AJP podcast host Carlene McMaugh speak to Fei Sim about some of the more recent developments in the pharmacy policy agenda.

Among the topics covered are: 

Click here to listen to Carlene’s earlier chat with Dr Sim, published in early May

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

In this podcast, Carlene McMaugh speaks to regular AJP contributor Angelo Pricolo about his varied career , including his pioneering and leading role in addiction medicine, as well as his time with the Pharmacy Guild and his current work in youth mental health.

Among the topics covered are: (1 min:30) Angelo’s views on the increasing inequality in access to, and quality of, addiction medicine services. 

(3:40) Understanding addiction, and how to treat it. Understanding that it is a ‘chronic relapsing disease’, it is not a moral failure, it is a medical condition.

(7:30) The role of naloxone and other opioid treatments 

(9:50) Why the ‘War on Drugs’ is a failure and a concept we need to move away from if we are to understand and better treat addiction

(11:00) What the Purdue Pharma case reveals about the US system, and why it caused so much harm in treating addiction 

(14:30) The importance of naloxone supply through community pharmacy

(16:30) Angelo’s work with a GP clinic administering long-acting injectable buprenorphine 

(20:50) His thoughts on the methadone program and where it should go next

(25:30) Angelo’s work with the Pharmacy Guild, and his views on the push for pharmacist prescribing

(28:50) His current role working in youth mental health support

To see more on the topics of harm minimisation and addiction medicine from Angelo Pricolo, go here and here

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

Morwell, Victoria pharmacy owner Sam Armstrong talks to AJP Podcast host Carlene McMaugh about how changes to opioid dependence therapy went into action on 1 July – starting with how the software his two pharmacies use had a “database error” and wasn’t operational.

“To their credit, they fixed it quickly,” Armstrong says, but the episode highlights just how “rushed” the implementation of ODT changes have been.

“We’re still coming up, finding scenarios where we just haven’t been told how to work, or how to process or proceed,” he says, saying that overall, “the rollout’s been pretty poor”.

He says that “we still don’t know everything” about issues such as how to claim payment, and outlines some experiences other pharmacists have told him about – and how challenging they have been for both pharmacists and patients.

Armstrong also places the ODT changes in the context of wider sector challenges like 60-day dispensing – and the lack of confidence pharmacists now have in the federal Department of Health and Ageing.

“A lot of us are feeling very hurt in the way that we were there during Covid, stayed open, worked through…and then to have this done to us,” he says.

The rushed implementation of the ODT program, with potential harms for patients as some pharmacies stop a program which he calls very rewarding, is just another nail in pharmacy’s coffin, Armstrong tells McMaugh.

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

Guild Victorian branch president Anthony Tassone speaks to AJP Podcast host Carlene McMaugh about the latest developments in 60-day dispensing – including the announcement of the first tranche of medicines to be affected by the policy.

“It’s extraordinary that the Federal Government would register the first 92 medicines in the tranche that commences from September the first without actually notifying the wholesalers first,” Tassone says.

Tassone discusses the recent Ergas report on the impact of 60-day dispensing on the community pharmacy sector – and the wider community – which he describes as a “real wakeup call” for the Government if the policy proceeds as announced, without further consultation and review.

He takes a look at the purported reinvestment into community pharmacy, calling it a “furphy” and taking a particular focus on opioid dependence therapy, which he says will have potentially “horrific” consequences for patients.

And what about an early 8CPA? Tassone says a new funding agreement is needed – including whether an 8CPA could be brought forward to coincide with the beginning of 60-day dispensing.

“There’s still the opportunity for the Labor Government to abide by their previous undertakings to the Guild and the community pharmacy profession,” he tells McMaugh, noting previous Labor commitments to working with the Guild on reducing the price of medicines to patients without impacting the viability of the sector.

“They still have the opportunity to do that, but it has to come with a new funding agreement.”

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

Taren Gill, who owns a pharmacy in Victoria’s western region – in the state’s lowest socioeconomic shire – talks to AJP Podcast host Carlene McMaugh about the host of new changes about to impact the pharmacy sector and its patients…and her frustration with the Government’s lack of engagement on the changes.

It’s this lack of consultation with pharmacy about so many of the impending changes which frustrate her, she says, saying that 60-day dispensing is a “logistical, rostering, recruitment and operational nightmare” – probably for all pharmacists, but particularly those practising in regional and rural areas.

“I think it’s actually a catastrophe to give, particularly in my town, people with low health literacy, 60 days’ worth of medicine,” Gill tells McMaugh.

“In a time when we’re not trusted to give out paracetamol,” or “almost harassing questioning of S3 Panadol Osteo,” pharmacists can now give out two months’ worth of a medicine which could have fatal results if taken inappropriately.”

And she critiques the money that is supposedly being reinvested into the sector – saying that as it stands, despite her pharmacy’s ranking on the Modified Monash Model scale, it will not be eligible for the increase in the rural maintenance allowance.

But alongside the other things that have not been communicated to pharmacies is the fact that this could change as 60-day dispensing reduces her script volumes.

As for opioid dependence therapy, “It’s so poorly thought out by the Government.”

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

He’s confident that in the long term, 60-day dispensing will not be catastrophic, but potentially result in a “positive outcome” for the community pharmacy network and patients.

But Bonner said that with only two and a half months to go until the first tranche of medicines become subject to double dispensing, now is the time for aged care facilities and pharmacists to ascertain who may benefit from it – which, when it comes to nursing home residents, will be a small minority – and whether 60-day dispensing is right for them.

Teething problems will include how facilities, particularly in rural and regional areas, will manage fallout from the community sector – particularly given changes to the residential onsite pharmacist initiative.

“The onsite pharmacist funding redirection of that $350m to the community pharmacy network did come as a very disappointing announcement for the care providers – they were looking forward to having that funding, to be able to have the autonomy over the services they receive and the pharmacists they engage,” Bonner said.

“They’re now very concerned, and getting communication from their supply pharmacies around the impact that the 60-day dispensing will have on their service.”

With 70% of aged care providers operating at a loss, they won’t have the capacity to absorb the extra financial load if they are charged more for services such as dose administration aid packing, Bonner warned.

And he says that for the community sector, “The best approach to get the Government and the stakeholders to listen at this point is focus more on the impact to the consumer and the patients, how this is going to affect them.”

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

Speaking to Carlene McMaugh for the AJP Podcast, Topp said that the senior staff who run the Health Department, “Quite frankly…do not understand this at all”.

“It’s pretty gobsmacking, isn’t it, that this can be dreamed up as a concept – obviously, a long time ago, without us being aware of it – and then landed in pharmacy’s lap with literally a few weeks to work out how they’re going to handle the impacts,” Topp tells McMaugh in this discussion on double dispensing.

This goes “right down to the granular level,” he said, questioning how patients will access methadone, how extra services will be managed with fewer staff, how aged care changes will take place and how pharmacies can build infrastructure without a sufficient income stream.

Topp calls the impact analysis used to support the measure “embarrassing” and “was written to retrofit the policies”.

“We know there will be pharmacies that do not survive this.”

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

From a potential reduction in employment opportunities, to having to manage the expectations (and misunderstandings) of the general public, pharmacists on the front line will have a lot to deal with, Dunkley tells AJP Podcast host Carlene McMaugh.

“We’re already seeing some impacts on frontline staff when members of the public have actually…incited others to complain to pharmacies and make a fuss, and tell them to take down the signage, and stop running the petitions, and things like that,” she said.

“We’re already seeing pharmacists and pharmacy staff who are going to work and receiving unpleasant behaviour and abuse from members of the public, because of the introduction of 60-day dispensing and the campaigns around that.”

Dunkley said she is “very concerned” for pharmacists’ wellbeing as a result of the move – and points out that a “wide range” of pharmacists had been in touch with the PSS, sparking a sudden rise in calls.

She discusses the problems patients may face as a result of double dispensing, including confusion as scripts run out over different times – and has advice for pharmacists who want to protect themselves and their staff.

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

Speaking with Carlene McMaugh, Tassone warned that community pharmacies were already planning to cut a range of services, to offset the forecast losses stemming from the controversial Budget measure.  

“There are pharmacies reviewing whether they can continue to service residential aged care facilities, based on what 60-day dispensing will represent from 1 September,” he said.  

“If there’s pharmacies potentially walking away from these contracts, or not sure whether they can continue them, or needing to review pricing – we have a perverse policy outcome where our older, most vulnerable, patients are actually worse off, in that they have less access to services from their local pharmacy. 

“They may need to pay more for their home deliveries, or Webster packing, or dose administration aid services, whilst not actually receiving a financial benefit in out-of-pocket expenses if they are still reaching the safety net.” 

Tassone said that the Guild had been in negotiations with the Department of Health and Aged Care for much of April about the government’s plan, but a scheduled meeting on 24 April had been cancelled, with the Minister for Health announcing the policy two days later.  

“The Guild remains committed to working with the government, that if they are insistent on taking forward 60-day dispensing as a measure for patients, that we sit down at the table and find a way forward that won’t leave patients worse off, and won’t leave pharmacies worse off,” he said.  

“But we need to sit down to discuss that further together, because at this stage, as announced, this measure will have dramatic negative impacts for patients and pharmacies.”  

Go here for the full list of active AJP podcasts. These can also be accessed via Apple Podcasts and Spotify

What will be the day-to-day impacts of the government’s 60 day dispensing announcement? In this AJP Podcast, Carlene McMaugh talks to Victorian independent pharmacy owner Natalie Kopas about her thoughts around the decision and its impacts.

How will 60 day dispensing add to the pressures they are already experiencing at the coalface? What will be the impact on financial security, workloads, the services they can offer to patients? How will it impact medicine shortages?

Natalie Kopas

Go here for the full list of active AJP podcasts, including a recent series covering the 60-day dispensing issue. These can also be accessed via Apple Podcasts and Spotify

Carlene McMaugh, Podcast host