States jumped the gun on pharmacist prescribing, Sax Institute report finds.
A new Sax Institute report shows pharmacist-led prescribing improves medication access, but evidence on its clinical effectiveness and safety is weak.
The RACGP commissioned the Leeder Centre at the University of Sydney to create the report on evidence-based research into pharmacist-led prescribing.
College president Dr Michael Wright told The Medical Republic the report questioned the evidence supporting ongoing pharmacy prescribing rollouts.
“We’ve repeatedly been told by the government and The Pharmacy Guild of Australia that these rollouts are evidence-based, but this report confirms … the evidence just isn’t there,” Dr Wright told TMR.
“What does exist is limited or of very low quality,” he said.
As of 2026, all jurisdictions have announced rollouts of community prescribing, ranging from UTIs, contraceptives, and minor skin conditions in NSW to up to 23 minor conditions in Victoria.
“The bulk of these conditions have never been formally evaluated in robust clinical trials internationally, let alone in Australia,” Dr Wright said.
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The report’s two-part evidence check review consisted of international peer-reviewed evidence and grey literature in Australia.
Of the 140 international studies assessed in component one, only 18 were eligible for inclusion. None were from Australia, making it difficult to assess their applicability in an Australian context.
“Of the small number of studies available within the past five years, most are based on weak study designs and report no clinical, health service (including economic) or safety outcomes,” the report read.
Component two assessed 122 Australian documents, but only two contained extractable outcomes – a 2024 Queensland UTI pilot evaluation and a 2023 Victorian pilot for herpes zoster, UTIs and plaque psoriasis flare-ups.
AMA president Danielle McMullen said the report’s findings reinforced the concerns the association raised in its submission to the Pharmacy Board of Australia on 29 June.
“I think it does highlight the expansion of pharmacy prescribing in Australia is now occurring ahead of the evidence,” Dr McMullen said.
“[The report] doesn’t say pharmacist prescribing is unsafe, but it does conclude that we don’t have evidence on safety across the range of conditions now being treated,” she said.
Dr McMullen said the Pharmacy Board of Australia and state and territory governments should weigh the report against submissions cautioning against endorsement and consider models supporting continuity of care and collaborative prescribing.
TMR sought comment from AHPRA and the Pharmacy Board of Australia, but they respectfully declined.
The Pharmacy Board of Australia is reviewing stakeholder feedback on pharmacist prescribing standards after consultations closed on 15 June, a spokesperson told TMR.
ACRRM president Dr Rob Martin told TMR the lack of sufficient evidence for expanding pharmacist prescribing was not a “defensible decision”.
Dr Martin told TMR it was “very concerning” that the federal department of health had adopted pharmacists’ expanded scope of services with “such a low level of evidence” – a decision he said would be unacceptable in medicine.
“It confuses access to medication with access to an appropriate diagnosis and appropriate provision of medication,” he said.
Dr Martin said the reform might contribute to fragmented, “gig economy healthcare” and expressed concern over the lack of research on pharmacist-led prescribing in rural and remote communities.
“How is [pharmacist-led] prescribing going to work when there’s not enough access to doctors and nurse practitioners, who do have the training to conduct a proper diagnosis, in the first place?”
“There need to be proper, well-designed, well-structured trials before these sorts of experiments into looking after people’s health care are brought to Australia,” he said.
“Any of the suggestions we’ve put forward have been largely ignored, and the process is rolling on regardless. We’re not going to sit in a meeting condoning something we’ve repeatedly tried to change,” he said.
National vice president of the Pharmacy Guild of Australia, Simon Blacker, said the report confirmed that pharmacist prescribing improves access to treatment – a finding that aligned with its recent Rewriting the Script report.
“The RACGP commissioned this review seeking to examine pharmacist prescribing and, despite its narrow scope and acknowledged limitations, the strongest conclusion is that pharmacist prescribing improves access to medicines and care,” Mr Blacker said.
“What the report doesn’t fully reflect is the extensive recent evidence demonstrating pharmacist prescribing is safe, effective and highly valued by patients,” he said.
“Australia now needs a nationally consistent approach to improve access, reduce delays and help more people get the care they need when they need it,” he said.
