commend the bill to the House.

Debate adjourned.