‘A lot of countries can learn from our model’

And my current engagement is on rather on a global level with the federation, the International Pharmaceutical Federation FIP. And I'm currently in the first year of a four year term as president.

I recall in my days as part of and leading the negotiating team for the sixth agreement that was always in the background, the threat of that. But that wasn't progressed at that point, but it was always at some point likely to come back onto the table. I think the guild have done a very, very good job in negotiating this agreement.

There was a real opportunity, I think, for government to disrupt our industry further in the professional side of it, but they have seen, I think the value that community pharmacy offers, the value and the opportunity to further leverage community pharmacy as we go forward. And there is also I think a great opportunity in this agreement to be a platform for further progression of scope of practice broadening and looking forward to the end of this agreement and future agreements.

I would hope that professional services funding is greatly increased as our scope broadens and the opportunity for pharmacists to contribute more is realized by policymakers, government and bureaucrats.

inflation, the cost of living, this sort of thing. In many countries, the pharmaceutical benefits or the pharmacy schemes are funded by insurance companies. Insurance companies tend to take a much harder line on the value of the pharmacist. You certainly don't enjoy the same level of recognition of cost of living, recognition of cost associated with running a business that increase each year so that in many places you

are forced to do more for less. In Australia, we are very fortunate to have a system where the time of the pharmacist is recognized, the value of the premises is recognized. In Germany for instance, they haven't had a meaningful increase in their dispensing fees for more than

the past 10 years. And in many countries, particularly with the genericization of medicines and there has been a mandating of dispensing of generics where the insurance company actually makes decisions on the patient's behalf, the return on prescriptions has decreased dramatically and it has become an exercise in volume rather than individual patient care. You also see overseas, particularly in a number of the larger marketplaces, significant mail order operations, which are volume-based.

We haven't had that here in Australia. And some insurance companies in some models are direct the patient to be provided by a particular provider.

So the fact that we have patient choice here, we have the ability of patients to engage with their local community pharmacy and build relationships rather than be dealing with an unknown supplier perhaps on the other side of the country in a relationship that is defined only by the price of the service that's been able to be provided rather than by the level of care.

So I think that the Guild has done a very good job in maintaining a linear increase to all the fees In the eighth agreement they have clawed back by $4 79 extra a HI payment for double dispensing some of the hurt that was felt with the original decision. And I think that that is a real win for pharmacy that maintains to a large degree the profitability of the professional dispensing service provided by pharmacists.

It allows proprietors to have certainty firstly when negotiating leases, which is one of their principal costs, and also being able to recapitalize their businesses by way of shock bits, which better facilitate provision of services. So I think all in all we are in a very strong position compared to a lot of services overseas where governments and insurance companies are just ratcheting down the value of the pharmacists and what they're paid per providing their services.

When the payer is the government, then you're in the very fortunate position of if the system fails or the service levels deteriorate to a large degree, the government is being held accountable by the public every three or four years when there are elections. And the last thing government wants is to make provisional pharmacy services an election item because pharmacists have such a strong reach into every local community.

And that's been seen any number of times when pharmacy has been subject to an enforced policy change government. So I think we're fortunate that the government is, our payer insurance companies are effectively for profit organizations and they don't, they're not held to the same level of accountability in the uk it's all done through the NHS, but you find a system there where the NHS is faltering and under enormous pressure. So there has been consequences there in terms of remuneration.

So I think we are very fortunate. You look at other developed marketplaces like Canada. Canada has a model not dissimilar to our model. Services are paid for on a provincial level rather than a commonwealth level. And the degree of those services provided tends to vary according to the resources and wealth of the province. But in terms of payment for provisional services,

some Canadian provinces certainly lead the way. So there's lessons all around, but I think by and large we are fortunate to have the system we have and it's served the Australian public very well. For a long time the community pharmacy agreements have served the Australian public and the government for a long time and I think this eighth agreement reserves that value and it's a great platform going forward.

What isn't defined is as scope of practice broadens where the money for those services, whether they be for extended pharmacy services in other healthcare, in other healthcare settings where that money will come from. But I think the fact that the PSA now has its own agreement, it takes a lot of tension out of the way that agreements were previously negotiated.

It separates the PSA effectively from the dispensing and services money and lets then focus on professional standards, accreditation, credentialing, et cetera. And that's where the profession will be driven forward with scope of practice. And to have an effective scope of practice broadening, you have to have pharmacists achieving certain levels of accreditation, credentialing and extended learning. And the PSA will effectively take responsibility for that.

I think that's a good separation and takes to a large degree a lot of the preexisting tension out of the former arrangement. With respect to the wholesalers, I think the wholesalers need to be held to far greater account. They have continued to make record profits during the seventh, sixth, and seventh agreement. They have dramatically cut back rebates to pharmacists and I think that they had the community service obligations in the existing

agreements. I think that the wholesalers, it's good they had their own agreement, but I think that they need to be held more greatly to account for services. They need to provide service levels to pharmacists must be maintained because that's the basis on which pharmacies meet their obligations in provision of medicines to the Australian public. But I think it makes sense to separate the agreements.

There is a school of thought that says we are stronger together, but there is very much self-interest in each of those agreements. And I think that I support the notion of them separating them and I think it will make it easier going forward for each of those to get a stronger agreement with government for their respective roles.

And also we do hear a lot about the scope of practice opportunities that already exist in the UK and the us so where we might be heading.

The challenge for pharmacy has been demonstrated overseas is that we have to have the competencies and the skills to deliver those services. We have to provide the infrastructure within our pharmacies. It's very encouraging now to see pharmacies being refitted with three and four consultation rooms because they will be the drivers for our profession going forward. There is a well identified lack of capacity within general practice. We have to be able to offer

a service that will fill that gap. Pharmacies are well trained and well equipped to do that in certain things such as UTIs for instance and minor ments. We will have to upskill by way of accredited training and that's a good thing. That's part of the notion of lifelong learning and that needs to become very much part of the way that pharmacists look to their profession and practice their profession.

So I think there's a very good platform now we can see great opportunity for further prescribing rights. Ideally in the perfect situation, we would have medical benefit scheme numbers MDS numbers as the doctors do, and we would be able to prescribe against the MBS in a much broader field as is starting to happen in a number of other places in the UK in 2026, every graduate pharmacist will be a certified prescriber. That's a great step forward.

There are big challenges there in terms of turning that competency into practice in the community setting or the medical practice setting, but their challenges that will need to be dealt with and those learnings will inform the next and subsequent groups of pharmacist graduates. But I think that's very much the vision of our profession globally, to do more and to be able to provide more within our community pharmacies. We need only, look back to 10 years ago when vaccination

was really just a pipe dream. Everyone was talking about it, everyone was against it. But through a very well-defined process of developing a concept, proof of concept evaluation and then implementation, we have been able to provide extraordinary value to the health service and the health system. And I think that will continue as we improve our competencies as the government sees the value of what we can deliver and they leverage that value across the health system.

We now have effectively a full range of vaccine services through pharmacy, but a full or a broaden prescribing formulary so that we can treat minor ailments and broader than minor ailments. We also need to be able to have services such as in some Canadian provinces where they can continue therapy based on the patient's performance in terms of KPIs within their disease state.

That's very important so that the patient sees their doctor for instigation therapy, they then go to their pharmacy for continuation of that therapy. That builds a much stronger relationship between the patient and the pharmacist and it becomes a health provision service rather than a product service. And I think that's very important. We need to advocate very strongly for that.

We need to advocate strongly for the role of pharmacists in other healthcare settings and such as the aged care facilities, which is now underway. We need to look at providing pharmacists in areas where there are limited general practitioner services. We need to expedite their expansion of practice so that those services that those people should have access to readily available to them within their community.

There are any number of communities in Australia where there is a pharmacist, a community pharmacist, but no general practice. And to be able to leverage that health hub called a community pharmacy to further deliver more services is a natural progression I think, of the services of community pharmacy.

The first step that needs to happen here is that pharmacists need to be recognized as healthcare professionals to be able to have access to that platform that is happening. And in Pennsylvania, pharmacists can provide services in all outpatient settings where they have the ability to build medical claims. So there's community pharmacy, ambulatory clinics and medical offices. And they also have access to the preferred drug list.

And the preferred drug list is that list of drugs, which is identified as the first choice by the payers. Now that typically in America is the generic brand and the alternate drug list is made up of the proprietary brands. So that's happening in a number of states. For example.

There have been legislative changes in many of the states thanks to the advocacy of the American Pharmacists Association, where they have advocated very strongly that there is example evidence that interventions and care from pharmacists are often associated with improved clinical outcomes and decreased healthcare costs. And are those are obtaining provider status.

As an example, Pauline, in Wyoming last year, pharmacists were allowed authorization of reimbursement for services provided by pharmacists under Medicaid within their scope of practice. And that scope is defined at a state level. In Virginia, a similar bill has been passed in Maryland, the general assembly passed a bill for reimbursement of services rendered by a pharmacist, effective April 1st, 2023, Missouri's Medicaid program allows pharmacists to receive reimbursement for any

covered service that falls within their scope of practice. Pharmacist providers will apply the same billing codes and receive the same reimbursement as other practitioners. And this includes provision of services such as medication therapy management and comprehensive medication management. So there is a very strong move in the US to give access to Medicaid and that will be, again, a great step forward. A number of states in America have recognized prescribing status, but not all states.

Some states recognize pharmacists as healthcare professionals, but not all states. So that journey is underway there and that's the equivalent here of Australian pharmacists having access to the MBS so that you get prescribing status or access to the MBS with an MBS number for a service provided in the pharmacy. And that effectively takes that payment away from the community pharmacy agreement and into the general Medicare budget.

So that's great opportunity and that's hopefully we'll learn from what's happening in the uk. We'll learn from what's happening in the USA and Canada, and we'll then be able to look to that,

see what we can adapt to our system. But anything that improves, I think the access of pharmacists to provisional professional services, which can be delivered from a community pharmacy setting or even in a domestic setting, I think will be very good for our health system because pharmacists now, as they are graduating from university, have a very, very well developed skillset and we need to utilize that skillset not in packing we to pack, not in filling robots,

but in delivering community-based primary healthcare services to our communities.

And the notion of having pharmacists supervised, and this happens in a number of countries where there might be a supervising pharmacist who oversees a number of pharmacies, but unfortunately in Australia we have a model here where the pharmacist takes responsibility for everything that happens in their pharmacy and there must be a pharmacist on the premises every moment that pharmacy's open. So that's a bill that's being worked up in the moment at Germany.

There is a very strong opposition to that from the professional organization of pharmacists called ABDA. They have sought support from FIP for that which we have given them. And that's the risk that we look for particularly in countries where there is a shortage of pharmacists, where there are workforce issues, the opportunity to provide more through the pharmacy is diminished because they don't have the professional workforce to deliver that.

So that's something that we are keeping a very close eye on. Obviously in the states with the provider recognition that's happening across more and more constituencies in South America, there is a push to have a higher level of regulation, to have a regulatory framework so that issues such as pharmacies operating without a pharmacist are not so prevalent. And it makes it much a much stronger pathway for people coming out of the tertiary setting with a pharmacy degree if there's

surety about the marketplace into which they're looking to practice. So different places have different challenges. There are common challenges across the planet. They mainly revolve around remuneration and reduction in remuneration. There is a number of countries where there are pushes for use of pharmacy technicians, and there are very strong arguments for that in terms of allowing the pharmacist

to be freed up to deliver professional services. In some countries, technicians are very highly trained and are part of the established pharmacy team. So there are challenges everywhere. But I think that in looking across the pharmacy landscape, we have our challenges here, but we are, I think in very good shape.

It's a fabulous networking opportunity and I would certainly welcome any Australian pharmacist who would like to engage with pharmacy from a broader perspective and the opportunity to engage with fellow pharmacists from around the world with an excellent of present workshops and social activities. So I'd extend an invitation to all Australian pharmacists and they can look at the program and the registration forms that fip.org.