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Thursday, 1 March 2012
Page: 1381


Senator FIERRAVANTI-WELLS (New South Wales) (13:03): The bill contains the continued dispensing initiative and the medication chart initiative, as included in the Fifth Community Pharmacy Agreement between the Commonwealth and the Pharmacy Guild. It also makes amendments to conditions for authority required medications. The most recent pharmacy agreement, signed in 2010, will provide $15.4 billion over a five-year period for community pharmacy.

The coalition provided policy certainty and stability for community pharmacy when it was in government, and the coalition supports, in principle, the fifth agreement, but will consider all legislative changes presented to parliament.

The continued dispensing provision will allow pharmacists to supply pharmaceuticals without a prescription. The eligible pharmaceutical items and the conditions of supply are not specified in the bill, and will be determined by legislative instrument. It was stated in the department's consultation paper and the previous health minister's second reading speech that the measure will apply to oral hormonal contraceptives and lipid modifying agents—cholesterol-lowering drugs. These groups were chosen because they are claimed to be well-tolerated and have a good safety profile.

The consultation paper provides conditions and parameters for the operation of continued dispensing including: 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; or where the patient must be able to demonstrate that they have been prescribed the medicine for at least six months, and that they have been taking the medicine immediately prior; or supply of increased maximum quantities based on an authority approval will not be permitted where supply cannot be utilised for consecutive occasions and there can be no switching of medicines within the same class. The department has clarified that patients must not have received the medicine by continued dispensing within the last 12 months. The department also states that the pharmacist must provide, within 24 hours, written communication to the most recent prescriber advising of the supply of the medicine to the consumer.

The targeting of this provision to two well-tolerated medications, in combination with clear conditions and protocols, should assist in addressing any issues regarding patient safety. The coalition is concerned, however, that this detail is not in the legislation. While it would be preferable to have a copy of the draft legislative instruments, the office of the Minister for Health has confirmed that details of the consultation paper, including the pharmaceutical groups affected, will be specified in the instruments to be tabled. Any future changes to eligible pharmaceuticals and conditions would have to be done by legislative instrument and would therefore be subject to parliamentary scrutiny and disallowance. The coalition will carefully consider any future changes in close consultation with all stakeholders, including the medical profession.

The proposed continued dispensing initiative is intended to complement existing emergency supply provisions. Former health minister Nicola Roxon gave an undertaking that a review would be conducted after two years. PBS statistics that are published annually should also contain information on the continued dispensing provisions. This is not reflected in the legislation. This is a government that does not have a good history on keeping to its word; hence, the coalition proposed amendments in the House, which I am pleased to say have been supported, to ensure the government meets its commitments. The coalition's amend­ments are consistent with the government's stated intent and will be facilitated by recording requirements contained in the guidelines for pharmacists for continued dispensing.

More broadly, the Rudd-Gillard Labor government's actions on pharmaceutical policy have seriously jeopardised timely access to subsidised medicines for Australian patients. Until last year, a health minister could list medicines costing less than $10 million in a given year on the Pharmaceutical Benefits Scheme. Cabinet considered medicines over $10 million. Almost without exception, previous governments listed according to the advice of the independent Pharmaceutical Benefits Advisory Committee.

In February 2011 the government indefinitely deferred the listing of seven new medicines and a vaccine recommended by the PBAC due to the Commonwealth's 'fiscal circumstances'. This occurred just months after Minister Roxon had signed a memorandum of understanding with Medicines Australia to provide policy stability in return for $1.9 billion in savings to the PBS. Minister Roxon promised that the MOU would provide 'policy predictability to the industry for the next four years, cut red tape and speed up the addition of new medicines to the PBS'. The government eventually agreed in September last year to list medicines deferred in February However, the government's announcement did not provide any greater certainty for the PBS listing process and in the process caused a lot of angst for a lot of patients. That was very clear from the Senate inquiry into those deferrals. We received some very telling and poignant evidence in Melbourne to that effect.

The Gillard government on 30 September last year announced that there would be further 'deferrals into the future' for new medicines subsidised through the PBS. It is still not clear which patients will be denied access to their medicines and on what grounds. The uncertainty means companies may reconsider attempting the process to list new medicines in Australia, let alone having the impact on patients that I referred to earlier.

The second initiative in the bill will allow for the supply and claiming of pharmaceuticals based on a standardised medical chart in residential aged-care facilities. This measure has broad support, with the claim it will reduce the administrative burden in aged-care facilities and improve patient safety. The Australian Commission on Safety and Quality in Health Care has commenced development of a standardised chart, and further consultation is due to occur during 2012.

The coalition does not oppose this bill, but our amendments will ensure the govern­ment's commitments will be honoured. The coalition's amendments ensure that a review is conducted of continued dispensing and is publicly available after two years. They will also ensure annual statistics are published on pharmaceutical items supplied under this initiative. The coalition will examine in detail future legislative instruments, particu­larly in relation to continued dispensing, to ensure there is genuine parliamentary scrutiny of this measure. Given that the government agreed to the coalition's amendments in the House, the coalition will not be opposing this bill.