• Written by John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University
Pharmacists receive no financial incentive to counsel patients about how to take their medicines. That needs to change. from www.shutterstock.com

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

This so-called fee-for-service funding means pharmacies maximise their revenue if they dispense many prescriptions quickly.

Rather than fast dispensing, it would be better for patients and the health-care system if the funding model paid pharmacists for improving the use of medicines, not just for supplying them.

This is possible, according to our research published recently in the Australian Health Review. And it should be considered as part of the next Community Pharmacy Agreement, which outlines how community pharmacy is delivered over the next five years.


Read more: Explainer: what is the Community Pharmacy Agreement?


Dispensing medicine is more complex than it looks

Dispensing medications may seem simple but this can be misleading: it includes both commercial and professional functions.

Under the PBS, the pharmacy receives a handling fee and mark-up on the cost of the drug to cover the commercial cost of maintaining the pharmacy and stock.

It also receives a dispensing fee for the pharmacist’s professional activities. These include reviewing the prescription to ensure it is legal and appropriate, taking into account factors such as your age, whether you are pregnant and which medicines you’ve been prescribed before; creating a record of the dispensing; labelling the medicine; and counselling you, including providing a medicine information leaflet if needed.

Higher dispensing fees are paid for medicines needing greater levels of security (such as controlled drugs including opioids) and for medicines the pharmacist must make up (such as antibiotics in liquid form).


Read more: Health Check: is it OK to chew or crush your medicine?


But for the vast majority of PBS prescriptions, a pharmacy receives the same basic dispensing fee, currently A$7.39.

If you have a medicine dispensed for the first time, if it has a complicated dose, or it carries particular risks such as side effects or interactions, a pharmacist is professionally obliged to provide counselling matched to the risk. The more detailed the counselling, the greater the time needed.

However, at present, the dispensing fee to the pharmacy does not change depending on the level of counselling you need. Indeed, the current funding model is a disincentive for the pharmacist to spend time with you explaining your medicine. That’s because the longer they spend counselling, the fewer prescriptions they can dispense, and the fewer dispensing fees they receive.

What could we do better?

Performance-based funding, in which payment is adjusted in recognition of the efforts of the service provider or the outcomes of the service delivered, is becoming more common in health care and can correct some of the volume-related issues mentioned above.

It’s already being used in Australia. For instance, GPs are paid a Practice Incentives Program (PIP) to encourage improvements in services in areas such as asthma and Indigenous health.

However, performance-based funding has yet to be used for pharmacists’ dispensing in Australia.

We propose dispensing fees should be linked to the effort pharmacists make to promote improved use of medicines. This is based on the principle that counselling means people are more likely to take their medications as prescribed, which improves their health.

In other words, pharmacists would receive higher dispensing fees when more counselling is required or if counselling leads to patients taking their medications as prescribed.

Pharmacists who spend longer counselling, for instance if someone’s health status has changed, should be rewarded for it. from www.shutterstock.com

Dispensing fees could be linked to the actual time taken to dispense a prescription: the longer the time, the higher the fee. The time taken would depend on the nature of the drug; the complexity of the patient’s treatment; recent changes in the patient’s health status or other medicines that need to be taken into account; consultation with the prescribing doctor; and the level of advice and education provided.

A blended payment model could include a fee-for-service payment for commercial processes and a performance-linked payment for professional functions.

The most experience with performance-based payments to pharmacy is in the United States, where evidence is developing of patients taking their medicine as prescribed and lower total health-care costs.

In England, the government’s Pharmacy Quality Scheme is similar to the Australian Practice Incentives Program for GPs. It funds improved performance in areas such as monitoring use of certain drugs and patient safety.

There is some concern about performance-linked payments. Performance targets need to be achievable without being onerous. And performance needs to be clearly linked to the payment being made, but not if other services suffer.

Incentives could apply to you too

Cost is a barrier to some people taking their medicines with over 7% of Australians delaying or not having prescriptions dispensed due to cost.

However, there is currently no financial incentive for you to have a generic (non-branded) medicine dispensed, which would save on PBS expenditure. So it makes sense for generic medicines to be a lower cost to you.


Read more: Health Check: how do generic medicines compare with the big brands?


There is also currently no financial incentive for you to take your medicine as prescribed, which would likely improve your health and save the health budget in the long run. We are not aware of any country varying patient charges based upon this, although there are ways of monitoring if people take their medicines as directed.

However, countries such as New Zealand and the United Kingdom have lower or no patient prescription charges, minimising costs as a barrier to patients taking their medicine.

What would need to happen?

Dispensing a prescription should be an invitation for the pharmacist to interact with you and help you with advice on the effective and appropriate use of your medicine. At present, there is no incentive, other than professionalism, for pharmacists to add such value.

The proposed changes would require a major restructure to the funding of dispensing to provide incentives that are equitable and transparent and that did not adversely affect disadvantaged, rural and Indigenous people.

There would need to be agreement on reliable and valid performance measures and reliable information systems.

However, funding based on a professional service model rather than a dispensing volume model would support your pharmacist to provide greater benefit to you and the health-care system.

John Jackson is a Fellow of the Pharmaceutical Society of Australia and of the Society of Hospital Pharmacists of Australia and conducts research into pharmacy practice at Monash University Faculty of Pharmacy and Pharmaceutical Sciences.

Ben Urick conducts research into performance-based pharmacy payment models at the University of North Carolina. He also consults with Pharmacy Quality Solutions, an IT vendor in the United States which supports performance-based community pharmacy payment models. Additionally, he is affiliated with the Pharmacy Quality Alliance, a medication-related quality measure developer, as a scientific advisor.

Authors: John Jackson, Researcher, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University

Read more http://theconversation.com/pay-pharmacists-to-improve-our-health-not-just-supply-medicines-124641

Switch It Up: What’s the Relationship Between Lighting and Your Work Performance

It’s no secret that light has an immense impact on the way our bodies function on a daily basis. Light is closely linked to our circadian rhythms or our ‘built-in clocks’, and as such, it larg...

Lilly Miller - avatar Lilly Miller

How to Get Rid of Rats?

Do you suffer from scratching noise in the night or find strange signs such as gnawed pieces of wooden furniture or droppings in your house? Then, you have to prepare for an unpleasant fight with ro...

News Company - avatar News Company

VIDEO: Michelle Grattan on an extended travel ban, a royal commission, and zero emissions by 2050

Michelle Grattan talks with Assistant Professor Caroline Fisher about the week in politics, including the extension of the coronavirus travel ban, the royal commission into the bushfires, and labor&rs...

Michelle Grattan, Professorial Fellow, University of Canberra - avatar Michelle Grattan, Professorial Fellow, University of Canberra

I've seriously tried to believe capitalism and the planet can coexist, but I've lost faith

RAJAT GUPTA/EPAThis article is the first in a three-part series on radical ideas to solve the environmental crisis. As the Productivity Commission confirmed this week, Australia’s economy has ...

Samuel Alexander, Research fellow, Melbourne Sustainable Society Institute, University of Melbourne - avatar Samuel Alexander, Research fellow, Melbourne Sustainable Society Institute, University of Melbourne

What is hypnobirthing, the technique the Duchess of Cambridge used?

In a new parenting podcast, Catherine, the Duchess of Cambridge, said she used hypnobirthing techniques to help her get through severe morning sickness – a condition called hyperemesis gravidaru...

Mary Steen, Professor of Midwifery, University of South Australia - avatar Mary Steen, Professor of Midwifery, University of South Australia

Memories overboard! What the law says about claiming compensation for a holiday gone wrong

FRANCK ROBICHON/EPAWhen booking a luxury cruise, you generally expect relaxation and enjoyment, not forced quarantine and distress. Unfortunately, for the thousands of vacationers trapped on cruise s...

Mark Giancaspro, Lecturer in Law, University of Adelaide - avatar Mark Giancaspro, Lecturer in Law, University of Adelaide

Without more detail, it's premature to say voluntary assisted dying laws in Victoria are 'working well'

ShutterstockThe Voluntary Assisted Dying Review Board has this week published a report detailing the first six months of the legislation in action in Victoria. The report reveals 52 people legally e...

Courtney Hempton, Associate Research Fellow, Deakin University - avatar Courtney Hempton, Associate Research Fellow, Deakin University

I've always wondered: who would win in a fight between the Black Mamba and the Inland Taipan?

Wes Mountain/The Conversation, CC BY-NDThis is an article from I’ve Always Wondered, a series where readers send in questions they’d like an expert to answer. Send your question to always...

Timothy N. W. Jackson, Postdoctoral Research Fellow, Australian Venom Research Unit, University of Melbourne - avatar Timothy N. W. Jackson, Postdoctoral Research Fellow, Australian Venom Research Unit, University of Melbourne

Australia, we need to talk about who governs our city-states

Benny Marty/ShutterstockIn 1971, a Time magazine article, titled “Should New York City Be the 51st State?”, observed: States have not only short-changed and hamstrung their cities but a...

Benjamen Franklen Gussen, Lecturer in Law, Swinburne University of Technology - avatar Benjamen Franklen Gussen, Lecturer in Law, Swinburne University of Technology

Sick and Tired of Your Dead End Job? Try Teaching!

Tired of the same old grind at the office? Want an opportunity to impact lives both in your community and around the world? Do you love to travel and have new experiences? Teaching English is the perfect job for you! All you need is a willingness to ...

News Company - avatar News Company

The Impact of an Aging Population in Australia

There’s an issue on the horizon that Australia needs to prepare for. The portion of elderly citizens that make up the country’s overall population is increasing, and we might not have the infrastructure in place to support this. Australians h...

News Company - avatar News Company