It looks like the Pharmacy Guild is all in on pushing governments to allow pharmacists to autonomously prescribe up to Schedule 8 drugs and it’s apparent it is hard at work laying the groundwork for winning over the relevant politicians.
In his usual Baptist-preacher-from-the-pulpit style, Pharmacy Guild president Trent Twomey this week made the centrepiece of his opening plenary to the largest annual gathering of pharmacists in the country – the Australian Pharmacy Professional conference on the Gold Coast – the idea that pharmacists should be given the ability to “autonomously” prescribe and sell Schedule 2, 4 and 8 drugs within the foreseeable future.
Worryingly, immediately preceding Mr Twomey on the podium, Queensland premier David Crisafulli alluded to his interest in a model for pharmacists with a much broader scope than currently planned.
Mr Twomey took it from there and said:
“The best model will allow qualified pharmacists to administer, obtain, possess, prescribe, sell, supply, review and use Schedule 2, 4 and 8 within their individual, self-determined, documented scope of practice after completing, of course, an Australian Pharmacy Council-accredited prescribing course.
“We need prescribing to be included in the base registerable degree, so that every student leaving university can assess, diagnose and treat both everyday health conditions and long-term chronic conditions.
“This is absolutely the only direction for our profession choosing because they know that their ticket will take them to new heights.”
The idea of pharmacists being allowed to autonomously prescribe up to S8 drugs was first floated in October last year in a submission to the Pharmacy Board of Australia by the Guild, the Pharmaceutical Society of Australia and Advanced Pharmacy Australia.
Mr Twomey pretty much stuck to the exact wording in what was a highly controversial paper.
“Autonomous prescribing, where a health professional undertakes prescribing within their individual, self-determined, documented and authorised scope of practice…”. Emphasis here on “self-determined”.
Although Mr Twomey went to the stock Guild arguments for governments to start seriously considering the idea – that it would improve care access by reducing pressure on GP practices, help access for rural patients and generate system savings – he also spent a good part of his address bemoaning the financial woes of many his membership in the last year.
“As your Guild, our job is to work with you to make the very best of a very bad situation.
“This year, we have seen what happens when flat dispensing volumes due to 60-day dispensing, ownership concentration in large groups, greed and over-leverage collide, where unsuspecting, often junior partners, pharmacy owners, their communities and their families suffer when the wheels fall off, and unaccountable bean counters thriving in a fantasy land, together with an unrealistic corporate strategy, has had a devastating impact on our members, their families and the communities that they support.”
Who is Mr Twomey unhappy with here?
If we leave aside the federal government and 60-day prescribing, he’s almost certainly pointing to the corporatisation of pharmacy by network groups such as Chemist Warehouse, Terry White Chemmart, Star Pharmacy Group, Blooms The Chemist, and Priceline Pharmacy, all of which have aggressively grown on the back of extended debt facilities, provided in partnership with financial institutions, often private equity.
“Unsuspecting pharmacy owners” and “greed and over-leverage collide” are probably a reference to the collapse of the Star Group in South Australia, when a lot of smaller pharmacist shareholders were exposed and lost everything.
Under this model the corporate group controls the business and junior partner pharmacists buy into stores with large personal loans.
Mr Twomey is also probably referencing the billion-dollar windfalls made by the founders and shareholders of Chemist Warehouse, a networking and ownership model that thwarted the local pharmacist ownership rules and predatory priced a lot of smaller owners out of major catchment areas.
Things are indeed getting ugly in Pharmacy Land.
But can Mr Twomey on the one hand promise the politicians he will solve all their GP access woes with broadscale autonomous pharmacy prescribing, and on the other admit that well over 50% of pharmacy outlets are now in the hands of evil financially driven corporates?
Surely, he wouldn’t want this sort of vertical prescribing and selling power in the hands of such uninhibited and “greedy” big corporate entities?
How would that likely pan out in terms of patient safety and cost to the system – prescribing S8s at scale in big corporate entities, often owned essentially by big financial institutions, most often private equity?
Sounds like it would be fine, right?
When the autonomous prescribing paper first saw the light of day last year both the RACGP and the AMA immediately put in the standard and sensible objections in submissions to the Pharmacy Board:
- The inherent commercial conflict in supply, prescribe and sell power;
- The disintermediation of GP networks where obtaining prescriptions could well become far more transactional, especially given the rise and rise of the online prescription platform vendors;
- The inherent danger in disconnecting doctors from the prescribing process and creating the ability for episodic drug buying across different pharmacies, most especially in the S8 category.
But the AMA and the RACGP should be aware by now that the Guild are political operators of the highest order, reminiscent of top-notch Washington lobbyists.
On Thursday, the premier of Queensland gave some sanction to Mr Twomey to get up and make the “autonomous prescribing call” by referencing the potential for his state of a broader scope of practice.
The next day our federal health minister Mark Butler had to pay his respects to the Guild as well by delivering the morning plenary. And after that, of course, the opposition health spokesperson, Senator Anne Ruston, did her thing.
The Guild is on a bit of a full-court press here.
Mr Twomey, unlike a Donald Trump, is articulate and charismatic. His persona this week was a preacher in front of his people promising to take away their pain by removing the evils of corporate greed and convincing our all governments of the upsides to the Guild’s broader scope of practice plans.
He was pitching a promised land, balanced somewhere between re-establishing financial stability and better patient access and safety
Mr Twomey, a little like a MAGA Republican, was pushing the narrative that the greedy corporate pharmacy strategies that have been fired up by debt funding, acquisition and crazy growth targets, “have blown up”. The Guild will be the ones to protect independent pharmacists and negotiate new funding models and scope of work moving forward.
The big problem with Mr Twomey’s argument, of course, is that the corporates have not blown up at all.
They are thriving despite the 60-day prescribing cashflow glitch.
Worse, it was the Guild that unsuspectingly ran cover on the massive growth of these corporates in pharmacy by obstinately maintaining what it thought would be a monopoly position for smaller independent pharmacists on pharmacy ownership, but which was comprehensively outmanoeuvred legally and commercially by the Chemist Warehouses of this world.
Mr Twomey is now between the devil – the big corporates, which many of his members now work for – and the deep blue sea – his struggling independents running a model that seems destined to keep declining without some sort of intervention by the federal government.
Would the government really want that? After all the big networks have done what the supermarkets were never enabled to do, create much patient access and pricing.
Mr Twomey has a much bigger challenge, though – convincing the federal government that the “autonomous prescribing up to the highly delicate S8 category”, in the hands of the big machine-like networks that operate largely through scale, would be safe for patients, and cheaper for the PBS.
Remember, it wasn’t so long ago that Wesfarmers, which owns distributor API and network chain Priceline, owned Australia’s poster child of retail corporate ethical good behaviour, Coles.
