Pay pharmacists to improve our health and not just deliver medicines

If you have a drug dispensed at your local pharmacy under the Pharmaceutical Benefits Scheme (PBS), two things happen. The federal government determines how much the pharmacy receives for the delivery of your medicine. It also decides what you have to pay.

Through this so-called service charge, pharmacies maximize their revenue when they deliver many recipes quickly.

Instead of giving up quickly, it would be better for the patients and the healthcare system if the funding model pays pharmacists to improve the use of medicines rather than just their delivery.

This is possible according to our recent study published in the Australian Health Review. And it should be seen as part of the next Community Pharmacy Agreement, which describes how Community Pharmacy will be delivered over the next five years.

The delivery of drugs is more complex than it looks

Medication may seem simple, but it can be misleading: it includes both commercial and professional functions.

As part of the PBS, the pharmacy will receive a processing fee and a mark-up on drug costs to cover the commercial costs of maintaining the pharmacy and inventory.

There is also a fee for the professional activity of the pharmacist. This includes verifying the prescription to make sure it is legal and appropriate. It takes into account factors such as your age, your pregnancy and the medicines you have already prescribed. Creating a record of the levy; Labeling of the drug; and to advise you, including providing a package leaflet for medicines, if necessary.

For medicines that require a higher level of safety (eg controlled medicines, including opioids) and for medicines that the pharmacist needs to top up (eg antibiotics in liquid form), higher fees are charged.

For the vast majority of PBS recipes, however, a pharmacy receives the same basic fee of currently AUD 7.39.

If you are starting to take a medicine for the first time, if it has a complicated dose, or if it involves special risks such as side effects or interactions, a pharmacist is professionally committed to providing risk-adjusted counseling. The more detailed the advice, the more time is needed.

However, at present, the pharmacy issue fee will not change, depending on the level of advice you need. In fact, the current funding model is an obstacle for the pharmacist to spend time with you to explain your medicine. This is because the less recipes they can deliver, the less they get the more donations they spend on counseling.

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What could we do better?

Benefit-based funding that adjusts the payment to the efforts of the service provider or the results of the service provided is becoming more commonplace in healthcare and can address some of the volume related issues mentioned above.

It is already in use in Australia. For example, GPs are given a Practice Incentives Program (PIP) to promote the improvement of services in areas such as asthma and indigenous health.

However, for the delivery of pharmacies in Australia, a success-based financing must still be used.

We suggest that the royalties be linked to the efforts of pharmacists to promote the improved use of medicines. This is based on the principle that through counseling, people are more likely to take their medication as prescribed, which improves their health.

In other words, pharmacists would be charged higher fees if more advice is needed or if counseling causes patients to take their medication as prescribed.

Issue fees may be tied to the actual time for dispensing a prescription: the longer the time, the higher the fee. The time required would depend on the type of drug; the complexity of the patient's treatment; recent changes in the patient's state of health or other medicines that need to be taken into account; Consultation with the prescribing physician; and the level of advice and training provided.

A blended payment model might include a fee for service payments for commercial processes and a performance-based payment for professional features.

Most experience with performance-based payments to the pharmacy is in the United States, where evidence suggests that patients take their medication as prescribed and lower the overall healthcare costs.

In England, the government's Pharmacy Quality Scheme is similar to the Australian Practice Incentives Program for General Practitioners. It funds increased performance in areas such as drug use monitoring and patient safety.

There are concerns about performance payments. Performance goals must be achievable without being annoying. And the benefit must be clearly linked to the payment made, but not when other services suffer.

Incentives can also apply to you

The cost is an obstacle for some people taking their medication, as more than 7% of Australians delay or not receive prescriptions because of the cost.

However, there is currently no financial incentive for you to give generic (not brand), which would save on PBS spending. Therefore, it makes sense that generic drugs are cheaper for you.

There is currently no financial incentive for you to take your medicine as prescribed, which is likely to improve your health and save the long-term health budget. We are not aware of a country where patient fees vary because of these circumstances, although there are ways to monitor whether people are taking their medication as instructed.

However, in countries such as New Zealand and the United Kingdom, there are lower or no fees for prescribing patients, thereby minimizing costs as a barrier for patients taking their medications.

What would have to happen?

The submission of a prescription should prompt the pharmacist to contact you and help you with advice on the effective and appropriate use of your medicine. At present, there is no incentive for pharmacists other than professionalism to create such added value.

The proposed changes would require a comprehensive restructuring of the funding of the levy in order to create incentives that are fair, transparent and do not affect the disadvantaged, rural and indigenous peoples.

An agreement should be reached on reliable and valid power measurements and reliable information systems.

However, funding based on a model of professional services rather than a spending volume model would help your pharmacist get more value for you and the healthcare system.