No downside to 8CPA

And that sparked a strong response from the community pharmacy sector amid concerns of what that would mean for patient services, staffing and viability of pharmacies to continue to operate and trading hours and whatnot through the Save Our Local pharmacy campaign. And what it did was help bring forward the negotiations for an eighth community pharmacy agreement to commence from the 1st of September, 2023.

So we had a seventh agreement in place that was meant to go through to 2025 and essentially through a public campaign and an advocacy, we're able to bring forward the negotiations for the eighth community pharmacy

agreement. So a big thank you to community pharmacies across the country and their teams in helping advocate for the need for consultation with our profession and sector on such important change and the need to have earlier negotiations for the eighth community pharmacy agreement to have a sustainable way forward to deliver more affordable medicines and cheaper medicines. I mean, we all want more affordable medicines for patients.

Medicines are very useful to treat acute illnesses and manage chronic conditions, but they only work if you take them and you can't take them if you can't afford them. So more affordable medicines is a good thing. But the way that the federal government initially announced 60 day dispensing and was looking to implement it without a new funding agreement, the government was essentially shouting the bar but wanted the bar to pay for it.

And that was a huge concern for our profession and what it meant for our staff and our patients. So from September one, we had the eighth community pharmacy agreement negotiations and it took for the best part of almost nine months of negotiation. So I essentially was in Canberra every week, and I've been in Canberra every week since the end of March, 2023 through to June.

I almost lived in Canberra essentially during the week advocating on 60 day dispensing and negotiating the eighth community pharmacy agreement. It took 104 flights between Melbourne and Canberra alone. I mean who was counting, but it was 104.

So a big thank you to members of the Pharmacy Guild for all their membership and support because we have the resourcing to be able to do that advocacy, but we can't do that without your support in membership and supporting our campaigning along with our health economics team, our analysis and flying my negotiation team members from around the country, some coming from as far as Perth national counselor from Western Australia, Natalie Willis. She was coming over most weeks from Perth.

So it was a big exercise, it was very involved, but it was worth it in the end for our patients and for our pharmacies.

So essentially the $1 discount should be given to all patients and phased in for everyone, not only for some patients depending on where they live. We wanted to put an end to postcode lotto on cheaper medicines. So these were our principles and not negotiables. We wanted more affordable medicines for everyone. And the end of allowable discounting, we insisted that aggregate dispensing remuneration couldn't go backwards year on year and over the course of the agreement. So that

was another firm principle. We wanted to see a funded pathway towards full scope of practice. So there's going to be a new and then new and there will be expanded programs within the community pharmacy agreement that are yet to be announced that will help touch on that, that basically help further expand the scope of practice of pharmacists or at the very least, fund those expansions of scope of practice to rerate to help fund patient consultations with their pharmacist in these areas.

And whilst not a federal government matter pharmacy ownership, it's a state and territory government matter, we wanted to ensure that there was ongoing support for pharmacists only ownership of pharmacies as its regulation that is in the public interest and has served the public well.

So we had a set of principles that we were not going to sign an agreement unless it helped achieve those things, and we could have had an 8CPA signed earlier and done earlier, but until our principles were met, we were not going to enter into an agreement.

It was seeking advice from external consultants, whether they were of an economic nature, legal advice, nature, that piece, there was a really important collaboration with Nostra data who a company that provide data and analytics insights into community pharmacies. And I don't feel we would've got the successful outcome we did without that collaboration. I strongly believe that without data, you're just another person with an opinion.

And having that collaboration ensured that we didn't turn up with a knife to a gunfight so to speak, but it was a massive team effort that I'm very humbled that I was able to lead, that we had a greater purpose to achieve an outcome that ensured that our pharmacy, our pharmacies amongst our members and across the network had a sustainable way forward to deliver cheaper medicines for patients, deliver health services and be there for their communities.

That was the greater purpose, and that's what drove us all the way. There was many late nights. There was work every weekend, there was pre-meetings before the meeting with the Department of Health and there was debrief meetings and so on and so forth and rinse and repeat every week. And it takes a big sacrifice for quite a few people having to be away from home a lot. My kids would joke with me and say, how's your Canberra family going,

dad? And I'd say, oh, the Canberra kids are good. They behave. They don't back chat me like you do. And we'd just have a bit of a chuckle. But it was a big relief to all of us when it was over. When it ended, it was a nine month slog of negotiation after a five month public campaign. So it was a 14 month exercise essentially.

80th anniversary at the time. So it was written around 2008 and published then. And that book gave me such a rich insight into the history of the guild and the genesis of the first agreement, which is probably the most similar to the eighth, that there was a public dispute with the government that government was rushing reform without consultation at the time in the late eighties,

was going to reduce pharmacy markup from 25% to 10%. Pharmacies were very concerned about their viability, what it would mean for their patients. There was strikes, there was a public dispute. It led to the formation of the first community pharmacy agreement, and it's been five yearly agreements since reading that book. It gave me the confidence that it was history repeating itself.

This was the game plan of what our predecessors had undertaken to succeed that not only is it possible we will succeed, it's in our DNA to succeed for our patients and our pharmacy team. So I'd read that book, I'd get off the plane and people are sick of my sporting analogies, but I'd get off the plane, I'd walk off the plane and that air bridge that you go back into the airport and I felt like I was in the players race going out onto the field. I was ready.

I was ready to rumble with the Department of Health. I was good to go and I was convinced that we were going to succeed. And I love a sporting quote, and Vince Lombardi is a legendary grid iron coach or American football coach, and he had this saying that was, winners never quit and quitters never win.

So we just continued to turn up and we continued to be relentless in our advocacy and we were never going to let public servants or politicians outlast us in advocating for our patients and our industry because it's not only our livelihoods, it's the livelihoods of our friends, our colleagues and their teams and what it means for their community. So we would never going to be outlasted. So that was that.

But there were stressful moments car, absolutely. I mean, I remember on Father's Day last September, I woke up to a message from a pharmacy colleague who was in his pharmacy and was in a very fragile mental health state and wanted to self-harm and take his own life because of what he felt 60 days was going to mean to him and his pharmacy and his family. So the first part of my Father's Day last year was talking to and working with this colleague to make sure he didn't hurt himself,

and that was very confronting. So there were those sorts of moments. But overall, I have to say I was really well supported within the Guild by my family who I couldn't have done this without being able to play a role in the overall process. There were so many people who played a role that together we, I think achieved something really important, very special.

We went through an environment last year of trying to hang on and survive because we could see a train coming towards us through the tunnel and the light coming before us, and you don't wait until the last moment to jump out of the way. So you went from that environment to now one where there is confidence, there is certainty to invest in your people and your business overall. That's what's really important.

There's quite a few things to state that I'm really proud of, but I'm really pleased that there is an inter postcode lotto of affordable medicines and that allowable discounting will be gone by the end of this agreement so that we can ensure that pensioners and people receiving a PBS subsidized prescription get the same fair deal no matter which PBS approved pharmacy they go to across the country, whether it's in Fitzroy Crossing in WA or Fitzroy in metropolitan Melbourne,

you get the same fair deal.

Component two is the balancing payment that's paid on all subsidized scripts, whether they're 30 or 60 days, and it starts off being 78 cents. That $2.1 billion is basically guaranteed funding irrespective of the uptake of 60 days. So 60 days had a forecast uptake or 45% in year one, 58% in year two, and then it would peak to 63% by year four after implementation. As we sit here on the 11th month of the first year of implementation of 60 days,

it's hovering at a national average of around 14% of eligible prescriptions. So it's far short of the department's initial estimates, and it is difficult to estimate and forecast what the uptake will be because a number of factors. But something that I'm really pleased with that people might not fully appreciate is that that 2.1 billion of additional dispensing remuneration is paid to the pharmacy network over the course of the agreement irrespective of the uptake of 60 days.

So that gives a lot of certainty and stability. We expect a 60 day uptake to increase over time. It's not going to stay where it is forever, but how fast it increases when it's hard to know and because of that inherent unpredictability.

Another thing that I'm pleased with as part of the agreement to your point, is that the, what's called the payment adjustment mechanism, which supersedes what was the remuneration adjustment mechanism, has a range, a window from which we forecast what the prescriptions will be over the course of the agreement if it goes below a certain threshold, dispensing remuneration increases. If it goes above a certain threshold, then dispensing remuneration is adjusted downwards to keep it within a band.

This is the first agreement that I'm aware of where there is a 0% downside buffer over the course of the five years, and there's a 10% upside buffer. So it's a significant window of 10% and there's a 0% downside buffer. So again, this is certainty for the sector to say, you are guaranteed this minimum amount of dispensing remuneration over the course of the agreement regardless of 60 day uptake.

And that wasn't easy to achieve. It took a lot of advocacy, a lot of negotiation, a lot of meetings and discussion, but we got there.

So we refer them to our eight CPA calculator, which is another collaboration with Nostra data, and you can find out more info on the good website on that, but you go through Nostra data to get that calculator that helps give further context of what 8CPA means compared to the seven CPA. So yeah, it was really humbling to do the National Road Show with our president Trent Twomey. He did every capital city, which was an amazing effort in itself.

I only got to four of our eight capital cities to do to help co-host with him. And then I went to the Western Australian Forum last week in Perth. In addition, it's just really humbling to have members come up to you and their teams just to come up and say thank you. And really it was really a pleasure to be able to give them the opportunity to represent our profession in that way. And I'm relieved that we were able to get an outcome that they're happy with.

But at the same time, we were never going to sign something we weren't happy with and I was convinced we were going to succeed.

Take the opportunities that are there before you in your jurisdiction get you or get your staff trained in those services. Deliver whatever you can for your local community patients.

They'll thank you for it. They welcome it in Victoria, for instance, where in the latter stages of a 12 month prescribing pilot here in Victoria that focuses on a few areas such as antibiotics, were uncomplicated, urinary tract infections, repeat prescriptions for oral contraceptives, some skin conditions, travel health. The one comment that we hear from patients that's not positive is why can't the pharmacist do more?

This is great that I can go to my local pharmacy and get more services, but why can't they do more? So that's the only really non-positive comment I hear from patients. So it's really pleasing. And look, I know your listeners are probably sitting there, they've been listening to this interview and I hope they're still with us. Thanks for staying with us. It's great. I appreciate it.

But they might've been thinking, Anthony's been speaking a lot about the dispensary, the future of pharmacy is broadening our scope of practice and delivering more services. Absolutely. But you need a strong stable dispensary in order to deliver those other services in the pharmacy. And the analogy I would use with the Department of Health throughout the eighth community pharmacy agreement negotiations, and I think it wore them down at nauseum,

was that we were building a house together. The eight CPA, we are building a house together and you need a solid foundation, otherwise the house will fall over. And that foundation is the dispensary. You can have really pretty accessories and nice add-ons and bells and whistles and features of the house, and they could be some other health services, but without a solid foundation, the house will fall over. And that's the approach we took.

So there is a really encouraging and bright future for community pharmacy with scope of practice, with university leavers and future pharmacists getting more enthused about practicing in community pharmacy to be able to apply their knowledge around healthcare delivery in other areas.

So using the house analogy that we've built a foundation that's strong and broad enough to extend the house, to extend the house and build more rooms and more things to accommodate a bigger family, a bigger community, and be able to perform and deliver more funded services through community pharmacy to pursue further down our full scope of practice journey.

But we're going to call them therapeutic vapes and we're going to put them in pharmacies to be able to provide without a prescription over the counter. But we're not going to speak with pharmacists, we're not going to engage with pharmacies, but we're going to tell 'em it's great and we don't know whether it's going to be covered by their professional indemnity insurance. Oh, hope, hope it is, et cetera, et cetera. Look, I think you're getting a flavour where I'm coming from.

It was policy on the run. We didn't ask for this, we weren't asked about it. It has good intentions. The vaping law reforms in that we don't, no one wants vapes in the hands of kids or teenagers. I'm a father of essentially three teenagers, but the way we've gone about it in implementation has been poor. It's been rushed and there hasn't been consultation, and I don't think they will be successful. And I expect only a minority of pharmacies to choose to stock them.

And essentially we're making vapes illegal in this country. Unless you see a doctor currently or you go to a pharmacy after October one and you obtain one that's 20 milligram per milli or less for the purposes of quit smoking. And whether the government or anyone else likes it, or there are a cohort of people who vape without

the immediate intention of quitting. And in my pharmacy anyway, there are patients who have presented with prescriptions from their doctor because they can no longer obtain a vape otherwise, unless they go to the black market or elicit forms. They go to the doctor, they pay an out-of-pocket costs, they get a prescription, they come to the pharmacy. There's a restriction of flavors. It costs what it costs. And they think to themselves, this is more costly,

more inconvenient. I've got less choice of flavors and types of products. This is too hard. I might go to the black market or just take up smoking again. And that's a poor outcome. Look, the TGA's own website says that there's emerging global evidence of the long-term safety and impacts on health of vaping. But I think broadly speaking, in the main vaping's, probably safer than smoking probably it's not a high bar. You've got to jump across smoking being one of the leading causes of death in

the world. But when the TGA website even talks about emerging evidence on safety and limited evidence on being able to quit smoking on their own website in their vaping hub, but in the next breath, calling them therapeutic vapes, it's really astonishing. And that we've essentially sidestep the normal medicine regulation process here. It's quite unprecedented what the government's done here. I don't expect it to succeed. So we'll see what happens.

But if pharmacies do choose to stock it, that's a matter for them. Professional indemnity insurance is really important consideration because there's still ongoing deliberation by our indemnity insurers, whether they will cover it, what it means for your pharmacy, business, insurance premiums, trading, and education, because there is yet to be a released guidance on determining what is clinically appropriate in the dosage.

So there's a lot of unanswered questions right now, Carlene, but where I stand with it is it's a note as Simon Cowell says on American Idol. It's a no from me, at least until they're on the Australian Register of Therapeutic Goods and undergone the rigor and process of review like other medicines being quality, safety, and efficacy.