The answer very much depends on who you ask.
Rural access to pharmacies only made up a small portion of the Grattan Institute’s divisive pharmacy report, but it has continued to generate an outsized reaction throughout the sector.
The report, which was published just over one week ago, recommended that the government end the Community Pharmacy Agreement and loosen location and ownership rules.
Doing so would allow non-pharmacists to own pharmacies, and could potentially allow supermarkets to embed pharmacies within stores.
The Grattan pointed to evidence from Norway and Iceland, where a relaxation of pharmacy location rules led to fewer regions without a pharmacy, as justification for their recommendation.
It also contended that there is little evidence that Australia’s location rules have boosted pharmacy access for rural and regional communities.
The argument for deregulation
A research paper published in the Australian Journal of Rural Health in March looked at community pharmacy density across the country.
In general, pharmacy density across rural, remote, and regional areas tended to be higher than metropolitan areas.
While this finding “ostensibly suggests that Australia has prioritised remote/rural/regional people’s needs”, the researchers wrote, this did not stand up to further scrutiny.
Counting just the number of pharmacies, for instance, does not take into account the number of pharmacists working there.
“Large parts of NT had very low [community pharmacy density], as did outer-city areas of ACT and outer-city areas of all Australian states,” the Monash University researchers wrote.
“Our results suggest that, in the capital cities of Australian states, CPs tended to be concentrated in inner-city areas and relatively sparse in outer-city areas.
“It is, thus, necessary to increase [community pharmacy density] across certain areas of remote/rural/regional and metropolitan Australia.”
The paper also identified several large, remote regions of Australia, mostly concentrated in the Northern Territory, where there were no community pharmacies at all.
Commenting on the report, RACGP rural chair Associate Professor Michael Clements said ownership restrictions prevented GPs and other local healthcare providers from stepping in when community pharmacies were at risk.
“Patients in rural and remote Australia deserve the same access to medicines and healthcare services as people living in our major cities,” he said.
“Where communities cannot attract a pharmacist willing or able to purchase a pharmacy business, the current rules can leave patients with limited or no local dispensing services.
“In these circumstances, we need practical solutions that put patient care first.”
The college is now asking for exemptions that would allow non-pharmacists to own pharmacies in thin markets.
“Governments should be looking at ways to help these communities maintain services, not allowing outdated ownership restrictions to stand in the way,” Professor Clements said.
“This is not about undermining pharmacists. It is about ensuring every Australian, regardless of their postcode, can access safe, high-quality healthcare and the medicines they need.”
The argument against removing ownership rules
In its own response to the Grattan report, the Remote and Isolated Pharmacist Association Australia (RIPAA) warned that “blanket deregulation threatens to destabilise primary care access for Australia’s most vulnerable populations”.
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“It is time to stop pretending that what works in a major city suburb will work in a small rural or remote town,” association president Fredrik Hellqvist said.
“Remote pharmacies are not typical retail storefronts; they are essential, multi-disciplinary health infrastructure. In many communities across Australia, the local pharmacy is the only resident primary healthcare provider.”
The association strongly opposed any changes to location and ownership rules, arguing that doing so would allow corporate and supermarket giants to “hyper-concentrate” the pharmacist workforce in large hubs.
This would effectively “strip” pharmacists from towns with thin markets and worsen rural workforce shortages, the association said.
“If you deregulate location protections and cut the negotiated margins of small rural operators, you do not create supermarket competition—you simply force the local chemist to turn off the lights,” RIPAA wrote.
“In rural Australia, when the chemist closes, there is no backup plan.”
