review of pharmacy remuneration and...

Hall & Partners | Open Mind MEL: +61 (0)3 9662 9200 SYD: +61 (0)2 9925 7450 [email protected]

Review of Pharmacy Remuneration and Regulation Research Findings November 2016

Quantitative research report

Table of Contents Executive summary ............................................................................................................................. 4

Background and methodology ............................................................................................ 4

Findings from the consumer survey .................................................................................. 4

Pharmacy medicines and products ............................................................................................ 4

Pharmacy services and quality use ............................................................................................ 4

Findings from the Pharmacy Professionals Survey ..................................................... 7

Pharmacist remuneration ........................................................................................................... 7

Research context .............................................................................................................................. 10

The Review of Pharmacy Remuneration and Regulation ........................................ 10

Quantitative research overview ........................................................................................ 10

Research objectives ............................................................................................................... 11

Research methodology ..................................................................................................................... 12

Quantitative research approach ....................................................................................... 12

Target audience and sample .............................................................................................. 12

Data collection ........................................................................................................................ 13

Questionnaire structure and average survey length .................................................. 14

Data analysis .......................................................................................................................... 14

Findings from the Consumer Survey ................................................................................................. 16

Profile of consumers .............................................................................................................. 16

Pharmacy medicines and products .................................................................................. 24

Pharmacy services and quality use .................................................................................. 28

Access to medicines ............................................................................................................... 48

Affordability of medicines ................................................................................................... 58

Awareness of PBS medicines pricing mechanisms .................................................................. 58

Findings from the Pharmacy Professionals Survey ........................................................................... 66

Profile of pharmacy professionals.................................................................................... 66

Pharmacy remuneration ..................................................................................................... 70

Pharmacy regulation ............................................................................................................ 87

Wholesale, logistics and distribution ............................................................................... 95

Accountability and quality standards ........................................................................... 100

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16132 - 16146 – Department of Health – Pharmacy Remuneration and Regulation

Pharmacy consumer experience ..................................................................................... 103

A note on the research samples ....................................................................................... 110

Consumer Survey ....................................................................................................................... 110

Pharmacy medicines and products ................................................................................ 110

Pharmacy services and quality use ................................................................................ 110

Access to medicines ............................................................................................................. 111

Affordability of medicines ................................................................................................. 112

Pharmacy Professionals Survey ................................................................................................. 112

Pharmacy remuneration ................................................................................................... 112

Pharmacy regulation .......................................................................................................... 113

Wholesale, logistics and distribution ............................................................................. 113

Accountability and quality standards ........................................................................... 114

Pharmacy consumer experience ..................................................................................... 114

Appendix A: Coded responses to survey open ended questions .................................................... 115

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Executive summary Background and methodology

The Australian Government Department of Health is facilitating a review of pharmacy remuneration and regulation by an independent Review Panel. The Review Panel released a broad-ranging discussion paper intended to stimulate debate on issues in scope for the Review and engaged Hall & Partners Open Mind to undertake a program of research to accompany the formal public submissions process and feed into the Review. This report contains findings from a quantitative phase of research based on online surveys designed to provide members of the public and pharmacists an alternative avenue through which they can respond to issues raised in the discussion paper.

Findings from the consumer survey

Pharmacy medicines and products

While prescription, OTC and off the shelf medicines or treatments are clearly seen as the core product offering in pharmacy (in each case, at least 93% of consumers reported that such an item should be available in pharmacies), the majority of consumers participating in the survey were also in support of complementary medicines or treatments and retail products being available for sale (76% and 72% respectively). Indeed, close to two thirds of consumers wanted to buy these products themselves in a pharmacy (68% in relation to complementary medicines/treatments, 61% in relation to general retail products), and this was higher amongst women and frequent pharmacy customers. Despite support for complementary products in pharmacy, most of these consumers (65%) agreed that treatments that make dubious health claims should not be sold. It is unclear from this research what consumers consider a dubious health claim to be. When it comes to generic medicines, generic and biosimilar medicines were widely considered to be as safe as branded medications (just six percent considered them not as safe), though around one in eight (12%) would not choose a generic.

Pharmacy services and quality use

Unlike pharmacy products, many of the services that are provided in pharmacies (but not necessarily all pharmacies) were not well known among this sample of consumers. Half of these consumers (48%) indicated they are well aware of the pharmacy services and programs that are personally relevant, but many others were uncertain (44%). Participants saw increasing awareness of pharmacy services as being primarily the domain of pharmacies or doctors (mainly through in-person notification), as well as the government (including through mass media advertising).

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Most of this sample believe that little known services, such as ATSI programs and outreach services, should be available (76% and 85% believing they should, respectively), though few expected to access them themselves. Least support is expressed for services such as wound care (69%) or the issuing of medical certificates (57%). For those interested in accessing particular services, there was a willingness to pay for some of these services. This however is not the case for pharmacist advice about treatment or medicines – the vast majority of these consumers (at least 90%) claimed to want to access this advice but few (just 10%) indicated a willingness to pay for it. Most of the participants responding to the Consumer Survey (56%) disagreed that service levels across pharmacies are consistent – indeed on average each participant nominated 3.5 factors by which service standards vary. This is considered to be the result of factors far beyond the relationship with the pharmacist (52%) and is also to do with the pharmacist themselves and the pharmacy they operate within. Price variability across pharmacies is also noticed by consumers (40%) and some indicated that this, in turn, impacts service levels. The ability to provide customer feedback to pharmacies was considered to be important by 71% of participating consumers, however a minority (24%) appeared confident of how exactly they would provide feedback. Responses to this survey suggest appetite among pharmacy consumers for a pharmacy environment that reflects a more clinical focus. Across all the scenarios tested in this research, a dispensing or clinic style pharmacy was preferred, usually by the majority (except for the scenario of filling a repeat script), each time over a pharmacy environment with an equal or larger focus on retail. Indeed, nearly half believed that a creating a health care atmosphere (instead of a retail feel) should be a requirement of pharmacists given they receive government payments to dispense PBS medicines. A minority of these consumers (roughly one in ten) reported experiencing difficulty obtaining information about medicines or understanding how to use them. Of these, most believed that the solution lay in the hands of pharmacists and doctors taking the time to explain and respond to queries, while better and consistent provision of written information and public education were also seen to offer help in this regard. Expectations of the service provided by pharmacists at the time of dispensing prescription medicines was highly variable depending on whether it was an initial or repeat prescription – importantly, for the vast majority, most of these service expectations were not always met; just 14% said their expectations were always met.

Access to medicines

Access to pharmacies was reported as an issue by very few of these consumers (12%), even when they are away from home (just 13% say it’s more difficult to access pharmacies when they are away from home or their usual place of work). Main access issues seemed to focus on out of stocks within pharmacies rather than an inability to locate a pharmacy, though some people in particular locations

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(e.g. rural) did identify a shortage of outlets. Moreover these consumers largely supported location rules if they mean that all Australians have access to pharmacies. In terms of when access to pharmacy products and services is required, weekend (76% important) and evening access (60% important) was the priority for these consumers. Most (65%) also expect a nearby pharmacy to match the opening hours of medical centres. Prescription (89%) and over the counter (OTC) medicines (83%) were ‘must-haves’ for extended hours pharmacy access while interest in retail and complementary products after hours was subdued (both 19%). Interestingly, 44% of consumers claimed that they may be deterred from using an extended-hours pharmacy if prices were higher. On balance, technology enabled dispensing was seen by participants as potentially having a positive impact on public access to medicines (53% thought it would have a positive impact, just seven percent a negative impact) though one in five (20%) were concerned about its impact on the provision of advice. Most participants also saw that technology enabled dispensing could provide advantages relating to record keeping, such as access to personal medical history. Consumers were somewhat divided in their perceptions of hospital pharmacy as a means of improving access to pharmacy. While at least two in five (41%) were in support of the various scenarios tested, between one in ten (10%) and a quarter (24%) were against these ideas. Just over three in five (62%) said they would not be interested in using hospital pharmacies as a member of the public if it meant nearby community pharmacies were negatively impacted. Supermarkets were unpopular as pharmacy outlets in this sample (just 15% agreed that they would like to be able to access pharmacy dispensing services in a supermarket and 66% disagreed), except among participants living in areas where there are few accessible pharmacies.

Affordability of medicines

Awareness of the way in which prices of medicines are set appeared high among this sample, with most being aware of the role of the Commonwealth Government in negotiating (64% aware) and setting prices of PBS medications (81% aware), for instance. This is much higher than might be expected – given indications from the qualitative research (reported under a separate cover). Eight in ten (81%) reported they were aware that PBS subsidised medicines can represent a significant cost to the Government above the co-payment. Overall, those completing the Consumer Survey were supportive of consistent (75% agree) and transparent (74% agree) pricing for PBS medicines and some limits for pharmacist pricing discretion (64% agree), especially if it meant a price increase (just 11% supported this being allowed) as opposed to a discount (in contrast, 39% supported this being allowed). At least half (54%) of participants considered their co-payment to be a fair contribution and even more (71%) felt at least some contribution by patients towards the cost of medicines was appropriate. Less than a quarter

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(just 20%) reported having benefited from the $1 co-pay discount, and the large majority of these (82%) claimed this did not influence their choice of pharmacy.

Findings from the Pharmacy Professionals Survey

Pharmacist remuneration

Overall pharmacy professionals participating in this survey were not supportive of flat-fee dispensing payments, with roughly two in five (41%) believing this supports undesirable outcomes. Instead they favoured a combination of fixed and variable fees (similar to the current system; 47% preferring this option) or only variable fees (37% preferring this) – the amount of which would reflect the amount of time and effort involved in providing the pharmacy service and, to a lesser extent, the price of the medicine among other factors. With regards to the system by which pharmacists payments for dispensing would be distributed, pharmacists that are not owners favoured the option most commonly preferred overall, namely remuneration for advice under the Medicare Benefits Schedule (56% of non-owner pharmacists favoured this, compared to 36% of owners) while owners preferred payment on a per prescription basis (55% of owners favoured this, compared to just 26% of non-owner pharmacists). The vast majority of these participants (80%) were not in favour of discounting of the $1 PBS co-payment discount. , within the context of being asked what limits they felt should apply to pharmacist pricing discretion, some expressed the view that there should be fixed prices for PBS medicines (26% in a free-response question), that pharmacist discretion should not be allowed (21%) and that discounting can be damaging (11%) by focusing both pharmacists and consumers on price, rather than service and health outcomes (10% saying this in relation to patients). Smaller proportions reflected the view that there should be no limits on pharmacist discretion (10%), while some believed that under certain specific circumstances, discretion should be permitted (11%). Few (just 10%) believed that the $1 co-payment discount was a very positive step for consumers. Among this sample of pharmacy professionals there was a majority belief (52%) that negotiations about dispensing remuneration should include parties beyond just the Pharmacy Guild, in particular other professional bodies or unions representing pharmacists (93% of those thinking that parties beyond just the Pharmacy Guild should be included nominated such a group). Indeed, overall there was even more support amongst pharmacists and owners for non-Guild bodies or unions representing pharmacists to be included in such negotiations than there was support for Guild involvement (just 66%). A partnership remuneration approach was the most likely option to be selected by this sample (64% favoured this approach) over a licensing (16%) or contract approach (just four percent) when it comes to supporting pharmacists to provide the community with timely and reliable access to medicines.

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Pharmacy regulation

The majority of these pharmacy professionals were of the view that the removal of location rules across the board or just in urban areas would have a negative impact on consumer access to medicines – 60% were of this view in the context of removing all location rules, 54% in the context of removing such rules just in urban areas. Moreover, almost half believed that these changes would also have a negative effect on medicine affordability (43-45%). Of the other changes to location rules tested in this survey, not one change attracted support from more than half of this sample (the highest support being just 45%). Technology enabled dispensing was seen by many (42%) to be an inevitable change and one that will allow innovation in pharmacy medicine dispensing (54%). However around a third (34%) hold reservations about the benefits and drawbacks of remote dispensing, an innovation likely to emerge from technology enabled dispensing.

Wholesale, logistics and distribution

Under Community Service Obligations (CSO), minimum service requirements to regional and rural locations were perceived by this sample to have a very positive impact on access and affordability by two to three in ten (30% and 20%, respectively). Allowing direct supply by manufacturers outside of the CSO, on the other hand, most commonly received a negative response (48% felt it was having a negative impact with respect consumer access to medicines, 42% felt it was having a negative impact with respect medicine affordability). Indeed there was little support for the supply of PBS medicines direct to pharmacies from manufacturers (just 24% supported this, 41% did not). A popular suggested change to wholesaling arrangement (63% supporting) was placing the responsibility for timely delivery of medicines on manufactures as part of their PBS listing requirements.

Accountability and quality standards

In terms of pharmacy standards for delivery of services and dispensing of medicines, approaching half (46%) believed they are sufficient and most (60%) believed they are being upheld in community pharmacy, but this was not seen to be the case for discount pharmacies (just 12% believed they were upheld in the discount pharmacy context). These pharmacy professionals were mostly keen to see data on the impact of pharmacy programs on health outcomes (73% felt this would be very valuable), but while most (64%) realised they play a role in generating this data, they wanted funding to support this (63%).

Pharmacy consumer experience

Pharmacy professionals see themselves as well placed to offer a variety programs and services to consumers – both medicine and non-medicine related. Most common suggestions provided by this sample included: medicine checks and reviews (mentioned by 66% of those answering this free response question); advice, information, counselling and education (42%); chronic disease

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management services (40%); diagnostic, screening and testing services (38%); as well as vaccinations and immunisation information (35%). In terms of pharmacy services, similarly to consumers, pharmacy professionals surveyed see less of a role for themselves in providing wound care (although 79% still felt consumers should expect to receive this service from community pharmacies) and medical certificates (69%) than other services and programs tested. Unlike consumers, however, these pharmacy professionals were polarised in their views of the benefits of a clinic-style pharmacy environment. While two in five (40%) agreed that it would deliver a better health service than a retail-style pharmacy, more than a quarter (28%) expressly disagreed that it would. Pharmacy professionals on balance were of the view that consumers are not generally informed of the services and programs pharmacists can provide (32% felt they were not compared to 17% thinking that they are), nor those they are entitled to use (45% felt they were not compared to just seven percent thinking that they are). Many (40%) clearly attributed this to inadequate promotion of these services to consumers. When it comes to complementary medicines, pharmacies were most commonly seen as a suitable home for these products (48% agree), and their presence was infrequently considered to create a conflict of interest for the pharmacist (thought to create such a conflict by just 22% of the sample). Though some (42%) did admit the stocking of these products in pharmacy may suggest to consumers that there is scientific evidence to support their use. Indeed, around a third (34%) supported the idea that there should be limitations on the types of products pharmacies should sell.

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Research context The Review of Pharmacy Remuneration and Regulation

With our population ageing and our communities increasingly reliant on medicines to maintain health and wellbeing, pharmacy is a crucial part of health care in Australia. Pharmacy care and medicines are currently delivered to the Australian public by community pharmacies. The agreement under which pharmacy medicines and services are provided, the 6th Community Pharmacy Agreement, is due for review. The Australian Government Department of Health is facilitating a Review of Pharmacy Remuneration and Regulation by an independent Review Panel. The focus of the Review is to ensure consumers have reliable and affordable access to medicines through community pharmacies. The Review Panel will provide recommendations on remuneration, regulation, and other specific arrangements relating to the dispensing and supply of medicines provided under the Pharmaceutical Benefits Scheme and other pharmacy services. The changes which result may impact many aspects of pharmacy for both the providers of care and medicines, as well as their recipients – the Australian public. Panel recommendations will therefore be based on an extensive review of pharmacy in Australia including factors contributing to patient health outcomes and the use of medicines. Many voices will be considered in this process, which aims to ensure pharmacy in Australia provides reliable and affordable access to medicines and supports the quality use of medicines by consumers. In July, 2016, the Review Panel released a broad-ranging Discussion Paper intended to stimulate debate on issues in scope for the Review. Hall & Partners Open Mind was engaged to undertake a program of research, including qualitative and quantitative components, to accompany the formal public submissions process and feed into the Review.

Quantitative research overview

The quantitative component was designed to obtain feedback on the specific issues raised in the Discussion Paper. It employed an online self-completion method, which allowed interested pharmacists, consumers or other stakeholders the opportunity to respond to the discussion paper without having to make a formal written submission. The qualitative research component covered consumers only, with the objective of understanding their perspectives and experiences in more detail. This was achieved through consumer focus group discussions, one-on-one interviews and online discussion boards with people from around Australia. This report outlines the quantitative findings only. The qualitative findings are reported under separate cover.

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Research objectives

The specific objectives of the quantitative research component were to:

• Obtain responses of practicing pharmacists (including potentially employee pharmacists, pharmacist technicians, hospital pharmacists and pharmacy owners) to the most important topics raised, and questions posed, in the Discussion Paper.

• Obtain responses of consumers of pharmacy care and medicines to the most important topics raised, and questions posed, in the Discussion Paper.

The methodology employed for this research exercise is described in the following section.

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Research methodology Quantitative research approach

An online self-completion approach was selected for the study to increase participation and maximise success in capturing meaningful responses from the greatest number of willing participants. The issues raised in the Pharmacy Remuneration and Regulation Discussion Paper (July 2016) are complex, but a self-completion approach allowed participants the opportunity to engage with these ideas and respond in an efficient manner and at a time of their choosing without having to complete a formal written submission.

Target audience and sample

The online questionnaire aimed to engage interested stakeholders; including consumers, pharmacists, health professionals, hospitals, wholesalers and medicine companies to contribute their views. All participants in the survey were presented with the same initial screening question, and the answer determined which survey was the most appropriate for them to complete. Following this screening question, participants were redirected to one of two surveys. Each survey was tailored to the target audience being either:

1. ‘Pharmacy Professionals Survey’ - Pharmacists (owners and employee pharmacists), pharmacy assistants and technicians and stakeholders working in the medicines industry.

2. ‘Consumer Survey’ - Members of the general public, health professionals and practitioners (not qualified pharmacists).

A total of 2,298 people completed one of the two surveys; 809 of those completed the Consumer Survey and 1,489 completed the Pharmacy Professionals Survey. The surveys were completed via an open link located on the Pharmacy Review webpage and promoted by the Department of Health and the Review Panel. Given the goal was to enable participation by anyone interested in responding to the Discussion Paper, and no quotas were placed on the survey sample, it is not possible to treat these final samples are representative of either Pharmacy Professionals or Consumers, but simply reflective of those completing each survey.

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Table 1, below, shows the number of responses across each survey received from different types of respondents. It should be noted that the screening question directed anyone who did not indicate they were one of the four specified types of pharmacy professionals (shown in the table below) to the Consumer Survey. This means that a broad range of interested persons completed the Consumer Survey beyond simply members of the general public with no professional relationship to pharmacy. Table 1: Survey completions Survey Total (%) Total (n) Consumers Member of the general public 66% 533 Member of the general public who works in a role

that requires the use of pharmacy services 3% 25

Other health professional / practitioner 15% 118 Pharmacy Student/ Intern Pharmacist 7% 56 Pharmacy or medical management, allied health or

related industry, Department of Health employee, banker/advisor to pharmacy, retired pharmacist

7% 57

Patient advocacy, NFP, patient or illness peak body, patient with illness, carer, academic, researcher, medical researcher, journalist

2% 19

Base N 100% 809 Pharmacy Professionals

Pharmacist (not a pharmacy owner) 51% 754

Pharmacist who owns a pharmacy 38% 569 Pharmacy assistant or technician 6% 93 Someone working in the medicines industry (but

not a pharmacist) 5% 73

Base N 100% 1,489

Data collection

The survey questionnaires are included in this report as Appendix B. The questionnaires were designed by Hall & Partners | Open Mind, with input from the Department of Health and the Review Panel and were based on questions included in the Discussion Paper identified by the Review Panel as being of priority, which were then translated into a format suitable for a short online survey. The online surveys were programmed and hosted online by the accredited data collection company, Pureprofile. Given the substantial differences between the two questionnaires, the data files generated were independent from each other and have been analysed and reported separately within this report.

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A live link to the online surveys was embedded on the consultation webpage (www.health.gov.au/pharmacyreview#Consultation). The survey was open to anyone across Australia, with no quotas imposed on either the Consumer or Pharmacy Professionals Surveys. The online questionnaire link was live for 40 consecutive days, from 25 August to 3 October 2016. During this period, a total of 8,274 stakeholders clicked the ‘Complete the Questionnaire Now’ link and 2,298 completed one of the two surveys and submitted the answers. Although there were no quotas applied to the survey, the final samples contain a substantial number of responses from people in key sub-groups. Given this, appropriate significance testing has been applied to responses between selected sub-groups within the sample, and significant differences between sub-groups are reported throughout this document where relevant.

Questionnaire structure and average survey length

The average survey length for the Consumer Survey was 25 minutes and the Pharmacist Professionals Survey was 31 minutes. The Consumer Survey covered five topics, plus profiling questions, listed below:

• Consumer awareness and expectations of community pharmacy; • Service expectations and quality; • Access to medicines; • Price of medicines; • Improving access and understanding; and • Profiling questions (age, gender, education level, living situation, carers status, place was

born, CALD and Indigenous). The Pharmacy Professionals Survey covered five topics, plus profiling questions, listed below:

• Pharmacy remuneration; • Pharmacy regulation; • Wholesaling, logistics and distribution; • Quality standards; • Experience of pharmacy; and • Profiling questions (wholesaler or representative, employment status, pharmacy setting and

location).

Data analysis

Both surveys contained open ended questions answered by participants in free text fields to ensure the range and depth of possible responses to certain issues were captured. Open ended responses were coded in-house by researchers involved in the project. Hall & Partners | Open Mind consultants

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coded a total of nine (9) open ended questions (3 in the Consumer survey and 6 in the Pharmacy Professionals survey). Given that some of the open ended responses were particularly detailed or did not specifically respond to the question at hand, the code ‘other’ was created. In the open ended questions, ‘other’ includes those standalone comments that were too detailed or divergent in meaning to be grouped. All data analysis was conducted by Hall & Partners Open Mind consultants using Statistical Package for the Social Sciences (SPSS) and tables were created using the Q software package. The statistical analysis Chi-Square Test was used to highlight significant differences and compare responses across selected sub-groups within the sample. Significant findings are reported through this document where relevant. Analysis was performed using standard inferential statistics with a confidence level of 0.95. Only statistically significant differences have been highlighted and commented on in the report.

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Findings from the Consumer Survey Profile of consumers

This section provides an overview of the characteristics of the sample completing the Consumer Survey. The detailed survey results that follow this section should be interpreted in light of these characteristics. As shown in Figure 1, Consumer Survey participants were predominantly woman (63%) and aged between 30 and 69 years (78%).

Figure 1: Participant gender and age

Q30/31: Are you…? Base: All respondents n= 809

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All states and territories are represented in this sample, with Victorians (28%) more commonly participating than those from other states, followed by residents of New South Wales (25%). Three quarters of the Consumer Survey sample (76%) were residents of metropolitan areas, and 8% of the sample was located in in rural and remote areas. Figure 2: State and location1

Q43: Please enter your postcode Base: All respondents n= 809

1Participants’ residential location was based on postcodes provided in Q43. All Australian postcodes were allocated into state and into area [metropolitan (major cities), regional (inner regional) and rural/remote (outer regional, remote and very remote)] according to the Department of Health’s ARIA+ (Accessibility/Remoteness Index of Australia) classification.

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The majority of the Consumer Survey sample is degree qualified (72%), while a further 16% holds another form of post-school qualification (diploma or certificate). Over one third of those completing the Consumer Survey have children living at home (37%), while most of the remainder live in households without children (58%). Figure 3: Level of education and living situation

Q32: What is the highest level of education you have completed or are undertaking? Q33: Which of these best describes your living situation? Base: All respondents n= 809

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One quarter of Consumer Survey participants is involved in caring for children aged 18 or under (24%) and just under one in five (19%) stated they are caring for elderly or disabled family members or friends. Of the 48% overall who have caring responsibilities, 5% care for both adults and children. This means that the proportion of the sample that are carers (48%), is equal to the proportion that are not carers (48%). Figure 4: Caring responsibility

Q34: Do you have loved ones to whom you provide care, including support with medical care if required? This includes any children in your care, but does not include people you are paid to care for as part of a job. Please indicate all that apply. Base: All respondents n= 809

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Around a quarter (24%) of the Consumer Survey sample was born in a country other than Australia, however few speak a language other than English at home (4%). Further, very few people from Aboriginal or Torres Strait Island backgrounds completed the Consumer Survey (1%). Figure 5: Place of birth and language spoken at home

Q35: Where were you born? Q36: What is the main language spoken in your household.. Q37: Do you identify as.. Base: All respondents n= 809

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Almost all of the Consumer Survey sample reported having visited a pharmacy at least once in the last 12 months (99%) with the majority having frequented a pharmacy at least once a month (79%). Most tended to use the same pharmacy (65%) in the last year, while around a third (35%) tended to use a variety of pharmacies. Figure 6: Frequency of pharmacy visits and use of one or more pharmacies in the past year

Q39: In the last year, did you tend to use one particular pharmacy for most pharmacy needs, or did you tend to use a variety of pharmacies? Base: Respondents that visited a pharmacy at least once in the last year n= 803

Q38 In the last year, how often have you visited a pharmacy, either for you or for someone you care for? Base: All respondents n=809

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Almost half (46%) of those completing the Consumer Survey who have visited a pharmacy in the last year paid the general co-payment rate of $38.30 for their most recent prescription, 19% paid the concessional rate of $6.20, either through concessional status or as a result of reaching the Safety Net. Only 3% paid nothing for their most recent prescription having qualified for the concessional Safety Net rate. Eleven percent (11%) indicated they paid another amount and 12% did not recall how much they paid. Figure 7: Price paid for prescription medicine purchased under the PBS

Q38b: Thinking of the most recent prescription medicine you purchased that was covered by the Pharmaceutical Benefits Scheme, what amount did you pay for this PBS medicine (the co-payment)? Base: Respondents that visited a pharmacy at least once in the last year n= 803 More than eight in ten (84%) of those completing the Consumer Survey have used a ‘traditional’ community pharmacy in the last year, and 43% have used a discount warehouse pharmacy. More than a quarter (27%) have used both types of pharmacy in the last year. Those completing the Consumer Survey most commonly use pharmacies located on shopping strips or villages, with seven in ten (70%) indicating the community pharmacy they most commonly used in the last year is located in this type of shopping area. Around one in five (22%) indicated that the community pharmacy they used most often in the last year is located in a shopping centre or mall, and, for 7%, their usual pharmacy is located in a medical centre.

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Figure 8: Community pharmacy type and location

Q40: Which types of pharmacy did you used in the past year? You may indicate more than one. Base: Respondents that visited a pharmacy at least once in the last year n= 803 Q41: Was the community pharmacy you used most often located in a…? Base: Respondents who visited a community pharmacy n=674

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In the first set of questions in the Consumer Survey, participants were presented with five types of pharmacy medicines/products. For each type of medicine/product, participants were asked whether they:

• believed it to be currently available in pharmacies; • felt that it should be offered for purchase in pharmacies; and • personally wanted to be able to purchase it in pharmacies.

Results for those three questions were grouped and are presented in Figure 9. There was a very high level of awareness of current availability for each of the types of medicines/products asked about, with negligible difference in awareness between types. For each, at least 95% completing the Consumer Survey said they believed, based on their experience, that the type of medicine/product was currently available in pharmacies. Similar proportions believed that prescription-only medicines and treatments (98%), over the counter medicines/treatments (96%) and medicines/treatments available on pharmacy shelves (94%) should be offered for purchase in pharmacies. Views on whether complementary medicines/treatments or retail products other than medicines or treatments should be offered for sale were, however, more mixed, with 76% and 72%, respectively, saying they believed they should be available in pharmacies. Smaller proportions of those completing the Consumer Survey wanted to personally purchase complementary medicines or treatments (68%) or retail products other than medicines or treatments (61%) in pharmacies.

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Figure 9: Views on current availability and appropriateness of different types of medicines/products in pharmacies, and personal interest in accessing these

Q2: Based on your experience, which of the following types of medicines and products are currently available in pharmacies? Q3: And in your opinion, which of these medicines and products should pharmacies offer for purchase? Q4: Now thinking about your own situation, and considering any others you care for, which of these medicines and products do you personally want to be able to purchase in pharmacies? Base: All respondents n= 809 There were some significant differences between demographic groups participating in the Consumer Survey regarding perceptions of availability and preferences for purchasing different types of medicines/products in pharmacies:

• Participants that visited pharmacies at least once a week were more likely than those using pharmacies less frequently to believe complementary medicines or treatments should be available in pharmacies (83% of those using pharmacies once a week, compared to 74% using them less than once a month) and that retail products other than medicines/treatments should be available in pharmacies (77% compared to 64%). They were also more likely than less frequent pharmacy users to want to be able to personally purchase complementary medicines of products in pharmacies (78% of those using pharmacies on a weekly basis, compared to 63% of those using pharmacies monthly).

• Females were more likely than males to believe complementary medicines or treatments should be available in pharmacies (79% compared to 70%), and to want to personally be able to purchase complementary medicines or treatments (71%, compared to 64%) and retail products (64% compared to 55%) in pharmacies.

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• Older participants were more likely to want to purchase prescription medicines/treatments in pharmacies than younger participants (99% of those aged over 69 years, compared to 95% of those under 30 years).

Consumer Survey participants were presented with a number of statements dealing with expectations of the types of products that pharmacies should be allowed to sell. As illustrated in Figure 11, two in three (66%) indicated that they agreed that ‘pharmacies should not sell treatments that make dubious health claims’2. In contrast, one in four (25%) agreed that ‘there should be no limitations on the types of products that community pharmacies are allowed to sell’. Figure 10: Expectations of the types of products that pharmacies should be allowed to sell

Q15: Please indicate the extent to which you agree or disagree with each of the following statements Base: All respondents n=809 Looking at differences between subgroups participating in the Consumer Survey reveals that:

• Agreement with the statement that ‘pharmacies should not sell treatments that make dubious health claims’ was significantly higher among other health professional/practitioners (76%) than members of the general public (65%) and those who jobs require the use of pharmacy services (61%). It was also higher among participants aged over 50 years (69% of those aged 50 to 69 years, and 77% of those over 70 years), compared to those aged under 30 years (55%).

• Agreement with the statement that ‘there should be no limitation on the types of products that community pharmacies are allowed to sell’ was higher among members of the general public (29%) than among other health professionals/practitioners (12%). Participants that visited pharmacies at least weekly (35%) were also significantly more likely to agree with this statement than less frequent pharmacies users (23% of those using pharmacies around monthly and 20% of those using pharmacies less often than once a month).

Two statements in the Consumer Survey covered perceptions of and preferences for generic and biosimilar medicines. As shown in Figure 12, almost one in four of those completing the Consumer Survey (24%) provided a response suggesting they were undecided about whether or not generic

2 providing a response of between 5 and 7 on a 7-point scale from 1 – strongly disagree – to 7 – strongly agree.

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and biosimilar medicines are as safe to use as their equivalent brand name versions3. Seventy percent (70%) agreed that they were just as safe, although just 49% strongly agreed. Sixty five percent (65%) agreed that they were likely to choose a generic medicine where one was available. Figure 11: Perceptions and preference for generic and biosimilar medicines

Q15: Please indicate the extent to which you agree or disagree with each of the following statements Base: All respondents n=809 Significant differences were observed among some sub-groups in terms of attitudes towards the types of products that pharmacies should be allowed to sell.

• Agreement with the safety of ‘generic and biosimilar medicines subsidised under the PBS’ was significantly higher among members of the general public who work in a role that requires the use of pharmacy services (77% compared to 71% of general public and 55% other health professionals/practitioners) and those under 30 years (80% compared to 64% of those aged 50 to 69 years).

• Participants under 30 years old (79%) were significantly more likely to choose a generic medicine when available when compared to older participants (64% of those aged 30 to 49 years, 63% aged 50 to 69 years and 61% over 70 years). Similarly, those with a university degree (68%) were significantly more likely to choose generics than those with a diploma (56%).

3 20% providing a ‘neutral’ response of 3, 4 or 5 on a seven-point scale, and a further 4% expressly saying they didn’t know

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Mirroring questions reported above measuring perceived availability of, appropriateness of, and personal interest in, pharmacy medicines/products, were three questions about pharmacy services. Figure 13 presents the findings for these three questions together, ordered from the largest to the smallest proportion believing each service should be offered in pharmacies. For 10 of the 14 services asked about, a clear majority – at least three in five – of Consumer Survey participants indicated that they were aware that particular service was currently available at pharmacies. Awareness was highest for: advice on medicines or treatments available on pharmacy shelves, and advice for those available over the counter (both 94%); specific advice on using prescription medicine (92%); and advice on treating minor injuries or ailments (91%). These were also the services most consistently viewed as ones that pharmacies should be offering, alongside medication preparation or packaging services (each nominated by at least 90% of Consumer Survey participants). They were also the services most consistently nominated as services of interest to participants personally (each nominated by between 79%, for advice on treating minor injuries or ailments, to 90%, for the three other services). The four services with less than majority awareness included: ATSI programs (just 22% aware); wound care management (43%); medical certificates (48%); and pharmacy outreach services (50%). While comparatively small proportions of the survey sample indicated they would personally want to be able to access either ATSI programs (19%) or pharmacy outreach services (43%) – likely reflecting the size of the populations these services target – both of these were widely considered important services for pharmacies to offer (76% and 85%, respectively). In contrast, wound care management and medical certificates were services participants felt less strongly should be offered – these were the lowest ranked services on this measure, although still nominated by 69% and 57%, respectively – or that they would personally want to be able to access in pharmacies (50% and 46%, respectively).

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Figure 12: Views on current availability and appropriateness of different pharmacy services, and personal interest in accessing these services

Q5: In addition to selling medicines and products, pharmacies also offer a range of services. Based on your experience, which of the following services are currently available at pharmacies? Q6: And, in your opinion, which of these services should pharmacies offer? Q7: Now thinking about your own situation, and considering any others you care for, which of the following services do you personally want to be able to access in pharmacies? Base: All respondents n= 809

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Figure 13: Views on current availability and appropriateness of different pharmacy services, and personal interest in accessing these services (continuation)

Q5: In addition to selling medicines and products, pharmacies also offer a range of services. Based on your experience, which of the following services are currently available at pharmacies? Q6: And, in your opinion, which of these services should pharmacies offer? Q7: Now thinking about your own situation, and considering any others you care for, which of the following services do you personally want to be able to access in pharmacies? Base: All respondents n= 809 Key sub-group differences in perceptions of availability and appropriateness of, and personal interest in, specific pharmacy services, include:

• Specific advice on medicine prescribed by a doctor o Awareness of current availability was higher among those aged 50 to 69 years

(95%, compared to 90% of those aged 30 to 49 years and 88% of those aged under 30 years), residents of metro and regional areas (93% and 94% respectively, compared to 85% living in rural/remote areas) and weekly pharmacy users (97%,

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compared to 91% using pharmacies at least once a month and 90% less often than once a month).

• Advice on medicines or treatments that are available on pharmacy shelves o Awareness of current availability of this service in pharmacies was higher among

participants aged 50 to 69 years (97%), than among those aged 30 to 49 years (93%).

o People working in a role that requires the use of pharmacy services (94%) and members of the general public (90%) were more likely to want to access this service than other health professionals/practitioners (82%). Similarly, participants under 30 years were more likely than older participants to want to access this service in pharmacies (96% against 87% of those aged 30 to 49 years and 89% of those aged 50 to 69 years).

• Medication preparation or packaging services o Awareness of current availability was higher among people working in a role that

requires the use of pharmacy services (96%, compared to 83% of members of the general public) and participants aged under 30 years old (95%, compared to 81% of those aged 30 to 49 years and 84% of those over 70 years).

o Carers of adults were more likely to want to be able to access this service (72%) than non-carers (59%). Similarly, interest in accessing this service increased with age (56% of those aged 30 to 49 years, 61% of those aged 50 to 69 years and 77%, of those aged 70 and over), was higher among those living in rural/remote areas (74%) than regional areas (56%), and also higher among weekly pharmacy users (67%) than those visiting pharmacies less than once a month (53%).

• Advice on treating minor injuries or ailments o Awareness of current availability was higher among people working in a role that

requires the use of pharmacy services (97%, compared to 91% of members of the general public and 86% of other health professionals/practitioners) and residents of metro areas (93%, compared to 87% in regional and 85% in rural/remote areas).

o Participants who were a member of the general public and those working in a role that requires pharmacy services (83% and 85% respectively) were more likely to want to access this service than other health professionals/practitioners (54%). In addition, interest in accessing this service decreased with age from 89% of those under 30 years to 78% of those aged 30 to 49 years and 77% of those aged 50 to 69 years.

• Pharmacy outreach services o Awareness of current availability was higher among people who work in a role that

requires the use of pharmacy services (66%) and other health professionals/practitioners (57%) than among members of the general public (44%).

o People working in a role that requires the use of pharmacy services (92%) were also more likely to feel this service should be available from pharmacies than members

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of the general public (83%), who perhaps were less clear on what this service might entail.

o Carers of adults (50%) were more likely to want to access this service than carers of children (35%). Similarly, weekly pharmacy users (55%) were more likely to want to access this service than those that visit pharmacies on a monthly basis (41%).

• Diagnostic and screening services o Awareness of current availability was higher among people who work in a role that

requires the use of pharmacy services (87%, compared to 75% of other health professionals/practitioners and 72% of members of the general public), those born in Australia (78% compared to 67% of those born in another country) and those under 30 years (89%, compared to 76% of those aged 50 to 69 years).

o People working in a role that requires the use of pharmacy services (90%) were also more likely to mention that this service should be available in pharmacies than members of the general public (83%) and other health professionals/practitioners (53%).

o Those working in a role that requires the use of pharmacy services (73%) were more likely to want to access this service than members of the general public (64%) and other health professionals/practitioners (35%). Weekly pharmacy users were also more interested in accessing this service (69%) compared to those that visit pharmacies monthly (61%).

• Aboriginal and Torres Strait Islander programs that provide culturally appropriate support

o Awareness of current availability was higher among people working in a role that requires the use of pharmacy services (41%, compared to 17% of members of the general public and 21% of other health professionals/practitioners), non-carers (25%, compared to 15% of carers of adults) and those under 30 years (35%, compared to 21% of those aged 30 to 49 years and 18% of those aged 50 to 69 years).

• Administration of certain vaccines o Awareness of current availability was higher among people working in a role that

requires the use of pharmacy services (85%, compared to 74% of other health professionals/practitioners and 63% of members of the general public), those under 30 years (83%), Western Australian residents (84%, compared to 65% in NSW and 64% in Victoria) and metro and regional areas (71%, compared to 49% in rural/remote areas).

o Carers of children (80%) were more likely to feel this service should be available in pharmacies than carers of adults (70%), as were younger participants (84% of those under 30 years, compared to 70% of those aged 50 to 69 years and 64% of those over 70 years).

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o People working in a role that requires the use of pharmacy services (75%) were more likely to want to personally access this service from pharmacies than members of the general public (64%) and other health professionals/practitioners (36%).

• Medical certificates o Awareness of current availability was higher among those who work in a role that

requires the use of pharmacy services (70%) than members of the general public and other health professionals/practitioners (both 42%).

o People who work in a role that requires the use of pharmacy services (73%) also mentioned that this service should be available in pharmacies and 61% wanted to be able to personally access it in pharmacies, compared to 45% of members of the general public and 30% of other health professionals/practitioners.

• Provision of medication management and treatment services o Perceptions that this service should be available in pharmacies were higher among

people who work in a role that requires the use of pharmacy services (95%, compared to 85% of members of the general public, and 81% of other health professionals/practitioners), participants aged under 30 years (95%, compared to 86% of those aged 30 to 49 years and 83% of those aged 50 to 69 years) and those living in metro areas (88%; compared to 79% of those living in regional areas).

o Participants who work in a role that requires the use of pharmacy services were also more likely to want to access this service (68%, compared to 54% of members of the general public and 42% of other health professionals/practitioners), as were males (61%, compared to 52% of females) and weekly pharmacy users (64%, compared to 53% of those that visit pharmacies less than once a month).

• Medicine review services o Perceptions that this service should be available in pharmacies were higher among

people who work in a role that requires the use of pharmacy services (96%) than members of the general public (80%) and other health professionals/practitioners (89%).

o Those who work in a role that requires the use of pharmacy services (58%) and weekly pharmacies users (56%) were also more likely than members of the general public (44%) and those that visit pharmacies less than once a month (45%) to want to access this service.

• Preventive health care programs o Perceptions that this service should be available in pharmacies were higher among

people who work in a role that requires the use of pharmacy services (92%) than members of the general public (84%) and other health professionals/practitioners (64%).

o Those who work in a role that requires the use of pharmacy services (61%) were also more likely to want to be able to access this service in pharmacies, compared to members of the general public (47%), other health professionals/practitioners

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(34%). Those aged 30 to 49 years (50%) were more likely than those over 70 years (33%) to want to access these programs personally.

In the next question of the survey, a sub-set of just ten of these services were again asked about. The ten services were those for which a fee currently applies or may apply in the future. Each participant was only presented with those services they had previously indicated they personally want to be able to access in pharmacies, and were asked to indicate which ones, if any, they would be willing to pay a “small fee” for. As illustrated in Figure 15, willingness to pay was highest for administration of certain vaccines (83% of those wanting to be able to access this service would pay a small fee for this) followed by medical certificates (76%). The only two services that an overwhelming majority of participants wanting to be able to access that service said they would not be willing to pay a fee for, were advice on medicines/treatments available on pharmacy shelves (just 10% would be willing to pay for this service) and advice on treating minor injuries/ailments (just 15% willing to pay). These are of course two services not currently charged for, and were revealed in previous questions as widely perceived to be core services pharmacies should provide. Figure 14: Willingness to pay for services

Q8: Which, if any, of the following services would you be willing to pay a small fee for? Base: Respondents selecting that service in Q7- up to n= 760

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Consumer Survey participants who work in a role that requires the use of pharmacy services were significantly more likely to say they would pay a small fee for the following services when compared to members of the general public and other health professionals:

• Administration of certain vaccines, such as flu vaccinations (69%); • Medical certificates (52%); • Wound care management (46%); • Diagnostic and screening service (52%); • Medicine review services (43%); and • Provision of medication management, and treatment service (43%).

Participants were shown 10 different options for increasing general public awareness of the different pharmacy services and programs that are available. Participants were asked to nominate up to three options they felt would be most effective in improving awareness. As illustrated in Figure 16, merit was seen in all of the options asked about. The two options most commonly nominated were being notified in person when seeing your pharmacist – just over half (53%) nominated this as being a “top three” option in terms of effectiveness – and a poster or display at pharmacies – nominated by just under half (49%). These in-pharmacy measures slightly outstripped notification from a doctor (44%), and paid government advertising either on TV or in the newspaper (44%). Interestingly, far more nominated TV/newspaper advertising from government (44%) than from the pharmacy industry (16% for newspaper, just one percent for TV advertising).

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Figure 15: Perceptions of most effective means of improving awareness of pharmacy services and programs

Q9: How could the public be made more aware of the pharmacy services and programs that are available, including specialised services for people with different conditions, such as asthma or diabetes? Please select up to 3 options from the list below you think would be most effective in improving awareness. Base: All respondents n= 809

• Further, participants that visit a pharmacy on a weekly basis were significantly more likely to mention that being notified in person when seeing the pharmacist was the best way to inform the public about pharmacy services and programs that are available (61%) than those that visit the pharmacy at least once a month (52%).

• Members of the general public were significantly more likely to mention poster/display at pharmacies than those that work in a role that requires the use of pharmacy services (51%, compared to 40%).

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As illustrated in Figure 17, below, just less than half of Consumer Survey participants agreed that they were “well aware of the pharmacy services and programs that may be relevant or helpful for me”, rating their level of agreement at six or seven on a seven-point scale from 1 (“strongly disagree”) to 7 (“strongly agree”). However, almost as many – 44% – provided a more neutral response, suggesting they perceived themselves to have gaps in their awareness. Eight percent particularly disagreed that they were well aware of the services and programs that may be relevant or helpful for them. Figure 16: Awareness of pharmacy services and programs

Q15 (3): Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n=809 The level of agreement on the statement above was significantly higher among participants who work in a role that requires the use of pharmacy services (59% agreed, compared to 43% of members of the general public), those aged over 70 years (67% agreed, compared to 49% of those under 30 years, 42% of those 30 to 49 years and 50% of those 50 to 69 years), and weekly pharmacy users (61% agreed, compared to 44% of those that visit a pharmacy monthly). Consumer Survey participants were presented with seven factors and asked to indicate which, if any, of them they felt influenced the standard of service they receive at the pharmacist. They were also provided with an “other” option to specify other factors not listed. As illustrated in Figure 18, each of the seven factors was selected by between 19% and 88% as influencing the standard of pharmacy service. “The skills and/or personal qualities of individual pharmacists” was the factor most commonly seen to influence the standard of service at pharmacies, by 88% of participants. Staffing levels and how busy a pharmacy is (72%) and the type of pharmacy (63%) were also commonly selected as influencing service quality. Common responses provided in the “other” response option included the commercial or ethical focus of the pharmacy and/or its owner and the service provided by pharmacy staff (not limited to just the pharmacist), each mentioned by two percent (roughly 16 people).

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Figure 17: Perceived factors influencing standard of service

Q18: Based on your experience, which of the factors influence the standard of service you receive at the pharmacist? Base: All respondents n= 809 The factors perceived to influence the standard of service consumers receive at the pharmacist differed by sub-group. In particular, participants who indicated they work in a role that requires the use of pharmacy services were significantly more likely to see the standard of pharmacy service as influenced by:

• Staffing levels and how busy a pharmacy is (82% noted this, compared to 71% of members of the general public and 64% of other health professionals/practitioners).

• The type of pharmacy (74% noted this, compared to 61% of members of the general public and 59% of other health professionals/practitioners).

• Whether or not a private consulting area is available (41% noted this, compared to 25% of members of the general public).

Notable significant differences among other sub-groups include:

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• 76% of non-carers felt that staffing levels and how busy a pharmacy is impact on service standards, compared with 66% of carers of children and 65% of carers of adults.

• 67% of residents from regional areas and 64% of those in metro areas felt the type of pharmacy influenced service standards, compared to just 49% of those in rural/remote areas, perhaps reflecting the scarcity of certain types of larger pharmacies in these areas.

• 79% of participants aged over 70 years felt that how well you know a pharmacist contributed to service quality, compared to 53% of those under 30 years, 46% of those 30 to 49 years and 52% of those 50 to 69 years. In addition, 69% of Western Australian residents indicated this as a factor influencing service standards, compared to only 49% of those in Victoria.

Participants were presented with three statements relating to discount pharmacies and perceptions of differences in level of service across pharmacy types. They were asked about the extent to which they agreed with each statement. As illustrated in Figure 19, just 16% of participants agreed with the notion that there is little price difference across pharmacies, regardless of which type of pharmacy it is. At the same time, almost three in five (56%) disagreed with the statement “… all pharmacies provide the same level of service, regardless of which type of pharmacy it is”. It seems clear that people completing the Consumer Survey perceive differences in service quality and price between different pharmacy types. Having said this, only 37% firmly agree that discount pharmacies offer a lower level of service than others. Figure 19 also illustrates level of agreement with three statements dealing with customer feedback and dissatisfaction. As illustrated, 71% of participants indicated that they agree that “it is important for people to be able to provide feedback so that pharmacists can determine how effective their services are” (with just 2% disagreeing with this statement). More rejected the notion that the only form of customer feedback needed is being able to choose your pharmacy and to change f you are not satisfied, than agreed with it (39% compared to 26%). Just one in four (24%) agreed that they were well aware of current avenues available to them to provide feedback or complain about pharmacy services.

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Figure 18: Services and feedback provided

Q19: Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n=809 Level of agreement with these statements were significantly higher among specific subgroups. In regards to the level of services provided by pharmacists, the following significant differences were noted:

• ‘Pharmacies that offer discount medicines tend to provide a lower level of service’: Males were more likely to agree with this statement than females (44% compared to 34%) and residents in regional areas were more likely to agree than residents in rural/remote areas (47%, compared to 26%).

• ‘All pharmacies provide the same level of service, regardless of which type of pharmacy it is’. Members of the general public were more likely to agree with this statement than those who work in a role that requires the use of pharmacy services (11% compared to 4%).

• ‘There is very little price difference across pharmacies, regardless of which type of pharmacy it is’. Survey participants resident in Victoria were more likely to disagree with the statement than those in NSW or South Australia (46%, compared to 33% in NSW and 26% in SA).

Notable differences were observed for the following statements relating to feedback mechanisms:

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• ‘It is important for people to be able to provide feedback so that pharmacists can determine how effective their services are’. - Those aged over 70 years were more likely to agree (85%) than those aged 30 to 49 years (68%). South Australian residents (87%) were more likely to agree than those in Vic (71%) and NSW (67%). Weekly pharmacy users were more likely to agree than those visiting the pharmacy monthly (80% compared to 71%).

• ‘The only form of customer feedback needed is being able to choose your pharmacy and change if you are not satisfied’ – Males were more likely to agree than females (30% compared to 23%).

• ‘I am well aware of the avenues I have to provide feedback or complain about pharmacy services’ Other health professionals/practitioners (49%) were more likely to disagree with this statement than members of the general public (38%) and those working in a role requiring the use of pharmacy (24%).

A question early in the Consumer Survey asked participants about their preferences with regard to pharmacy lay-out, notably the relative focus on retail versus dispensing. Their preferences were sought in the context of four different scenarios. As illustrated in Figure 20, preferred lay-out was highly dependent on scenario, and the reasons individuals would be visiting the pharmacy. In the context of the scenarios asked about – filling scripts, discussing a health issue with a pharmacist, and accessing a health program/service – very few (ranging from three to six percent) reported favouring a shop-style pharmacy with a large focus on retail products. A shop-style pharmacy with equal focus on retail and dispensing – that is, arguably the “happy medium” – was never the most commonly favoured shop-style, although it was favoured by between 18% (in relation to accessing a specialised program/service) and 37% (in relation to filling a repeat script) in relation to each scenario. A clinic-like pharmacy with private consultation rooms was by far the most favoured shop-style for both accessing a specialised program/service (54%) and discussing a health issue with a pharmacist (49%). A dispensing pharmacy with less focus on retail was most commonly favoured, although not as overwhelmingly, for filling both a repeat script (41%) and an initial script (40%).

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Figure 19: Preferred pharmacy lay-out

Q13: Now let us know about your preferences regarding the layout of pharmacies. Most pharmacies in Australia have a ‘retail’ area, with products available on shelves, and a ‘dispensary’ area where the pharmacist talks to patients and dispenses medicines. Some pharmacies may have more of a retail focus and others may be more devoted to dispensing. It is possible in future that some pharmacies could be set up more like a clinic than a shop (e.g. minimal or no retail with private consultation rooms). For each of the following scenarios, please indicate which type of pharmacy you would prefer to use. Base: All respondents n= 809 Overall, females were significantly more likely to prefer a shop-style pharmacy with equal focus on retail and dispensing when filling a prescription for a medication that they have taken before (42%) and for a new medication (31%) when compared to males (29% and 21% respectively). In the context of filling a prescription for a medication that was never taken before, members of the general public who work in a role that requires the use of pharmacy (39%), non-carers (27%) and those under 30 years (38%) were significantly more likely to prefer a clinic-like pharmacy with private consultation rooms than members of the general public (18%), other health professionals (25%), carers of children and adult (19% each) and older participants (21% of those aged 30 to 49 and 20% of those aged 50 to 69 and 20% of those over 70 years). The clinic-like pharmacy with private consultation rooms was preferred in different scenarios, such as:

• When discussing a health issue with the pharmacist; 68% of members of the general public who work in a role that requires the use of pharmacy (compared to 48% other health professionals and 43% members of the general public), 65% of those under 30 years (compared to 44% of those aged 30 to 49 years, 49% of those aged 50 to 69 years and

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44% of those over 70 years) and 51% of participants that visit a pharmacy at least once a month (compared to 40% of weekly pharmacy users).

• When accessing a specialised health program or service; 72% of members of the general public who work in a role that requires the use of pharmacy (compared to 57% of other health professionals and 48% of members of the general public), 57% of non-carers (compared to 46% of carers of children), 71% of those under 30 years (compared to 51% of 30 to 49 years, 53% of 50 to 69 years and 38% of over 70 years), 55% of those that visit a pharmacy at least once a month (compared to 43% of weekly visitors).

In contrast, members of the general public (22%), carers of children (24%) and weekly pharmacy visitors (26%) were more likely to prefer a shop-style pharmacy with equal focus on retail and dispensing when accessing a specialised health program or service, when compared to members of the general public who work in a role that requires the use of pharmacy (11%), non-carers (15%) and those that visit a pharmacy at least once a month (18%). As illustrated in Figure 21, below, almost one in ten (nine percent) indicated they felt that they experienced difficulties understanding how to use medicines or obtaining information about them, with a further one percent saying they weren’t sure. Figure 20: Difficulties in understanding how to use medicines or obtaining information

Q27 (B): Do you face either of these difficulties regarding medicines for yourself or someone you care for? Base: All respondents n=809 There were no significant differences on key demographic sub-groups relating to difficulties in understanding how to use medicines. The nine percent indicating they had difficulties in understanding how to use medicines or obtaining information about them – reported in Figure 21 – were asked for their opinion on what should be done to improve people’s understanding, specifically in relation to prescription medicines. Participants were free to record whatever response they wished in a free response field which were then coded into categories with the results shown in Figure 22. Consumer Survey participants offered a number of possible solutions to improve their understanding of how to use prescription medicines. The most commonly provided solution related to having greater interaction with the pharmacist (40%), including pharmacists taking the time to explain, proactively communicating and educating consumers and responding to questions. Doctors are also

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seen to play a role by 17%, who sought better collaboration between doctors and pharmacists and more thoroughness from doctors in ensuring consumers information needs are met. Written information is the solution for 17%, with some complaints about CMIs and other written information being captured. Indeed some consumers comment that written information should always be provided and written in straightforward language. Specific health education by government or pharmacists themselves is also thought to have a role among one in eight (13%). Figure 21: Improving people’s understanding of how to use prescription medicines

Q29: In your opinion, what should be done to improve people’s understanding of how to use prescription medicines? Base: Respondents facing difficulties in understanding how to use medications or obtaining information about them n= 70 Due to small sample sizes, there were no significant differences observed across key demographic sub-groups. Participants were provided with a list of nine services pharmacists are required to provide to consumers when dispensing prescription medicines. Participants were asked to select the services they expected a pharmacist to provide when they fill a prescription. They were asked to separately consider a first versus repeat prescription. The results are presented in Figure 23, ordered from the service most commonly expected to the service least commonly expected for a first prescription.

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As illustrated, a clear majority – at least two in three or 67% – expected each of the services asked about to be provided. Particularly expected were that the pharmacist would check or ask about other medicines being taken (94% expected pharmacists to do this) and that they would provide advice on possible side effects (93% expected this). The three things still expected by a majority of participants in relation to a repeat prescription were that pharmacists would advise of any cheaper generics available (67%), would be in contact with their doctor if required (61%) and would check or ask about other medicines they may be taking (also 61%). Figure 22: Services expectation from pharmacists when filling a prescription

Q16: Which of the following do you expect a pharmacist to do or provide when they fill a prescription for you? Please select as many from the list below that you expect to receive when: a) Filling a prescription for a medicine you are taking for the first time and b) Filling a repeat prescription. Base: All respondents n=809 Consumer Survey participants who work in a role that requires the use of pharmacy services were significantly more likely than other participants to expect pharmacists to provide the following services when filling a first prescription:

• “Check or ask about other medicines you may be taking” – 99% selected this compared to 93% of members of the general public and 92% of other health professionals/practitioners.

• “Let you know if cheaper generic versions of the prescribed medicine are available” – 93% selected this compared to 82% of other health professionals/practitioners.

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• “Provide advice on what the medicine is for, how it will help your condition, how much to take and when” – 94% selected this compared to 84% of other health professionals/practitioners.

• “Suggest or refer you to other services that may be relevant to you or your condition” – 80% selected this compared to 68% of members of the general public and 50% of other health professionals/practitioners.

Further, participants younger than 30 years were significantly more likely to expect pharmacists to check or ask about other medicines they may be taking for a first prescription (99%), compared to those over 50 years (92%). Non-carers were more likely to expect to be informed of any discounts being applied to the price of medicine when filling a first prescription compared to carers of children (70%, compared to 59%). Expectations of services pharmacists should provide when filling a repeat prescription also varied significantly among sub-groups, notably:

• 45% of those aged 30 to 49 years and 47% of those aged 50 to 69 years expected pharmacists to provide advice on possible side effects, compared to just 28% of those over 70 years. Similarly, younger participants were more likely than those over 70 years to expect to be provided advice on what the medicine is for (38% of those aged 30 to 49 years and 40% of those aged 50 to 69 years) compared to older participants (18% of those over 70 years).

• Those who work in a role that requires the use of pharmacy services were more likely to expect pharmacists to suggest or refer them to other services (57%), compared 45% of members of the general public and 29% of other health professionals/practitioners.

As illustrated in Figure 24, below, just 14% said that they “always” receive the services they expect to receive when they have a prescription filled. Almost as many said their experience rarely or never matched their expectations (12% and one percent, respectively). The largest proportion – 47% – said their experience matched their expectations “most” of the time.

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Figure 23: Perceived frequency with which expectations of dispensing services match experiences

Q17: Thinking about the services you expect to receive when filling a prescription, how frequently would you say your experience matches this expectation? Base: All respondents n=809 Subgroup differences were observed in relation to perceived frequency with which expectations are met by pharmacies when filling prescriptions.

• Participants that visit a pharmacy on a weekly basis were significantly more likely than those that visit a pharmacy at least once a month to mention that they always receive the services they expect to receive (26% and 13% respectively).

• Similarly, participants aged over 70 years always found their experience matched their expectation (33%, compared to less than 16% of all other age groups).

• Members of the general public were also more likely to feel they always had their expectation met, than those who work in a role that requires the use of pharmacy services (17%, compared to 8%).

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Access to medicines

As illustrated in Figure 25, below, just over one in 10 (12%) consumers surveyed said they had difficulties accessing medicines for themselves or someone they care for.

Figure 24: Difficulties in accessing medicines

Q27: Do you face either of these difficulties regarding medicines for yourself or someone you care for? - (B) Accessing Medicines Base: All respondents n=809

• Participants that cared for adults and/or children were significantly more likely to feel they have difficulties accessing medicines for themselves or someone they care for, when compared to non-carers (18% care for adults, 15% care for children and 9% non-carers).

• Similarly, participants aged 30 to 69 years were more likely than those under 30 years to feel they have difficulties accessing medicines for themselves or someone they care for (14% and 4% respectively).

The 12% indicating they have difficulties accessing medicines were asked for their opinion on what should be done to improve people’s access to prescription medicines. Participants were allowed to record their answer in a free response field. Responses to this question were coded where possible and the coded results are shown in Figure 26. Addressing stock problems was the most commonly mentioned solution offered for improving access to medicines. This was mentioned by 16% of those giving a response at this question, which is a reflection of the reasonable proportions of people in this sample with some relationship to the pharmacy profession. Increasing the number of pharmacies in particular areas was raised by around one in eight (13%). While a handful coded into this category specifically mentioned allowing dispensaries in supermarkets, it should be noted that this question appeared in the survey after this proposition was already raised as an idea. Twelve percent (12%) of participants identified better links between doctors and pharmacists as a possible way to resolve access issues and the same proportion mentioned affordability as an issue affecting access.

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Figure 25: Improving people’s access to prescription medicines

Q28: In your opinion, what should be done to improve people’s access to prescription medicines? Base: Respondents that faced difficulties in accessing medicines in Q27 n= 101 Potential solutions proffered by Consumer Survey participants differed among some sub-groups in the sample.

• Addressing stock problems was more commonly mentioned by people who work in a role that requires the use of pharmacy services (33%, compared to 10% of members of the general public)

• Males were more likely than females to offer solutions relating to increasing the number of pharmacies in particular areas (30%, compared to 6% of females).

• Those in regional (29%) and rural/remote areas (30%) were also more likely than those living in metropolitan areas (6%) to suggest increasing the number of pharmacy outlets in particular areas (i.e. rural areas).

As illustrated in Figure 27, below, participants most commonly reported it important (rating their level of agreement at six or seven on a seven-point agreement scale) that they can access a pharmacy that opens on weekends (78%), for the same hours as nearby medical clinics (65%) and after

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standard retail hours, for example, until 9pm (60%). Being able to access pharmacies before standard retail hours or at “all hours” was rated far lower in importance, with almost as many, if not more, rating each of these “not important” as “important”. Figure 26: Rating of importance of different options for pharmacy opening hours

Q10 (A): Thinking about your use of pharmacies for yourself and any others you care for, how important it is that you can access a pharmacy that opens…? Base: All respondents n=809 Statistically significant differences in the level of importance placed on different types of opening hours were observed between some sub-groups in the Consumer Survey sample, including: Younger participants were more likely than older participants to see almost all of the opening hours options as important, including being able to access pharmacies that:

• open on the weekends (82% of those aged under 30 years and 84% of those aged 30 to 49 years rated this as important, compared to 75% of those aged 50 to 69 years and 61% of those over 70 years),

• hold the same opening hours as nearby medical clinics (71% of those under 30 years and 70% of those aged 30 to 49 years rated this as important, compared to 54% of those over 70 years),

• open later in the evening (66% of those aged 30 to 49 years rated this as important, compared to 43% of those over 70 years) and

• open early in the morning (40% of those under 30 years rated this as important, compared with 16% of those over 70 years).

In addition, participants from metro areas (81%) were significantly more likely than those in regional areas (70%) to see being able to access a pharmacy on the weekends as important.

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Participants who saw any of the extended opening hours options as important were asked whether they would be deterred from using such a pharmacy if the extended opening hours led to higher prices. These participants were almost evenly divided on their response to this question. As illustrated in Figure 28, just over two in five (41%) said it would not be a deterrent, while almost the same proportion believed it would be a deterrent (44%). Figure 27: Higher prices as a deterrent to using extended hours pharmacy

Q10 (B): If extended opening hours led to higher prices, would this be a deterrent to using a pharmacy that opened extended hours? Base: Respondents that rated 4-7 out of 7 on importance to access pharmacy that opens extended hours n= 785 The only significant difference between sub-groups on this question was in relation to gender. Males were less likely than females to see higher prices as a deterrent to using an extended hours pharmacy, with 47% of males indicating it would not be a deterrent, compared to 38% of females. As illustrated in Figure 29, below, interest in accessing prescription medicines and treatments after hours was particularly high. Almost nine in ten (89%) of those who had indicated in a previous question that access to a pharmacy with some form of extended opening hours would be important to them. Perhaps unsurprisingly, given such products can be purchased elsewhere, interest was far lower in accessing either complementary medicines/treatments (19%) or general retail products (19%) after hours.

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Figure 28: Medicines and products consumers want to access after-hours

Q11: Given your own situation, and considering any others you care for, which of the following medicines and products do you personally want to be able to access after-hours? Indicate as many as apply. Base: Respondents that rated 4-7 out of 7 on importance to access pharmacy that opens extended hours in Q10a n= 785

• Participants who work in a role that requires the use of pharmacy services were significantly more interested than others completing the Consumer Survey in having after-hours pharmacy access to over the counter medicines or treatments (90%, compared to 81% of members of the general public and 78% of other health professionals/practitioners) and to medicines available on pharmacy shelves (76%, compared to 61% of members of the general public and 60% of other health professionals/practitioners).

• Further, males were more interested than females in after-hours pharmacy access to complementary medicines (23% of males would like this, compared to 17% of females) and retail products (22% males and 16% females) after hours.

• Similarly, those aged under 49 years were more interested than those in older age groups in after-hours pharmacy access to complementary medicines (25% of those aged 30 to 49 years want to access these after hours, compared to 14% of those aged 50 to 69 years and 8% of those aged over 70 years) and retail products (22% of those aged under 30 years and 25% of those aged 30 to 49 years want to access retail products in pharmacies after hours, compared 12% of those aged 50 to 69 years and 8% of those aged over 70 years).

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The Consumer Survey explored perceived impacts of technology-enabled dispensing in terms of improving access to medicines and the provision of advice about them. After being presented with a brief description of technology-enabled dispensing, all Consumer Survey participants were asked to indicate on a seven point scale how positive or negative an impact they felt this innovation would have on access and advice. As illustrated in Figure 30, below, larger proportions of the sample felt technology-enabled dispensing would have a positive impact than felt it would have a negative impact on either access to medicines (53% versus seven percent) or the provision of advice about medicines (32% versus 20%). Figure 29: Technology enabled dispensing and its impact on public access to medicines and the provisions of advice

Q14: Currently a paper prescription from a doctor must be seen by the pharmacist before a prescription can be filled. It is possible that in the future, technology will remove the need for paper scripts (the electronically recorded prescription would be the legal record with a paper prescription as an option). This may enable alternative ways of accessing prescription medicines, such as online ordering (including remote dispensing) or going to the pharmacy without remembering to take your paper prescription. Please indicate whether you believe that this ‘technology enabled dispensing’ will have a positive or negative impact in relation to the following. Base: All respondents n= 809 There were no significant differences across key demographic sub-groups on the impact of technology on public access to medicines and the provision of advice. Consumer Survey participants were presented with a range of statements relating to pharmacy access, location and choice and asked to rate their level of agreement with each. As illustrated in Figure 31, support for government policies controlling where pharmacies can be located – with the aim of ensuring all Australians have access to pharmacies regardless of where they live – clearly outstrips support for pharmacies to be free to locate wherever they chose based on commercial considerations (63% versus 36% agree with the respective statements representing these views).

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Those completing the Consumer Survey were generally satisfied with the level of choice they had in relation to pharmacies (67% agreed with this proposition), although seven percent disagreed and one in four (25%) provided a more neutral response. A slightly larger proportion (72%) agreed that they were easily able to access a pharmacy when they need one, although again four percent disagreed and almost one in four (24%) provided a more neutral response. There is no clear suggestion, from the survey results, that those completing the Consumer Survey find it more difficult to access pharmacies when they are away from their usual home or place of work – almost three times as many disagreed as agreed with this notion (37% versus 13%), but the largest proportion – 45% – gave a more neutral response. Figure 30: Agreement with pharmacies location, access and level of choice

Q20: Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n= 809 There were some significant differences among key demographic sub-groups on agreement with statements about pharmacy location, access and choice, as detailed below:

• ‘I am easily able to access a pharmacy when I need one’. Agreement with this statement tended to be higher among those aged 50 to 69 years (76%), compared to those aged 30 to 49 years (66%), and among those in metro areas (74%), compared to those in rural/remote areas (57%).

• ‘I am satisfied with the level of choice I have in relation to pharmacies’. Agreement with this statement was higher among members of the general public and those who work in a role that requires the use of pharmacy services than among other health professionals/practitioners (54%). It was also higher among non-carers (72%) than carers of children (62%), and among females (71%) compared to males (62%).

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• ‘I support government policies controlling where pharmacies can be located’. Agreement with this statement was higher among people who work in a role that requires the use of pharmacy services (73%), compared to members of the general public (62%) and other health professionals/practitioners (54%).

• ‘Pharmacies should be free to be located wherever is best for their business’. Agreement with this statement was higher among survey participants that visit a pharmacy on a weekly basis (44%), compared to those that visit a pharmacy monthly (34%). It was also higher among members of the general public participating in the survey (41%) than among those who work in a role that requires the use of pharmacy services (25%).

• ‘When I travel away from my usual home or place of work, I find it more difficult to access pharmacies’. Survey participants that visit a pharmacy on a weekly basis were more likely to agree with this statement (20%) than those that use a pharmacy monthly (11%) or less often than once a month (9%).

Another potential method of improving access to PBS medicines mentioned in the Discussion Paper is to extend the services provided by internal pharmacies in public and private hospitals, either to additional customer groups or in terms of opening hours. Participants were presented with four potential “additional services” that hospital pharmacies could conceivably provide and were asked to indicate on a seven point scale how beneficial they felt each service would be to the public. The services are ranked in Figure 32 from the service most to least commonly perceived to be of potential benefit to the public. The service perceived to be of greatest public benefit was hospital pharmacies providing members of the public after-hours access to medicines, after local pharmacies have closed (58% rated this as beneficial). The service least commonly perceived to be of potential benefit to the public was providing medicines to members of the public at the usual cost (41% perceived this to be beneficial to the public).

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Figure 31: Perceived benefit to the public of possible hospital pharmacy service extensions

Q21: Public and private hospitals have internal pharmacies that provide medicines to patients of the hospital. To what extent do you feel each of the following additional services would be of benefit to the public? Base: All respondents n= 809 Notable differences between sub-groups in terms of the perceived benefit to the public of these additional hospital pharmacy services are listed below.

• ‘Continuing to provide any necessary medicines to hospital patients after they are discharged’ – Half of those residing in NSW (50%) saw this as beneficial, compared to 35% of those in Queensland and 31% of those in Western Australia.

• ‘Providing medicines to members of the public at the usual cost’ – 53% of those residing in NSW saw this as beneficial, compared to 38% of those in Victoria, 34% of those in South Australia and 31% of those in Western Australia. Residents in metro (42%) and regional (45%) areas were also more likely to rate this service as beneficial to the public than those in rural/remote areas (28%).

• ‘Requiring hospital pharmacies to operate 24 hours a day’. Female participants were more likely than males to see this service extension as beneficial to the public (51%, compared to 44% of males) and those that visit a pharmacy on a weekly basis were more likely to see this service as beneficial to the public compared to those that visit pharmacy monthly (57%, compared to 48%).

The Consumer Survey sought feedback on a range of additional ideas and issues regarding access to PBS medicines, including interest in being able to access personal PBS prescription history (including prices paid), using new technology to save or keep track of prescriptions, being able to

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access pharmacy services within supermarkets, and using hospital pharmacies if surrounding local pharmacies might be negatively impacted. As illustrated in Figure 33, just 15% of those completing the Consumer Survey agreed that they would like to be able to access pharmacy medicine dispensing services within their local supermarket. More than three in five (62%) agreed that they were not interested in using hospital pharmacies (as members of the public) if it meant nearby community pharmacies were negatively impacted. The other potential innovations asked about proved less controversial. Two in three (67%) expressed an interest in being able to access their personal history regarding PBS medicines used, including the prices they have paid. Close to three in five (62%) agreed that using new technology to save or keep track of prescriptions would make it easier for people to access medicines and manage their medication adherence. Figure 32: Reaction to statements dealing with access issues

Q22: Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n= 809 Notable sub-group differences in reactions to these ideas are listed below.

• Survey participants who work in a role that requires the use of pharmacy services were more likely than other groups to disagree that they would like to be able to access pharmacy medicine dispensing services within their local supermarket (75%, compared to 66% of members of the general public and 57% of other health professionals/practitioners ).

• Participants that visit the pharmacy on a weekly basis were more likely than those using the pharmacy less frequently to say they are not interested in using hospital pharmacies if it meant nearby community pharmacies were negatively impacted (71% of those using pharmacies weekly agreed they were not interested in this, compared to 59% of those using pharmacies monthly and 58% of those using pharmacies less often than once a month).

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The Consumer Survey included a range of questions seeking feedback on issues raised in the Discussion Paper relating to the government’s role in setting PBS medicines prices, affordability of PBS medicines and the co-payment scheme, and PBS medicines discount mechanisms. Responses to these issues are presented in this section.

Awareness of PBS medicines pricing mechanisms

As illustrated in Figure 34, four in five (81%) of those completing the Consumer Survey indicated that they were aware (rating their level of awareness at six or seven on a seven-point scale) that the government sets a maximum amount that members of the public pay for medicines covered by the PBS. The same proportion (81%) said they were aware that the cost to the Government for such medicines can be substantially higher than the amount the public is required to pay (i.e. the co-payment). Self-reported awareness that competition from generics drives the cost of medicines down was slightly lower, at 74%, and awareness that the government negotiates the price of medicines directly with manufacturers was lower again, at 64%. Figure 33: Awareness of PBS medicines pricing mechanism

Q23: Before today, how aware were you of the following? Base: All respondents n=809 Levels of awareness of different elements of PBS medicines pricing mechanisms were significantly higher among those with a professional relationship to pharmacy, than those who indicated they were members of the general public, as detailed below:

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• ‘The Commonwealth Government sets a maximum amount that members of the public pay for medications covered by the PBS’. Survey participants who work in a role that requires the use of pharmacy services were more likely than members of the general public to be aware of this (91% aware, compared to 78%). Similarly, participants aged 50 to 69 years were more likely to be aware of this compared to those aged 30 to 49 (86%, compared to 75%).

• ‘Competition from generic versions of brand name medicines drives the cost of medicines down for consumers and Government’. Survey participants who work in a role that requires the use of pharmacy services and those who are other health professionals/practitioners were more likely than members of the general public to be aware of this (89% and 83%, compared to 68%, respectively).

• ‘For medicines subsidised under the PBS, the cost to the Government can be substantially higher than the amount the public is required to pay’. Survey participants who work in a role that requires the use of pharmacy services and other health professionals/practitioners were also more likely than members of the general public to be aware of this fact (89% and 88%, compared to 77% of members of the general public).

• 'The Government negotiates the price of medicines directly with the manufacturers on behalf of the Australian public’. Survey participants who work in a role that requires the use of pharmacy services and other health professionals/practitioners were also more likely than members of the general public to be aware of this (78% and 76%, compared to just 57% of members of the general public).

Attitudes towards the consumer co-payment for PBS medicines

Consumer Survey participants were presented with a battery of 13 statements reflecting various attitudes towards the PBS co-payment scheme and the way prices for medicines are calculated. Figure 35 (overleaf) ranks these statements by total level of agreement, in descending order of frequency. Encouragingly, very few – just five percent – rejected the proposition that that they pay a fair contribution for PBS medicines through the consumer co-payment. That said, only around half (54%) of consumers surveyed agreed that the amount they pay was a fair contribution. Fewer than two in five (38%) agreed that the prices pharmacies charge for prescription medicines are affordable. Almost two in three (64%) agreed that there should be limits on the amount pharmacists are able to charge above or below the co-payment, with only 11% agreeing pharmacists should be allowed to charge above the co-payment and 39% agreeing that pharmacists should be allowed to discount the co-payment. Three in four participants (74%) agreed that the prices pharmacies charge for medicines and services should be transparent before a prescription is filled, and a similar proportion (75%) agreed with the idea that the amount consumers are required to pay for PBS medicines should be the same across all pharmacies.

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Figure 34: Attitudes towards various aspects of the co-payment scheme and pricing of medicines by pharmacies

Q24: Please indicate the extent to which you agree or disagree with the following statements. Base: All respondents n=809 The level of agreement with the following attitudes towards the consumer co-payment and the way prices for medicines are calculated varied by demographic sub-groups.

• ‘The amount I pay for my PBS medicine should be the same at all pharmacies’. Participants in regional areas were more likely than those in metro areas to agree with this statement (84%, compared to 72%).

• ‘The prices pharmacies charge for medicines and services should be transparent before a prescription is filled’. Other health professionals/practitioners completing the

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survey were more likely than members of the general public and those who work in a role that requires the use of pharmacy services to agree with this statement (87%, compared to 73% and 65%). Agreement with this statement also increased significantly with age of participant, with 61% of those under 30 years agreeing with the statement rising to 80% of those aged over 70 years.

• ‘The price that the Government pays towards the cost of a medicine is printed on the label applied by the pharmacist. It is important that this information is available when buying medicines from a pharmacy’. Other health professionals/practitioners completing the survey were more likely than members of the general public and those who work in a role that requires the use of pharmacy services to agree with this statement (76%, compared to 60% and 63%).

• ‘Given the price of medicines can be substantially higher I think it’s fair to make a small contribution through the co-payment’. Those who work in a role that requires the use of pharmacy services were more likely than members of the general public and other health professionals/practitioners to agree with this statement (83%, compared to 68% and 69%).

• ‘There should be limits on the amount pharmacists are able to charge above or below the co-payment’ – Other health professionals/practitioners completing the survey were more likely than members of the general public and those who work in a role that requires the use of pharmacy services to agree with this statement (74%, compared to 64% and 62%).

• ‘I consider the amount I pay for PBS medicines (the co-payment) to be a fair contribution’. Those that visit the pharmacy on a weekly basis were more likely than those that visit monthly to agree with this statement (62%, compared to 51%).

• ‘Pharmacies receiving government payments to dispense PBS medicines should be required to prioritise medicines dispensing over retail sales to maintain the atmosphere of a healthcare setting’. Agreement with this statement appeared to increase somewhat with age, with 56% of those aged 50 to 69 years agreeing, compared with 40% of those aged 30 to 49 years and just 36% of those aged under 30 years.

The statements above reflecting various attitudes towards the PBS co-payment scheme and the way prices for medicines are calculated were analysed against the most recent prescription medicine purchased that was covered by the Pharmaceutical Benefits Scheme, as shown in Figure 36. Seven in ten participants (71%) agreed that the price of medicines can be substantially higher and it is fair to make small contribution through the co-payment. The level of agreement with this statement was consistent across those that paid the general and concessional co-payment – both at 73%. Around one in five had neutral views about the contribution through the co-payment (21% of those that paid the general co-payment and 20% of those that paid concessional).

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Figure 35: Perceived fairness of consumer contribution given high medicine prices by recent co-payment amount

Q24: Please indicate the extent to which you agree or disagree with the following statements. Base: All respondents n=809 Q38b: Thinking of the most recent prescription medicine you purchased that was covered by the Pharmaceutical Benefits Scheme, what amount did you pay for this PBS medicine (the co-payment)?Base: Respondents that visited a pharmacy at least once in the last year n= 803 Figure 37 shows that nearly two thirds (63%) of participants that paid the concessional co-payment agreed that the amount for PBS medicines to be a fair contribution – while 55% of those that paid the general co-payment agreed with the statement. In contrast, participants that paid the general co-payment had more neutral views about the contribution fairness (36% compared to 27% of those that paid the concessional co-payment).

Figure 36: Perceived fairness of consumer contribution to PBS medicines by recent co-payment amount

Q24: Please indicate the extent to which you agree or disagree with the following statements. Base: All respondents n=809 Q38b: Thinking of the most recent prescription medicine you purchased that was covered by the Pharmaceutical Benefits Scheme, what amount did you pay for this PBS medicine (the co-payment)?Base: Respondents that visited a pharmacy at least once in the last year n= 803

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Participants that paid the concessional co-payment were more likely to agree that prices pharmacies charge for prescription medicines to be affordable (41% compared to 38% of those that paid the general co-payment). Overall, as illustrated in Figure 38, participants had neutral views about the affordability of prescription medicines – 45% of general and 40% of concessional co-payment – and over one in ten disagreed with the statement (15% of general and 14% of concessional co-payment) Figure 37: The prices pharmacies charge for prescription medicines are affordable by most recent prescription medicine purchased that was covered by the PBS

Q24: Please indicate the extent to which you agree or disagree with the following statements. Base: All respondents n=809 Q38b: Thinking of the most recent prescription medicine you purchased that was covered by the Pharmaceutical Benefits Scheme, what amount did you pay for this PBS medicine (the co-payment)? Base: Respondents that visited a pharmacy at least once in the last year n= 803 Consumer Survey participants were informed that, since January 2016, pharmacies have been able to discount the PBS medicines co-payment by $1, if the pharmacy chooses to do so. They were then asked if they or someone they care for had benefited from this discount. As illustrated in Figure 39, below, one in five (20%) consumers surveyed said that the $1 co-payment discount had been of benefit to them or someone they care for.

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Figure 38: Receiving the $1 co-payment discount

Q25a: Since January 2016, pharmacies have been able to discount the PBS medicines co-payment by $1, if the pharmacy chooses to do so. As far as you are aware, has this discount been of benefit to you or someone you are caring for? Base: All respondents n=809

• Participants that visit a pharmacy on a weekly basis (28%) were significantly more likely to agree that the $1 discount had been of benefit to them or someone they care for than participants that visit the pharmacy less often (19% at least once a month and 12% less than once a month).

• In contrast, 62% of participants who work in a role that requires the use of pharmacy services were significantly more likely to disagree that the discount had been of benefit to them or someone they care for, when compared to other health professionals and members of the general public (both 45%).

Among the 20% reporting having benefited from the $1 discount to the PBS medicines co-payment, a larger proportion indicated that the discount had been applied to medicines for which they would have been charged the concessional co-payment (61%), than indicated that it had been applied to medicines for which they would have paid the full co-payment (50%).

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Figure 39: Consumers that received the $1 co-payment discount

Q25b: And when you or someone you care for has received this discount, has it been applied to… Base: Respondents who benefited from PBS discount n= 159

• Participants older than 30 years (53% of those aged 30 to 49 years and 59% of those aged 50 to 69 years) were more likely to have had the discount applied to medicines for which they would have paid the full (non-concessional) co-payment compared to those younger than 30 years (22%).

As illustrated in Figure 41, fewer than one in ten (8%) reported having specifically selected a pharmacy in order to obtain the $1 discount. Figure 40: The $1 co-payment discount as a driver of pharmacy choice

Q26: Since January 2016, have you personally chosen to use a particular pharmacy because they were offering the $1 discount? Base: All respondents n= 809

• Members of the general public (11%) were significantly more likely to have reported having specifically selected a pharmacy to obtain the $1 discount than other health professionals/practitioners and those who work in a role that requires the use of pharmacy services (11%, compared to 3% for both other health professionals and those who work in a role that requires pharmacy services).

• Weekly pharmacy users were more likely than less frequent pharmacy users to have chosen a pharmacy in order to obtain the $1 co-payment discount (10%, compared to 4% of those using a pharmacy less often than once a month).

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Findings from the Pharmacy Professionals Survey Profile of pharmacy professionals

As for the consumer sample, it is difficult to determine whether the final pharmacy professional sample is representative of all Australian pharmacy professionals. The characteristics of this sample are presented in this section in order to enable survey findings detailed in the subsequent sections to be interpreted in this context. As Figure 42 shows, around half (51%) of those completing the Pharmacy Professionals Survey work as practicing pharmacists who do not own a pharmacy, while almost four in ten (38%) are pharmacy owners. Further, the sample contains sub-groups of individuals who are working as pharmacy assistants, technicians or in the medicines industry. These sample sizes allow responses to the survey responses to be analysed by these pharmacist types, and enable statistically significant differences in responses between these groups to be identified. Figure 41: Type of pharmacist

Q1: Are you a…? Base: All respondents n= 1,489 Two thirds (66%) of practicing pharmacists in the sample are employee pharmacists, meaning they make up 34% of the pharmacy professionals sample overall as shown in Figure 43. A further one in five (19%) of non-owners are hospital pharmacists and almost one in ten (9%) are self-employed consultant pharmacists.

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Figure 42: Pharmacist that are not pharmacy owners

Q25b: Are you a…? Base: Respondents that are pharmacists (not a pharmacy owner) n=754 Among the 73 participants who work in the medicines industry but are not pharmacists, Figure 44 illustrates that some work for a pharmaceutical company (15%), a professional body (8%) or a PBS medicines distributor or wholesaler (5%), but the majority (71%) are none of these.

Figure 43: Role of those working in the medicines industry

Q25a: Are you a…? Base: Respondents that work in the medicines industry n=73

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As Figure 45 displays, community pharmacies that are part of a banner group and independent community pharmacies are almost equally represented (44% and 38% respectively) among the work settings of all the pharmacists, assistants and technicians in the sample. Large discount pharmacies and hospital settings are also represented in the sample. In terms of where these community pharmacy are positioned, most of this sample report their place of work is in a shopping strip or village (69%), one in five (21%) inside a shopping centre and 8% in a medical centre setting, which very closely reflects the proportion of participants in the Consumer Survey sample indicating they regularly visit the pharmacy in each of these locations.

Figure 44: Work setting

Q26: Which of the following best describes the setting you work in? Q27: Is this community pharmacy located in a…? Base: Q26 respondents that are pharmacists, pharmacy owners, assistant or technicians n=1,288 Base: Q27 respondents that work at independent, community or large discount pharmacy n=1,156 In Figure 46 below, the majority of community pharmacies staffed and owned by participants in this sample are reported as being located in metropolitan areas (57%) with three in ten located in regional areas (30%) and 13% in remote or rural areas. When compared to participants’ own location, based on their postcode, Figure 46 shows a greater proportion living in metropolitan areas (70%). This could reflect some pharmacy owners living in metropolitan areas but owning pharmacies in regional areas but is more likely to be the result of people misattributing the location of pharmacies located on the outskirts of each type of area to a different category than the ARIA+ classification for their postcode.

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Figure 45: Location4 of community pharmacies and participants

Q28: Is this community pharmacy located in a…? Base: Respondents in independent community pharmacy or community pharmacy that is part of a banner group n= 1,052 Q29: Please enter your postcode Base: All respondents n= 1,489

4 The method of determining location varied between the location of community pharmacies and the location of the pharmacy professional themselves. The location of community pharmacies was determined by pharmacists nominating whether the pharmacy they work in is in a metropolitan, regional or remote or rural setting; whereas the location of the pharmacists themselves was based on postcodes provided in Q29 classified using the ARIA+ classification of remoteness (this was the same method applied to Q43 in the Consumer questionnaire).

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Pharmacy remuneration

The Pharmacy Professionals Survey included a number of questions on the topic of pharmacist remuneration. The results from these questions are described in this section. As illustrated in Figure 47, below, three in five (60%) completing the Pharmacy Professional Survey disagreed with the notion that the current approach to remunerating community pharmacists appropriately rewards them for their dispensing expertise and advice. Two in five (41%) agreed that providing pharmacists with a flat-fee payment supports undesirable outcomes, although almost one in four (23%) did support this status quo. The largest proportion of participants – 39% – rejected that pharmacists should be able to choose whether to charge consumers above the PBS dispensed price for a medicine, and an even larger proportion – 63% – rejected that pharmacists should ever be able to discount PBS subsidised medicines. This reflects views shared in the open-ended question reported later in this section and detailed in Table 1 in Appendix A. Figure 46: Community pharmacists’ remuneration

Q2 (1-4): Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n= 1,489 Disagreement that the current approach to remunerating community pharmacists appropriately rewards them for their professional expertise and advice were significantly higher among:

• Pharmacists who are not owners (71%), compared to pharmacy owners (51%), pharmacy assistants (38%) and those working in the medicines industry (37%);

• Those working in internal pharmacies within a public and private hospital (71%), compared to community pharmacies that are part of a banner group (57%); and

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• Those working in community pharmacies located in metropolitan areas (61%) compared to those working in pharmacies in regional areas (55%).

Further, disagreement that community pharmacists should be able to discount the PBS subsidised medicines in certain circumstances was significantly higher among:

• Pharmacy professionals in New South Wales (66%), compared to Victoria (57%) and South Australia (50%).

• Pharmacist owners (77%), compared to pharmacists who are not owners (60%), pharmacy assistants (33%) and those working in the medicines industry (23%).

In contrast, agreement that community pharmacists should be able to choose whether to charge consumers above the “PBS dispensed price” for a medicine was higher among:

• Participants that worked in a large discount pharmacy (38%), compared to those in internal pharmacy within a public and private hospital (20%); and

• Participants in Western Australia (36%), compared to those in New South Wales and Queensland (25% each).

In terms of a system for remunerating pharmacists for dispensing medicines, Figure 48 illustrates that most (47%) reported a preference for a combination of fixed and variable fees. Fixed fees applying across all pharmacists and circumstances were the least popular option (11%) while over a third (37%) favoured a variable fee approach. Figure 47: Fees paid to pharmacists for dispensing medicines

Q3: In your view, should fees paid to pharmacists for dispensing medicines be…? Base: All respondents n= 1,489; Pharmacist n= 754; Pharmacy owner n=569; Pharmacy assistant/technician n=93; Someone working in the medicines industry n=73

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Importantly, sub-group analysis reveals significant differences between types of pharmacists when it comes to preferred dispensing remuneration approaches. While pharmacists who own a pharmacy (60%) were significantly more likely to prefer fees based on a combination of fixed and variable fees than all other participants (38% pharmacists not owners and someone working in the medicines industry and 44% pharmacy assistants or technicians), this preference changed when based on variable fees according to specific factors; 45% of pharmacy non owners chose this approach compared to 39% of pharmacy assistants or technicians. Further, preferred approaches to remuneration were significantly different among participants that worked in specific settings and areas, as detailed below:

• 56% of participants working in community pharmacies that are part of a banner group preferred the current system, which was significantly higher than among those in independent community pharmacies (49%), in large discount pharmacies (43%) and those in internal pharmacies within a public or private hospital (27%). Similarly, 56% of those with community pharmacies in regional areas mentioned this approach compared to 50% of those working in pharmacies in metropolitan areas.

• 36% of those in independent community pharmacies preferred variable fees, compared to 29% of those in community pharmacies that are part of a banner group.

Given the level of support among these participants for a variable or a fixed and variable dispensing remuneration system, pharmacy professionals were then asked to indicate by which factors they believe dispensing fees should vary and then to rank these in order of importance. Figure 49 below shows that, across all types of participants, the most commonly given answer was that the complexity of the pharmacists’ involvement and the level of time or effort required should be a factor in dispensing fee variability – 80% indicated this is an appropriate factor. Overall, half (50%) were in favour of the manufacturer price of the medicine playing a role in dispensing fee variability. Just under four in ten (39%) saw whether the prescription being filled is an initial or a repeat prescription to be an appropriate factor to consider in determining dispensing fees. The factor on which dispensing fees should vary that was ranked as most important was based on the complexity of the pharmacists’ involvement, with an average ranking of 2.4. The second most important factor, with an average of 4.7 was the manufacturer price of the medicine.

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Figure 48: Appropriate factors on which dispensing fees should vary

Q4i: Which of the following do you believe are appropriate factors, if any, on which dispensing fees should vary? Q4ii: Please rank the factors you chose in order of importance. With number 1 being the most important. Base: All respondents n= 1,489; Pharmacist n= 754; Pharmacy owner n=569; Pharmacy assistant/technician n=93; Someone working in the medicines industry n=73 Practicing pharmacists who are not owners were significantly more likely to believe the type of prescription (initial or repeat) should play a role in fee variability (51%) than were pharmacy owners (24%), pharmacy assistants/technicians (26%) and someone working in the medicines industry (37%). Pharmacists working in pharmacies within a public and private hospital (61%) were significantly more likely to believe the type of prescription should play a role compared to

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independent community pharmacy (36%), pharmacies part of a banner group (35%) and large discount pharmacy (23%).

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Dispensing fees varying according to the location of the pharmacy was more strongly held among pharmacists who are not owners (43%, compared to 26% of those working in the medicines industry and 31% of pharmacy owners) and community pharmacies located in regional areas (47%, compared to 31% in metropolitan areas). Pharmacy Professional Survey participants were asked to nominate which payment arrangement they felt was most appropriate for remunerating community pharmacists for providing professional advice to customers. As illustrated in Figure 50, below, remunerating the provision of advice under the MBS system was the most commonly preferred arrangement at the overall level, selected by 46% of all participants. The current, per prescription, system was favoured by 38% of participants overall, thus being the second most favoured arrangement. Figure 49: Appropriate payment arrangements for the provision of professional advice to customers

Q5: Community pharmacists are remunerated by the Commonwealth Government for providing professional advice to customers when they dispense medicines. Which of the following payment arrangements do you see as most appropriate? Base: All respondents n= 1,489; Pharmacist n= 754; Pharmacy owner n=569; Pharmacy assistant/technician n=93; Someone working in the medicines industry n=73

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Pharmacy owners were more likely to prefer the current system to an MBS system (55% versus 36% respectively). For practicing pharmacists who are not owners, the reverse was observed – 56% supported remuneration via the MBS while fewer than half this (26%) supported the current per prescription payment method. Practicing pharmacists (56%) were significantly more likely to prefer remuneration under the MBS system when compared to someone working in the medicines industry (38%), pharmacists who own a pharmacy (36%) and assistants/technicians (33%). Those working in independent community pharmacies (48%) were also more likely to prefer this system, compared to 40% of pharmacies that are part of a banner group and 31% of large discount pharmacy. Those in metropolitan areas (48%) were also more likely to support this approach than those in regional areas (38%). In contrast, payment under the current system was more preferred by participants working in large discount pharmacies (53%), compared to those working in independent pharmacies (39%) and internal pharmacies within a hospital (17%). It was also more preferred by those working in pharmacies in regional areas (48%) than in metropolitan areas (38%). As illustrated in Figure 51 below, most pharmacy professionals (80%) believed that the $1 discount to the PBS consumer co-payment should not be allowed. There were also significant differences among pharmacy professionals on this issue, such that pharmacists that are not owners and pharmacy owners (83% and 84%, respectively) were significantly more likely than assistants/technicians and participants working in the medicine industry (66% and 42% respectively) to agree that the $1 discount should not be permitted.

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Figure 50: Views of $1 Pharmaceutical Benefits Scheme co-payment discount

Q6: Community pharmacists currently have the ability to discount the co-payment for PBS medicines by up to $1. What is your view of this discretionary discount amount….? Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73 There were also significant differences according to the setting in which pharmacists worked, with those in independent community pharmacies (92%) more likely to agree that the discount should not be allowed, compared to those in pharmacies that are part of a banner group (86%), those within internal hospital pharmacies (77%) and those working in large discount pharmacies (34%). More feedback on the issue of pharmacist pricing discretion was collected in a follow-up question, which asked participants to freely respond with what limits, if any, they felt should apply to pharmacist pricing discretion. The responses sometimes indicated very strong opinions on this issue evident in the language used and the length of the responses provided. While there would be benefit to reading the responses in their entirety, all responses have been coded into meaningful categories to support understanding of patterns of response. The full coded output is reported in Table 2 in Appendix A, however the following are the most commonly observed categories of responses found in 10% or more of participants’ answers:

• Fixed prices for PBS medicines – 26% This includes comments stating that discounting of subsidised medicines or of co-payments

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should not be allowed; that, given the price is set by Government, there should be no price variation; the PBS is for equity, the aim is to support equal access, the PBS stands for fairness.

• Discretion should not be allowed – 21% This includes comments that there should be no discretion in pricing of prescription medicines, prices should be fixed, there should be certainty in pricing, pricing should be consistent for all Australians.

• Discounting is damaging – 11% This includes comments that discounting devalues the pharmacy profession, it can undermine pharmacist integrity, increase focus on profit, and/or lower clinical service levels. Discounting means pharmacies compete on price, it can encourage a retail rather than a patient focus, impacts health outcomes, means less investment in patient health and the need for higher volumes puts pressure on pharmacists.

• Pharmacist pricing discretion is sometimes okay – 11% This group believes discretion is okay under specific circumstances such as: under-co-pay scripts, PBS general co-pay where cost is <$38.30, in hardship, where extra services are provided, to reflect extended opening hours, for cheaper OTC items, for drugs other than drugs of dependence, for branded products. Comments grouped in here also mentioned discretion is okay as long as limits of discretion are clear, and that discretion could vary by type of medicine or type of pharmacy.

• Discounting focusses patients on price not service – 10% This group believes that consistency and care and advice are not valued under a discounting regime, it confuses people, it leads to shopping around, it commoditises or devalues medicines, supports patient reliance on medicines, encourages bulk buying, price matching, wastage, time is spent discussing price not medicine, impacts patients ability to retain information about medicine.

• No limits on pricing discretion – 10% This group feels it should be entirely up to the pharmacist’s decision, pharmacists should be able to vary prices, prices should be up to market forces, and that discretion encourages beneficial competition.

As can been seen from the responses listed above, most answers to this question indicated that the pharmacy professional was not in favour of discounting or pharmacist price discretion, in particular discounts on those medications covered by the PBS. Many pharmacy professionals believe that discounting runs counter to the intention of the PBS and a range of perceived negative impacts are identified; among them a reduced focus on patients and an increased focus on sales. Pharmacy Professional Survey participants were asked to indicate their view on how pharmacist remuneration arrangements should be negotiated. Figure 52 illustrates that the majority believe that negotiations about remuneration of both dispensing (52%) and other professional services (65%) should involve parties other than the Pharmacy Guild of Australia.

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Once again, pharmacy owners and non-owner practicing pharmacists completing the survey differ in their views here. Non-owner pharmacists were significantly more likely to mention that both negotiations should include other parties (73% and 84%), when compared to other pharmacy professionals. In contrast, pharmacy owners were significantly more likely than all other types of professionals to feel that both negotiations should remain under the current arrangement (73% and 54%). Figure 51: Opinions on how remuneration arrangements should be negotiated – negotiation of remuneration for dispensing

Q8: The Commonwealth Government currently negotiates formal remuneration arrangements for the dispensing of medicines for community pharmacy via a partnership agreement with the Pharmacy Guild of Australia. In your opinion, how should future remuneration arrangements for dispensing be negotiated? And how does this differ for remuneration for other professional services delivered by community pharmacists? Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

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Figure 52: Opinions on how remuneration arrangements should be negotiated – negotiation of remuneration for other professional services

Q8: The Commonwealth Government currently negotiates formal remuneration arrangements for the dispensing of medicines for community pharmacy via a partnership agreement with the Pharmacy Guild of Australia. In your opinion, how should future remuneration arrangements for dispensing be negotiated? And how does this differ for remuneration for other professional services delivered by community pharmacists? Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73 There were also significant differences in responses to this question according to the setting in which pharmacists worked and their location, for both remuneration negotiations, as detailed below:

• Negotiation of remuneration for dispensing o Those who feel other parties should be involved in the process were more likely

to be those working in internal hospital pharmacies (90%, compared to 43% of those working in pharmacies that are part of a banner group and 39% of those working in independent pharmacies), and those located in metropolitan areas (45% compared to 36% of those in regional areas).

o Those who feel that future agreements should be made in the same way as they currently are were more likely to be those working in independent pharmacies (59%, compared to 13% of those working in large discount pharmacies and 8% of those working in internal hospital pharmacies), and those located in regional areas (61%, compared to 52 in metropolitan areas).

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• Negotiation of remuneration for other professional services o Those who feel other parties should be involved in the process were again more

likely to be those working in internal hospital pharmacies (90%, compared to 43% of those working in pharmacies that are part of a banner group and 39% of those working in independent pharmacies), and those in metropolitan areas (45%, compared to 36% of those in regional areas).

o Those who feel that future agreements should be made in the same way as they currently are were more likely to be those working in independent pharmacies (41% compared to 13% of those working in large discount pharmacies and 4% of those working in internal hospital pharmacies), participants located in Western Australia (45%, compared to those in all other states).

The participants indicating that other parties should be involved in the process of negotiating remuneration agreements were asked to select which parties, or bodies representing them, they believed should be involved. The findings with respect to both remuneration for dispensing and remuneration for other professional services are illustrated in Figure 54. Only Pharmacy Guild of Australia and “other professional bodies or unions representing pharmacists” (such as PPA, AACP etcetera) were selected by a majority of participants, specifically by 66% and 93% of all participants, respectively, in relation to remuneration for dispensing, and by 65% and 93% of all participants, respectively, in relation to remuneration for other professional services.

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Figure 53: Other parties that should be involved in the process of negotiating remuneration agreements with the Commonwealth Government – negotiation of remuneration for dispensing

Q9: Which of the following parties5 (or a body representing them) do you believe should be involved in negotiating remuneration agreements with the Commonwealth Government? Please select as many as you believe should be involved in these processes. Base: Respondents that mentioned that other parties should be involved in the process; Q9a n= 770

5 Abbreviations of professional bodies mentioned: Professional Pharmacists of Aust (PPA), Australian Association of Consulting Pharmacists (AACP), Pharmaceutical Society of Australia (PSA) and Friendly Society Medical Association (FSMA)

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Figure 54: Other parties that should be involved in the process of negotiating remuneration agreements with the Commonwealth Government – negotiation of remuneration for other professional services

Q9: Which of the following parties6 (or a body representing them) do you believe should be involved in negotiating remuneration agreements with the Commonwealth Government? Please select as many as you believe should be involved in these processes. Base: Respondents that mentioned that other parties should be involved in the process; Q9b n= 964 Views on parties that should be involved in negotiating remuneration agreements differed significantly by setting. Those working for independent community pharmacies or as part of a banner group were more likely to select Pharmacy Guild of Australia, with 73% and 69%, respectively, seeing them as important to be involved in negotiations on remuneration for dispensing, and 72% and 70%, respectively, seeing them as important to be involved in negotiating remuneration for other professional services. This is compared to just 47% and 45% of those working in a large discount pharmacy who feel the Pharmacy Guild of Australia should be involved in negotiations on remuneration for dispensing and other services, respectively.

6 Abbreviations of professional bodies mentioned: Professional Pharmacists of Aust (PPA), Australian Association of Consulting Pharmacists (AACP), Pharmaceutical Society of Australia (PSA) and Friendly Society Medical Association (FSMA)

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Those working for independent community pharmacies or as part of a banner group were also more likely to select “other professional bodies/unions” – with 93% of people working in either type of pharmacy seeing a role for these bodies in negotiating remuneration for dispensing, and 91% of people working in either type of pharmacy seeing a role for these bodies in negotiating remuneration for other professional services. This is again compared to those working in a large discount pharmacy, among whom 80% who feel that other professional bodies/unions have a role to play in negotiating remuneration for dispensing, and 82% see a role for these in negotiating remuneration for other pharmacy services. Those working in an internal pharmacy within a hospital (44%), were significantly more likely than those working in an independent community pharmacy (23%), those working in a community pharmacy that is part of a banner group (24%), or those working in a large discount pharmacy (19%), to feel that consumers should be involved in negotiating remuneration. Negotiation of remuneration for other professional services was significantly higher among those working in an internal pharmacy within a hospital (53%) when compared to those from independent community pharmacy (24%), pharmacies that are part of a banner group (25%) and large discount pharmacy (18%). A further question on remuneration asked pharmacy professionals about the remuneration approaches they felt would best support pharmacists to provide the community with timely and reliable access to medicines. Of the four approaches asked about, an overwhelming preference was expressed for a partnership approach, nominated by 64% of participants overall. This was the approach particularly strongly favoured by pharmacy owners, with more than four in five (84%) of this group nominating this as their preferred approach to ensuring timely and reliable access to medicines, compared to between 45% and 54% of other pharmacy professionals.

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Figure 55: Remuneration approaches that would best support pharmacists to provide the community with timely and reliable access to medicines

Q10: Which of the following remuneration approaches do you believe would best support pharmacists to provide the community with timely and reliable access to medicines? Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

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Those working in independent community pharmacies were more likely than those working in other settings to advocate a partnership approach – 76%, compared to 38% of those in internal pharmacy within a public and private hospital, 46% large discount pharmacy and 68% pharmacy that is part of a banner group. Further, those residing in South Australia were least likely of all the states to advocate a partnership approach, with just 50% selecting this option, compared to 63% in NSW, 65% in Vic, 66% in Qld and 70% in WA. A licensing approach was the preferred remuneration approach among pharmacists in internal pharmacy within a public and private hospital (30%) and those in large discount pharmacy (23%) – compared to pharmacy that is part of a banner group (15%) and independent community pharmacy (10%). As illustrated in Figure 57, below, just one in 10 participants agreed (providing a rating of 6 or 7 on a 7-point agreement scale) that the introduction of the $1 co-payment discount for PBS medicines is a very positive step for consumers. Sixty eight percent (68%) disagreed. Figure 56: Consumer benefit from $1 co-payment discount for PBS medicines

Q23 (11): Please indicate the extent to which you agree or disagree with each of the following statements about consumer experiences and expectations of community pharmacy. Base: All respondents n=1,489 Participants working in the medicines industry were significantly more likely to agree that the introduction of the $1 co-payment discount for PBS medicines is a very positive step for consumers (27% compared to 12% of pharmacist owners and 6% of pharmacist that is not an owner). Further, more than half of pharmacists that work in large discount pharmacy (54%) agreed with this statement – compared to those that are in a pharmacy that is part of a banner group (8%), independent community pharmacy and internal pharmacy (4% each).

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Pharmacy regulation

Those completing the Pharmacy Professionals Survey were asked whether they felt that removing the location rules for pharmacies – either completely, or just in urban areas – would have a positive or negative impact on access to medicines and, separately, medicine affordability. As illustrated in Figure 58, in both cases, more felt the change would have a negative impact than felt it would have a positive impact. Views were strongest in relation to the impact on consumer access to medicines of removing the location rules for all pharmacies. Just one in five (21%) “sat on the fence” in relation to this, providing a neutral response suggesting they thought it would have negligible impact, with three in five (60%) saying that it would have a negative impact. Figure 57: Pharmacy location rules and potential impact on consumer access and affordability

Q11: For each of the following issues relating to pharmacy location rules, please indicate whether you believe this potential change would have a positive or negative impact on access and affordability. Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73 Pharmacy owners were particularly likely to express the view that removing the location rules would have a negative impact on access to medicines particularly if it applied to all locations (75% compared to 42% of someone working in the medicines industry, 50% of pharmacists not owners and 60% of pharmacy assistants/technicians). Pharmacists working in independent community pharmacy (73%) and pharmacy that is part of a banner group (68%) were also more likely to express negative views when compared to those in internal pharmacy (39%) and large discount pharmacy (19%).

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In regards to removing the location rules for pharmacies in urban areas, negative views were more predominant among pharmacist owners (69% compared to 47% pharmacy assistant/technician, 45% pharmacist not owner and 45% of those working in the medicines industry), pharmacists working in independent community pharmacy and pharmacy that is part of a banner group (64% and 61% respectively and compared to 33% large discount pharmacy and 32% internal pharmacy) and pharmacies in metropolitan areas (66% and 57% in regional areas). The same pattern of differences was observed with respect impact on medicine affordability. That is, pharmacy owners were more likely to think there would be a negative impact on medicine affordability if the location rule was removed either entirely (63% saying it would have a negative impact, compared to 33% of pharmacist not owners, 40% of participants working in the medicines industry and 41% of pharmacy assistant/technician) or just in urban areas (61% saying it would have a negative impact, compared to 32% of pharmacist not owners, 33% of pharmacy assistants/technicians and 37% of participants working in the medicines industry). Those working in community pharmacies (either independent or part of a banner group) were also more likely than those working in other settings to perceive that changing the location rules – completely or just for urban areas – would have a negative impact on consumer medicine affordability. For example, 57% of those working in an independent community pharmacy and 52% of those working in pharmacies that are part of a banner group indicated that removing the location rules for all pharmacies would have a negative impact on medicine affordability, compared to 16% of those in large discount pharmacy and 19% of those in internal pharmacy within a public and private hospital. In addition, removing location rules for pharmacies in urban areas were also a higher concern for those working in independent community pharmacy (54%) and pharmacy that are a part of a banner group (49%) – compared to 27% of those in large discount pharmacy and 18% of those in internal pharmacy. None of the changes to pharmacy location rules asked about attracted majority supported. As illustrated in Figure 59, almost one quarter (24%) of participants surveyed said they didn’t support any of the changes. The two changes attracting the most support were requiring approved pharmacies to maintain minimum service levels in locations where rules restrict additional pharmacies from operating (45% overall reported supporting this) and relaxing rules relating to shopping centre proximity so pharmacies are not locked into one centre (42% overall reported supporting this). Support for all changes except the least commonly supported change (“removing the location rules for pharmacies in a context where state ownership rules are relaxed so that any party can own a pharmacy”) was significantly higher among pharmacists who are not a pharmacy owner compared to pharmacy owners.

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Figure 58: Support for changes to pharmacy location rules

Q12: Which of the following changes to pharmacy location rules do you support? Please select any you support. Base: All respondents n= 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73 Pharmacists working in internal pharmacy within a public and private hospital were significantly more likely to support the requirement of approved pharmacies to provide a minimum level of services in addition to dispensing PBS medicines (53%) and maintain minimum extended opening hours (46%), compared to those working in independent pharmacies (42% and 34% respectively) and large discount pharmacy (28% and 30% respectively). The support for relaxing the location rules related to short distance relocation from shopping was significantly higher among those working in large discount pharmacy (67%) than those in internal pharmacy (54%), pharmacy as part of a banner group (38%) and independent pharmacy (33%).

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Figure 60, below, illustrates level of agreement with various statements dealing with options for improving access to medicines. Reaction to the statements tended to be quite mixed. For only two of the statements was there a majority who either agreed or disagreed with the statement. Specifically:

• 54% agreed with the idea that the electronic prescription serving as the legal record would allow pharmacy to adopt innovative approaches to dispensing medicines; and

• 52% disagreed with the idea that hospital pharmacies should be allowed to service the broader community (with pharmacy owners most likely to disagreed with this idea – 71% compared to just 39-49% of other pharmacy professionals)

Reaction to all other statements was decidedly more mixed, with neither a majority agreeing nor disagreeing with the statements. That said, twice as many agreed (42%) as disagreed (18%) that technology-enabled dispensing is an inevitable part of the future of pharmacy, but disagreed (34%) as agreed (17%) that “the benefits offered by remote dispensing outweigh the risks or drawbacks to consumers” as agreeing with it. More than twice as many disagreed (47%) as agreed (20%) that hospital pharmacies should be able to continue to serve patients post-discharge. The largest proportion – 42% – provided a neutral response with respect the idea that access to medicines could be improved if pharmacies operating out of hospitals were required to operate 24 hours a day. Figure 59: Options for improving access to medicines

Q13: Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n= 1,489 Pharmacy owners were most likely to disagree with hospital pharmacies allowing services to the broader community, with 71% disagreeing, compared to 49% of pharmacy assistants/technicians, 40% of those working in the medicines industry and 39% of pharmacist not owners. Those working in

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independent pharmacies (59%) and pharmacies that are a part of a banner group (57%) were significantly more likely to disagree with this statement compared to those in large discount pharmacies (45%) and internal pharmacies within a hospital (27%). Agreement with the electronic prescription serving as the legal record and allowing pharmacy to adopt innovative approaches was significantly higher among:

• Pharmacists who are not owners (59%), compared to pharmacy owners (48%) and pharmacy assistants (39%);

• Those working in internal hospital pharmacies (73%) and large discount pharmacies (64%), compared to those in pharmacies that are part of a banner group (53%) and independent pharmacy (44%).

Agreement with technology-enabled dispensing of medicines being an inevitable part of the future of pharmacy was significantly higher among:

• Participants working in the medicines industry (51%), pharmacy assistants and not owners (47% each), compared to pharmacy owners (34%);

• Those working in large discount pharmacies (70%), compared to internal pharmacies (50%), pharmacies that are part of a banner group (43%) and independent pharmacy (32%);

• Pharmacies in metropolitan areas – 41% and 33% in regional areas. As illustrated in Figure 61, below, a clear majority of participants – 63% – expressed the view that the right balance has been achieved with respect to promoting medicines and related services to consumers. Almost one in five (19%) felt current limits were too restrictive, but almost as many (14%) felt current limits were not restrictive enough. Figure 60: Limitations on promotion of medicines and related services

Q22: Thinking about the current limits on the ability of pharmacies to promote medicines and related services to consumers, how restrictive do you find these to be? Base: All respondents n=1,489 Those working in the medicines industry but who were not pharmacists were most likely to think current limits were too restrictive (34% compared to 20% pharmacy owner and 18% for both pharmacists not owners and assistants). Those working in large discount pharmacies were similarly more likely than those working in other settings to think current limits were too restrictive (54%

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compared to 19% of those in pharmacy as part of a banner group, 16% internal pharmacy and 14% independent pharmacy). Figure 62, below, provides a summary of responses provided to the open-ended question of what could be done to improve public awareness of available pharmacy programs and services. As illustrated there were a myriad of responses to this question, with no clear stand-outs. The most common suggestion, mentioned by roughly one in five (21%), was for a government-funded public advertising campaign. Pharmacy assistants (23%) and pharmacy not owners (17%) were significantly more likely to mention TV advertising than pharmacy owners (10%). It should be noted that 32% of pharmacy professionals did not answer this question. Figure 61: Improving public awareness of available pharmacy programs and services

Q21: What could be done to improve public awareness of available pharmacy programs and services? Base: Respondents that answered the question n= 1,015; Pharmacist (not a pharmacy owner) n= 484; Pharmacist who owns a pharmacy n= 428; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

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Figure 62: Improving public awareness of available pharmacy programs and services (continuation)

Q21: What could be done to improve public awareness of available pharmacy programs and services? Base: Respondents that answered the question n= 1,015; Pharmacist (not a pharmacy owner) n= 484; Pharmacist who owns a pharmacy n= 428; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

As illustrated in Figure 64, an overwhelming majority of participants – 81% – agreed that the income generated by the sale of schedule 2 and 3 medicines is important to pharmacies. Just one percent disagreed.

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Figure 63: Income generated by the sale of schedule 2 and 3 medicines

Q23 (13): Please indicate the extent to which you agree or disagree with each of the following statements about consumer experiences and expectations of community pharmacy. Base: All respondents n=1,489 Pharmacy owners were most likely to agree with the importance of the income generated by the sale of schedule 2 and 3 products, with 91% agreeing, compared to pharmacy assistants (80%), pharmacy not owners (76%) and those working in the medicines industry (60%). In contrast, those working in an internal pharmacy within a hospital were least likely to agree with the above (59%, compared to 89% of those in large discount pharmacy, 87% in independent pharmacy and 85% in pharmacy that is part of a banner group). As illustrated in Figure 65, roughly three in four (74%) expressed a view suggesting they thought the current restrictions on the sale of schedule 2 and 3 medicines strike the right balance between consumer safety and access (providing a rating of 3-5 on a 7-point scale ranging from 1 – too restrictive – to 7 – not respective enough). Roughly three times as many thought current restrictions to be not restrictive enough (19%) than thought them to be too restrictive (six percent). Figure 64: Current restrictions on the sale of schedule 2 and 3 medicines in pharmacy

Q24: Thinking about current restrictions on the sale of schedule 2 and 3 medicines in pharmacy, do they strike the right balance between consumer safety and access? Base: All respondents n=1,489 Those working in large discount pharmacies were most likely to consider the current restrictions to be too restrictive (22%, compared to just 5% of those in pharmacies that are part of a banner group and 4% independent and internal pharmacy).

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Participants were presented with four issues relating to the Community Service Obligation. For each, they were asked to indicate whether they believed that this will have or is having a positive or negative impact on access to, and separately affordability of, medicines. As illustrated in Figure 66, “minimum service requirements to regional and rural locations” was the issue most commonly seen as having a positive impact on particularly access to medicines (30%) but also medicine affordability (20%; although more, 22%, expressed the view that it is having a negative impact). For all other issues, at least four times as many participants felt that that issue is, or would have, a negative impact on either access to medicines or medicine affordability, than thought it is, or would have, a positive impact. “Introduction of minimum ordering quantities” was most clearly viewed as a negative with 65% thinking it would have a negative impact on access to medicines, and 54% thinking it would have a negative impact on medicine affordability. Figure 65: Community Service Obligation and impact on access and affordability

Q14i-ii: For each of the following issues relating to the Community Service Obligation*, please indicate whether you believe this will have or is having a positive or negative impact on access and affordability. * Under the 6th Community Pharmacy Agreement the Community Service Obligation (CSO) Funding Pool financially supports pharmaceutical wholesalers to supply the full range of PBS medicines regardless of pharmacy location and the relative cost of supply. This ensures that all Australians have access to these medicines via their community pharmacy, regardless of where they live and usually within 24 hours. Base: All respondents n= 1,489

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There were some significant differences between sub-groups on the Community Service Obligation and the negative impact on access and affordability of medicines:

• Impact on consumer access to medicines o 72% of pharmacy owners, 73% of those working in independent pharmacy and 73%

of those in regional areas were more likely to mention that the ‘the introduction of minimum ordering quantities’ would have a negative impact – compared to 64% of pharmacy not owners, 44% of pharmacy assistants, 38% of those working in the medicines industry, 63% of pharmacy that is part of a banner group, 61% of internal pharmacy, 59% of large discount pharmacy and 63% of those in metropolitan areas.

o 68% of pharmacy owners, 61% of those working in independent pharmacy and 61% of those in regional areas were more likely to mention that the ‘extension of the guaranteed supply period’ would have a negative impact – compared to 47% of pharmacy not owners, 29% of those working in the medicines industry, 24% of pharmacy assistants, 54% of pharmacy that is part of a banner group, 47% of large discount pharmacy, 32% of internal pharmacy and 54% of those in metropolitan areas.

• Impact on medicine affordability o 65% of pharmacy owners, 62% of those working in independent pharmacy, 57% of

those in pharmacy that is part of a banner group and 65% of those in regional areas were more likely to mention that the ‘the introduction of minimum ordering quantities’ would have a negative impact – compared to 50% of pharmacy not owners, 38% of pharmacy assistants, 33% of those working in the medicines industry, 40% of internal pharmacy and 55% of those in metropolitan areas.

o 56% of pharmacy owners, 51% of those working in independent pharmacy and 50% of those in regional areas were more likely to mention that the ‘extension of the guaranteed supply period’ would have a negative impact – compared to 33% of pharmacy not owners, 29% of those working in the medicines industry, 25% of pharmacy assistants, 43% of those in pharmacy that is part of a banner group, 36% of those in large discount pharmacy, 17% of internal pharmacy and 44% of those in metropolitan areas.

Participants were presented with seven statements related to the wholesaling and distribution of PBS medicines as asked to indicate the extent to which they agreed with each. The statements are presented in Figure 67, below, ordered by total level of agreement. Clear majorities agreed that:

• manufacturers that supply direct to pharmacies should be required to comply with minimum standards (85% agree; note that far fewer supported, 24%, than did not support, 41%, manufacturers supplying such medicines direct to pharmacies);

• the introduction of minimum ordering amounts under the CSO will increase inventory and wastage costs (71% agree);

• all PBS medicines should be available through the Community Service Obligation (67% agree); and

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• wholesalers should be required to only supply stock with agreed minimum remaining usage dates (66%).

Figure 66: Wholesaling and distribution of PBS medicines

Q15: Please indicate the extent to which you agree or disagree with each of the following statements about the wholesaling and distribution of PBS medicines. Base: All respondents n= 1,489 Pharmacy owners were particularly likely to disagree with the statement “I support manufacturers supply PBS medicines direct to pharmacies” (62% disagree, compared to 31% of pharmacist non owners, 22% of those working in the medicines industry and 10% of pharmacy assistants). Those working in independent pharmacies and pharmacies that are part of a banner group were also more likely to disagree with this (52% and 46% respectively), compared to those working in large discount and internal pharmacy (21% and 17% respectively). Notable differences between sub-groups in terms of agreement with statements associated with the wholesaling and distribution of PBS medicines are listed below.

• ‘Manufacturers that supply direct to pharmacies should be required to comply with minimum standards’ – 93% of pharmacy owners agreed with this statement, compared to 82% of pharmacist who are not owners, 73% of those working in the medicines industry and 70% of pharmacy assistants. Further, 90% of those working in independent pharmacy and 88% in pharmacy that is part of a banner group agreed with the statement (compared to 76% of those in large discount pharmacy and 74% in internal pharmacy).

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• ‘The introduction of minimum ordering amounts under the CSO will increase inventory and wastage costs’ – 82% of pharmacy owners agreed with this statement, compared to 68% of pharmacist who are not owners, 49% of pharmacy assistants and 41% of those working in the medicines industry. Those working in independent pharmacies were also more likely to agree with this statement (79% compared to 72% of those in pharmacy that is part of a banner group, 65% in internal pharmacy and 63% in large discount pharmacy).

Pharmacy professionals were presented with six possible changes to wholesaling arrangements and asked to select which ones, if any, they felt would improve consumer access and/or cost of medicines (to consumers and taxpayers). As illustrated in Figure 68, below, the only change that a majority of all participants – in this case, just over three in five or 63% – felt would improve consumer access and/or cost of medicines was placing the responsibility for timely delivery of medicines on manufacturers. Pharmacy not owners and pharmacy owners were significantly more likely to believe this change would improve consumer access and affordability than other pharmacy professionals. Pharmacy owners and those who are not owners were significantly more likely to mention that including s100 items and RPBS items in the CSO would improve consumer access and affordability when compared to other pharmacy professionals. The change least often viewed as likely to lead to improvements was shifting the responsibility for timeline delivery of PBS medicines onto community pharmacies, with just nine percent nominating this.

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Figure 67: Changes to wholesaling arrangements to improve access and affordability

Q16: Which of the following changes to wholesaling arrangements do you believe would improve consumer access and/or cost of medicines (to consumers and taxpayers). Please select any changes listed below you believe would be beneficial. Base: All respondents n=1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73 Other significant differences noted on changes that would improve consumer access and affordability by sub-groups are detailed below.

• 52% of those working in internal pharmacy within a hospital selected s100 items in the CSO, compared to 40% of those in independent pharmacy and 34% in large discount pharmacy.

• 49% of those working in internal pharmacy within a hospital selected the Commonwealth and state and territory governments working together, compared to 30% of community pharmacy as part of a banner group and 21% of independent and large discount pharmacy.

• 30% of those working in large discount pharmacies selected the Commonwealth Government tendering out the national delivery of PBS medicines, compared to 20% of community pharmacy as part of a banner group and 15% of independent pharmacy.

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Those completing the Pharmacy Professionals Survey were asked to comment on whether there are alternatives to the current CSO rules that would enable wholesalers to improve the efficiencies of their services without detracting from the consumer experience and access. A total of n=219 participants responded to this question. Diverse views were recorded and those suggested by more than 5% of participants are listed below:

• Remove direct from manufacturer supply arrangements/ undermine system/ inefficient/ wasteful/ take time from patients/ cause delays - 11%

• Increase or adequately fund wholesaling/ pay wholesalers fairly/ better remuneration/ reasonable margins - 10%

• Wholesalers should carry all lines/ make all PBS medicines available through wholesale supply chain/ including direct from manufacturer lines - 7%

• Wholesalers should carry more stock/ reduce out of stocks/ improve timely supply - 6% • CSO/ current system works/ works well/ is important/ effective/ fair/ keep CSO - 6%

As can be seen above, references were made to the impact of direct supply arrangements and restricted lines through wholesalers, low margins and the need to for reduced stock outs. A wide array of other topics were raised in response to this question which can be viewed in Table 2 in Appendix A.


As illustrated in Figure 69, 60% of pharmacy professionals agreed that pharmacy standards for the dispensing of medicines and delivery of services are being upheld in traditional community pharmacies (perhaps unsurprisingly, those working in independent community pharmacies were more likely to agree with this, 73%, compared to those working in pharmacies as part of a banner group (65%), large discount pharmacies (38%) and internal pharmacies (33%). A similar proportion (59%) disagreed that this was occurring in discount pharmacies (although this dropped to 13% among those themselves working in a large discount pharmacy). While just one in ten (11%) rejected that current standards are sufficient to result in quality pharmacy services (with pharmacy owners more likely than pharmacy assistants, those working in the medicines industry and pharmacies not owners to agree with this idea, 42%, 40% and 32% respectively), almost as many were “sitting on the fence” on this topic (41%) as agreed with the idea (46%).

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Figure 68: Current pharmacy standards for dispensing medicines and delivery of services

Q17: Please indicate the extent to which you agree or disagree that the current pharmacy standards for the dispensing of medicines and delivery of services are… Base: All respondents n=1,489 Pharmacists that are not owners (63%) and pharmacy owners (59%) were more likely to disagree that current standards were being upheld in discount pharmacies than pharmacy assistants (47%) and those working in the medicines industry (36%). Pharmacy professionals working in independent pharmacies were also more likely to disagree with the statement (69% compared to 61% of pharmacies that are part of a banner group and 13% in large discount pharmacies). Those completing the Pharmacy Professionals Survey were asked to comment on what kinds of data is accessible to pharmacies that would support the evaluation of the efficacy of pharmacy programs. A total of n= 643 participants responded to this question. Types of data suggested by more than 5% of participants are listed below:

• Clinical interventions/ intervention records and/or data - 17% • Patient feedback / customer survey / customer satisfaction - 15% • Compliance data/ patient behavioural changes / outcome - 11% • Script volumes/ dispensing data/ staff to script ratios - 9% • Guildcare programs, data or report - 9% • Time spent providing advice/ counselling patients/ discussing medications 9%

A full list of categorised responses is provided in Appendix A.

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As illustrated in Figure 70, very few participants disagreed either that: better data about the health outcomes created by pharmacy programs would be very valuable (2%); pharmacists have an important role to play in supporting the collection of data to analyse the efficacy of pharmacy programs (3%); or there is a need for funding to support the collection and analysis of such data (4%). Figure 69: Data to analyse and evaluate the efficacy of pharmacy programs

Q23 (3, 4, 5): Please indicate the extent to which you agree or disagree with each of the following statements about consumer experiences and expectations of community pharmacy. Base: All respondents n=1,489 Agreement with consumers experience and expectations on better data about health outcomes created by pharmacy programs would be very valuable and pharmacists having an important role to play in supporting the collection of data were significantly higher among pharmacy professionals working in internal pharmacy within a hospital (82% and 73% respectively) than those in independent pharmacy (71% and 62% respectively) and large discount pharmacy (64% and 59% respectively). Furthermore, both pharmacists that are not owners and pharmacy owners (67% and 63% respectively) were more likely to agree that there is a need for funding to support the collection of data – compared to 44% of those working in the medicines industry and 41% of pharmacy assistants. Those working in internal pharmacy within a hospital (75%) were also more likely to agree with the statement when compared to all other pharmacy settings – 64% of independent pharmacy, 63% of pharmacy that is part of a banner group and 52% of large discount pharmacy.

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As shown in Figure 71, just two percent disagreed with the idea that advice that pharmacists provide to consumers is valued by consumers. Figure 70: Value placed on medicines advice provided to consumers by pharmacists

Q2 (5): Please indicate the extent to which you agree or disagree with each of the following statements. Base: All respondents n= 1,489 Pharmacy assistants and pharmacy owners (95% and 94% respectively) were more likely to agree that advice that pharmacists provide is really valued by consumers, compared to pharmacists that are not owners and those working in the medicines industry (80% and 73% respectively). Those working in independent pharmacies (92%) and pharmacy that is part of a banner group (89%) were more likely than those working in other settings to agree with this idea (82% of large discount pharmacy and 74% of internal pharmacy). This survey captured pharmacy professionals’ ideas about which professional programs and services pharmacists, as medicine specialists, are well placed to provide for the benefit of consumers. A total of n=1,129 participants responded to this question. Types of professional programs and services suggested by more than 5% of participants are listed below:

• Medicine review/ checks/ medication regime review services - Home Medicines Review (HMR), Residential Medication Management Review (RMMR), Medscheck, Diabetes Medscheck - 66%

• Chronic disease management/ care/ monitoring/ medication management services (e.g. INR testing, diabetes and asthma services, medication adherence programs) - 40%

• Diagnostic/ testing/ screening and risk assessment services (e.g. blood pressure or cholesterol tests, blood glucose, bone density testing, hearing checks, sleep apnoea) - 38%

• Vaccinations and immunisation information - 35% • NET advice/ information/ education/ counselling - 28%

o Other advice/ information/ education/ patient consultation - 13% o Treating minor injuries or ailments - 10% o Counselling/ mental health - 6% o Diet/ exercise/ lifestyle/ healthy behaviours/ preventative health and wellbeing - 4% o Medicine specific/ drug interactions - 1% o Complementary medicine/ natural/ herbal medicines - 1%

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• Dose/ dosage administration aids (DAAs)/ packaging services (e.g. Webster pack or blister packs for daily dosing) - 18%

• Preventative health services/ wellbeing programs (such as quit smoking or weight loss programs) - 14%

• Prescribing certain medicines (like oral contraceptives) - 12% • Wound care management/ dressings/ first aid - 9% • Triage/ referral to other services (GP, pathology, allied health) - 6%

Also gathered were pharmacy professionals’ ideas as to which non-medicine-related services pharmacists are well placed to provide for the benefit of consumers. A total of n=867 participants responded to this question. Types of non-medicine related services suggested by more than 5% of participants are listed below:

• NET advice/ information/ education/ counselling - 42% o Other advice/ information/ education/ patient consultation - 24% o Diet/ exercise/ lifestyle/ healthy behaviours/ preventative health and wellbeing - 14% o Counselling/ mental health - 8% o Treating minor injuries or ailments - 6% o Complementary medicine/ natural/ herbal medicines - 3%

• Diagnostic/ testing/ screening and risk assessment services (e.g. blood pressure or cholesterol tests, blood glucose, bone density testing, hearing checks, sleep apnoea) - 35%

• Chronic disease management/ care/ monitoring/ medication management services (e.g. INR testing, diabetes and asthma services, medication adherence programs) - 20%

• Preventative health services/ wellbeing programs (such as quit smoking or weight loss programs) - 19%

• Wound care management/ dressings/ first aid - 15% • Vaccinations and immunisation information - 9% • Triage/ referral to other services (GP, pathology, allied health) - 6%

Participants were presented with 15 different services and asked to select the services they felt consumers should expect to receive from community pharmacies. They were also provided with an “other” field to use should they wish to specify a different response. The services appear in Figure 72 ranked by proportion of the total sample selecting that service. As illustrated, all services (except those recorded under “other”) were selected by a clear majority of participants, at least 69%. “Dispensing of prescriptions” was selected by virtually all participants (98%) and was the service with the highest average ranking (of 3) in the subsequent question which asked participants to rank the services they have selected as being ones that consumers should expect to receive, by order of importance. Perhaps unsurprisingly, pharmacists (owners and non-owners) were significantly more likely to select the services relating to advice (including: on medicines/treatments available on pharmacy

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shelves; on treating injuries/ailments; as well as specific advice on prescription medicines; each selected by 98%) than were others working in pharmacy (each selected by between 84-92%). Figure 71: Services that consumers should expect to receive from community pharmacies

Q20i: Which of these services should consumers expect to receive from community pharmacies? Indicate as many services as you wish. Q20ii: Please rank the factors you chose in order of importance. With number 1 being the most important. Base: All respondents 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

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Figure 72: Services that consumers should expect to receive from community pharmacies (continuation)

Q20i: Which of these services should consumers expect to receive from community pharmacies? Indicate as many services as you wish. Q20ii: Please rank the factors you chose in order of importance. With number 1 being the most important. Base: All respondents 1,489; Pharmacist (not a pharmacy owner) n= 754; Pharmacist who owns a pharmacy n=569; Pharmacy assistant or technician n=93; Someone working in the medicines industry n=73

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Those working in independent pharmacy and pharmacies that are part of a banner group were more likely than those working in a large discount pharmacy to select a number of services including:

• ATSI programs (80% and 79% respectively, compared to 63%) • Wound care management (82% and 83% respectively, compared to 63%) • Provision of medication management and treatment services (95% and 96% respectively,

compared to 88%) • Medication preparation or packaging services (97% each, compared to 92%).

Participants were presented with four statements dealing with perceptions of consumer experiences and expectations particularly relating to knowledge of pharmacy programs/services and for each asked to indicate how strongly they agreed or disagreed with the statement. As illustrated in Figure 74, below, reaction to each statement was decidedly mixed, with, in most cases, the largest proportion of participants providing a neutral response. Agreement was highest with the idea that a clinic-style pharmacy would deliver a better health service than a retail-style pharmacy, although still only two in five (40%) agreed with this idea. Interestingly, pharmacists not owners were more likely to agree with this – 57%, compared to 33% of those working in the medicines industry, 28% of pharmacy assistants and 20% of pharmacy owners. Those working in internal pharmacies (76%) and metropolitan areas (39%) were more likely to agree with this statement – compared to 38% of independent pharmacy, 33% of pharmacies that are part of a banner group, 22% of large discount pharmacy and 31% of regional areas. Disagreement was highest with the idea that consumers are generally aware of the pharmacy programs and services they are entitled to use (45% disagree, with just seven percent agreeing). Pharmacists who are not owners were more likely to disagree than pharmacy assistants/technicians (48% and 32% respectively).

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Figure 73: Perceptions of consumer knowledge of pharmacy programs/services plus reaction to clinic-style pharmacy set-up

Q23 (1, 2, 8, 12): Please indicate the extent to which you agree or disagree with each of the following statements about consumer experiences and expectations of community pharmacy. Base: All respondents n=1,489 As illustrated in Figure 75, below, roughly half of pharmacy professionals surveyed (48%) agreed that the availability of complementary products in pharmacies is a service of benefit to consumers. Roughly one in 10 (nine percent) disagreed. Pharmacists who are not pharmacy owners themselves were significantly less likely than other pharmacy professionals to agree with this (35%, compared to 65% pharmacy assistants, 62% of pharmacy owners and those working in the medicines industry), and those working in a large discount pharmacy far more likely to agree compared to those working in other settings (77%, compared to 57% of pharmacies as part of a banner group, 47% independent pharmacy and 13% of internal pharmacy). Roughly two in five (42%) agreed that when pharmacies sell complementary medicines/treatments it can suggest to consumers that there is scientific evidence to support their use. However, almost twice as many disagreed (42%) as agreed (22%) that selling of complementary products in pharmacies creates a conflict of interest for pharmacists which can impact quality of care. Pharmacists that are not owners were more likely than other professionals to agree with the latter statement (34%, compared to 16% of those working in the medicines industry, 13% of pharmacy assistants and 8% of pharmacy owners). Participants were almost equally divided on whether or not they agreed with the idea of limiting the types of retail products that community pharmacies are allowed to sell – 34% agree versus 31% disagree, with 33% neutral. Pharmacists that are not owners were again, more likely than others to agree with this statement (44%, compared to 27% of pharmacy assistants, 23% of pharmacy assistants and those working in the medicines industry).

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Figure 74: Complementary medicines

Q23 (6, 7, 9, 10): Please indicate the extent to which you agree or disagree with each of the following statements about consumer experiences and expectations of community pharmacy. Base: All respondents n=1,489

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Summary and conclusions

A note on the research samples

The online surveys – both the Consumer Survey and the Pharmacist Survey – aimed to engage interested stakeholders. As no controls were placed on the samples to enable participation by anyone interested in responding to the Discussion Paper, it is indeterminable as to whether these final samples are representative of either Consumers or Pharmacy Professionals. Some results from the Consumer Survey – for example, much higher awareness of Commonwealth government involvement in setting the price of medications than would be expected based on the accompanying qualitative research – certainly suggests that the Consumer sample at least is not representative of the broader Consumer population, being skewed towards those more knowledgeable about pharmacy in Australia than the average consumer. As such, ability to generalise the findings from this research to the broader populations are limited and any such endeavour should be treated with caution.

Consumer Survey


While prescription, OTC and off the shelf medicines/treatments are clearly seen as the core product offering in pharmacy, most consumers also support complementary medicines or treatments (excluding those that make dubious health claims) and retail products being available for sale and women and frequent pharmacy customers particularly would like to be able to buy such products in a pharmacy. The qualitative research had suggested to us that people are somewhat divided about the clinical integrity of generics but most appreciate the choice of a cheaper alternative. The results of the quantitative research suggest greater confidence in generics (but again, this could be a sampling issue); generic and biosimilar medicines were widely considered to be as safe as branded medications. However, while two thirds would choose them, around one in eight would not choose.


The research results suggest that unlike pharmacy products, many of the services pharmacies can provide are not well known. Perhaps half of consumers are aware of the pharmacy services and programs that are personally relevant, but many others are uncertain. Consumers see increasing awareness of pharmacy services as being primarily the domain of pharmacies or doctors, as well as the government. Although few expect to access them themselves, consumers appear to believe that little known services, such as ATSI programs and outreach services, should be available. Least support is expressed for services such as wound care or the issuing of medical certificates, which the

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qualitative research suggested consumers may consider to be outside the bounds of a pharmacist’s training or expertise or perhaps that the pharmacy if not considered to provide an appropriate environment for the delivery of such services. Certainly, as we saw in the qualitative research, consumers are most comfortable and interested in service that involve the core perceived competency of medicines knowledge. For those interested in accessing particular services, there was a willingness to pay for some of these services. This however is not the case for pharmacist advice about treatment or medicines – the vast majority of these consumers claimed to want to access this advice but few indicated a willingness to pay for it. This seems likely to be because these are core services consumers expect to receive at a pharmacy and for which they currently do not pay. In line with the qualitative research findings, this quantitative research suggests that consumers perceive service levels to vary considerably across pharmacies, with this variation being the result of factors far beyond the relationship with the pharmacist, and including issues relating to the pharmacist themselves and the pharmacy within which they operate. Price variability across pharmacies is also noticed by consumers and some feel this, in turn, impacts service levels. The ability to provide customer feedback to pharmacies is widely considered to be important by participating consumers, however just a minority feel confident that they know exactly how they should provide feedback. Responses to this survey suggest appetite among pharmacy consumers for a pharmacy environment that reflects a more clinical focus. Across all the scenarios tested in this research, a dispensing or clinic style pharmacy was preferred by the majority each time over a pharmacy environment with an equal or larger focus on retail. Indeed nearly half believed that a creating a health care atmosphere (instead of a retail feel) should be a requirement of pharmacists given they receive government payments to dispense PBS medicines. A minority of these consumers reported experiencing difficulty obtaining information about medicines or understanding how to use them. Of these, most believed that the solution lay in the hands of pharmacists and doctors taking the time to explain and respond to queries, while better and consistent provision of written information and public education were also seen to offer help in this regard. Expectations of the service provided by pharmacists at the time of dispensing prescription medicines was highly variable depending on whether it was an initial or repeat prescription – importantly, for the vast majority, most these service expectations were not always met.

Access to medicines

Access to medicines appears not to be an issue for many people but there are notable exceptions. Main access issues seemed to focus on out of stocks within pharmacies rather than an inability to

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locate a pharmacy, though some in particular locations (e.g. rural) did identify a shortage of outlets. Consumers largely support location rules if they mean that all Australian have access to pharmacies. In terms of when access to pharmacy products and services is required, weekend and evening access appears to be a priority. Those under retirement age (the pivot age being 50) are particularly interested in extended opening hours. This presumably relates to them being more likely to be in the full time workforce and hence have less ability to visit a pharmacy during standard business hours. Less likely to suffer from chronic illness requiring regular pharmacy visitation, younger consumers may also particularly value out of hours pharmacy in the case of unexpected illnesses. Consumers would also like to see nearby pharmacies to match the opening hours of medical centres. Prescription and TOC medicines are ‘must-haves’ for extended hours pharmacy access with interest in retail and complementary products more subdued. It seems clear that a sizeable proportion of consumers, perhaps unsurprisingly, will avoid using extended hours pharmacies, except for urgent needs, if prices are such pharmacies are higher. Consumers appear to see clear value in the use technology enabled dispensing in terms of its potential to improve public access to medicines but concern around the impact such technology may have on the provision of advice including on how use medicine would need to be managed. Consumers can also see advantages in relation to record keeping such as access to personal medical history. Consumers are more divided in their perceptions of hospital pharmacy as a means of improving access to pharmacy, and many would not favour the role of hospital pharmacies broadening particularly if it were to impact negatively on local pharmacies. This research unveiled little support for supermarkets as pharmacy outlets.


Overall, consumers appear supportive of consistent and transparent pricing for PBS medicines plus limits on pharmacist pricing discretion, especially in terms of price increases. Consumers acknowledge that at least some contribution by patients towards the cost of medicines is appropriate and a majority consider the current co-payment to be a fair contribution. Interestingly, few are aware of whether or not they have benefited from the $1 co-pay discount, and the ability to gain this discount appears not to be a key driver of choice of pharmacy.

Pharmacy Professionals Survey

Pharmacy remuneration

The results of this survey suggest that pharmacy professionals would not support flat-fee dispensing payments, favouring a combination of fixed and variable fees (similar to the current system) or only variable fees – the amount of which would reflect the amount of time and effort involved in providing the pharmacy service and, to a lesser extent, the price of the medicine among other factors. With regards to the system by which pharmacists payments for dispensing would be distributed,

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pharmacists that are not owners favoured remuneration for advice under the Medicare Benefits Schedule, while owners preferred payment on a per prescription basis. There is a fairly strong view that there should be fixed prices for PBS medicines, that pharmacist discretion should not be allowed and that discounting can be damaging by focusing both pharmacists and consumer on price and not service and health outcomes. It appears that few believe the $1 co-payment discount to be a particularly positive step for consumers. There is majority belief that negotiations about dispensing remuneration should include parties beyond just the Pharmacy Guild. Indeed, overall, there is even more support for non-Guild bodies or unions representing pharmacists to be included in such negotiations than there is support for Guild involvement. When it comes to supporting pharmacists to provide the community with timely and reliable access to medicines, a partnership remuneration approach is favoured over a licensing or contract approach. Generally, views on the various aspects of pharmacy remuneration do differ particularly by whether or not a pharmacist is themselves a pharmacy owner, as well as between community versus other pharmacies. It appears that those more at the grass roots level (and potentially with views less influenced by business considerations), have increased appreciation of customer interaction and the system required, and value remuneration systems tied to the service deliverable that reflects the actual time spent with customers.

Pharmacy regulation

This research failed to provide evidence of support for any of the possible changes to location rules tested. Most believe that the removal of location rules across the board or just in urban areas would have a negative impact on consumer access to medicines. Moreover, almost half believed that these changes would also have a negative effect on medicine affordability. Technology enabled dispensing is seen as an inevitable change and one that will allow innovation in pharmacy medicine dispensing. However, around a third of pharmacy professionals hold reservations about the benefits and drawbacks of remote dispensing, an innovation likely to emerge from technology enabled dispensing.


Under Community Service Obligations (CSO), minimum service requirements to regional and rural locations are perceived to have a positive impact on access and affordability. There is little support for the supply of PBS medicines direct to pharmacies from manufacturers. A popular suggested change to wholesaling arrangements is placing the responsibility for timely delivery of medicines on manufactures as part of their PBS listing requirements.

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Generally speaking, pharmacy professionals believe that pharmacy standards for delivery of services and dispensing of medicines are sufficient and are being upheld in community pharmacy. This, however, was not consistently seen to be the case for discount pharmacies, even among those themselves working in discount pharmacies. Pharmacy professionals are mostly keen to see data on the impact of pharmacy programs on health outcomes, but while they realise they play a role in generating this data, most feel they require funding to support this.


Pharmacy professionals see themselves as well placed to offer a variety programs and services to consumers – both medicine and non-medicine related – particularly medicine checks and reviews; chronic disease management services; diagnostic, screening and testing services; and advice, information, counselling and education. Similarly to consumers, participants see less of a role for themselves in providing wound care and medical certificates when compared to all other services and programs tested. Unlike consumers, pharmacy professionals are polarised in their views of a clinic-style pharmacy environment – some seeing key benefit, others not. On balance, pharmacy professionals believe that consumers are not generally informed of the services and programs pharmacists can provide, nor those they are entitled to use, and many clearly attributed this to inadequate promotion of these services to consumers. Pharmacy professionals generally seem to be comfortable with complementary medicines and treatments being available in pharmacies; their presence is infrequently considered to create a conflict of interest for the pharmacist, although some admit the stocking of these products in pharmacy may suggest to consumers that there is scientific evidence to support their use, and some support limitations being applied on the types of products pharmacies sell.

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Appendix A: Coded responses to survey open ended questions This Appendix includes the coded responses to all six open-ended survey questions in the Pharmacy Professionals Survey. Table 2: Limits applied to pharmacist pricing discretion

Responses Total

Fixed prices for PBS medicines/ discounting of subsidised medicines not allowed/ no discounting co-payments/ price set by government/ no variation under PBS/ PBS is for equity/ equal access/ fairness

26%

No discretion in pricing of prescription medicines/ discounting should not be allowed/ prices should be fixed/ certainty in pricing/ no pharmacist pricing discretion/ pricing consistent for all Australians/ universal price

21%

Discounting is damaging/ devalues profession/ undermines pharmacist integrity/ increases focus on profit/ lowers clinical service levels/ competing on price/ encourages retail rather than patient focus/ impacts health outcomes/ less investment in patient health/ need for higher volumes puts pressure on pharmacists

11%

Pharmacist pricing discretion is sometimes okay/ under specific circumstances (e.g. under co-pay scripts/ PBS general co-pay where cost is <$38.30/ hardship/ extra services provided/ extended opening hours/ cheaper OTC items/ not drugs of dependence/ branded products/ as long as limits clear/ type of medicine/ type of pharmacy)

11%

Discounting focusses patients on price not service/ consistency and care and advice not valued/ confuses people/ cheap price may not equal best care/ leads to shopping around/ commoditises/devalues medicines/ supports reliance on medicines/ encourages bulk buying/ price matching/ wastage/ time spent discussing price not medicine/ impacts ability to retain information

10%

Need limits on minimum price/ minimum co-pay with no discounts/ prices not below set limit/ not below dispensing cost 8%

Remunerated specifically for professional advice/ additional fees for clinical services or consultations/ based on standards and health outcomes/ pricing based on service/ place economic value on pharmacist's time/ reimburse under MBS/ encourage patients to value advice

6%

Pharmacist pricing discretion for private scripts/ non PBS items 6%

Consumers should be encouraged to choose on service not price/ focus pharmacy on health services provided/ pharmacists to compete on quality of professional service/ supports upskilling/ increasing knowledge

5%

Large/ discount banner groups have strong buying power/ unfair advantage/ reduced costs/ cut prices to gain market share/ have main advantage from applying discount/ business model built on volume not service/ will squeeze out small players and then

5%

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Responses Total

increase prices

Rural or regional patients can be disadvantaged by price discretion/ price should be same no matter where you live/ different limits for urban vs rural 5%

Small/ traditional community pharmacies find hard to compete on price/ still provide service and compete/ pressured to reduce price/ sustain discounts offered by discounters/ impacts viability/ leads to loss of competition

5%

Need limits on maximum price/ a cap prices can’t go over 4%

No discounting on concessional prices/ fixed concession prices for PBS medicines/ pricing discretion only for general co-pay 4%

Rethink/ scrap the $1 discount/ should not be at pharmacist's expense/ if reduction to co-pay needed, government should fund/ funding source not know to consumers/ gives impression pharmacists greedy/ undermines system/ reduces service quality

3%

Pharmacists should be adequately remunerated/ discounting negatively impacts pharmacist remuneration/ profession less attractive 2%

None/ no limits on pricing discretion/ it’s the pharmacists decision/ pharmacists should be able to vary prices/ up to market forces/ encourage competition 10%

Other 16%

Don’t know/ not sure 1% Q7: In your view, what limits, if any, should apply to pharmacist pricing discretion? Base: Respondents that answered the question n= 947 Table 3: Alternatives to the current CSO rules

Responses Total

Remove direct from manufacturer supply arrangements/ undermine system/ inefficient/ wasteful/ take time from patients/ cause delays 11%

Increase or adequately fund wholesaling/ pay wholesalers fairly/ better remuneration/ reasonable margins 10%

No (no further detail) 7%

Wholesalers should carry all lines/ make all PBS medicines available through wholesale supply chain/ including direct from manufacturer lines 7%

Wholesalers should carry more stock/ reduce out of stocks/ improve timely supply 6%

CSO/ current system works/ works well/ is important/ effective/ fair/ keep CSO 6%

Add fixed fee/ fixed handling fee 4%

Audit/enforce CSO system/ CSO rules not enforced/ change incentives, penalties, consequences/ tighten guidelines/ increase mandatory requirements 4%

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Responses Total

Wholesalers doing great/ excellent job 4%

Tender out delivery/ national tender for wholesaling 2%

CSO not working/ perpetuates inefficiency/ needs to be abolished 2%

Increase frequency of delivery in regional and remote areas / CSO only operate in remote pharmacies 2%

Should be government run wholesaler/ government purchase medicines 2%

Yes (no further detail) 1%

Move away from government claiming GST along supply chain/ at each step 1%

Other 30%

Don’t know/ not sure 6% Q16b: Are there alternatives to the current CSO rules that would enable wholesalers to improve the efficiencies of their services without detracting from the consumer experience and access? Base: Respondents that answered the question n= 219 Table 4: Data to support the evaluation of the efficacy of pharmacy programs

Responses Total

Clinical interventions/ intervention records and/or data 17%

Patient feedback / customer survey / customer satisfaction 15%

Compliance data/ patient behavioural changes / outcome 11%

Script volumes/ dispensing data/ staff to script ratios 9%

Guildcare programs, data or report 9%

Time spent providing advice/ counselling patients/ discussing medications 9%

Medscheck / numbers or results 5%

Number of adverse reactions/ hospital admissions 5%

Home medicines review/ RMMR / reports 5%

Sign up data (e.g. for patient programmes) 3%

Audit / auditable reports and programs/ peer review 3%

De-identified patient data/ demographic data 3%

Number of patients/ number of scripts per patients and/or per year 2%

Electronic documentation/ e health/ my health record 2%

Packaging service/ Webster pack data 2%

Professional services (blood pressure, blood glucose testing, vaccinations, etc) 2%

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Responses Total

Sales data 1%

Waiting times/ patient numbers at GPs surgeries/ hospitals 1%

KPIs / develop KPIs 1%

Mystery shopper data 1%

Referrals to GPs and other health professionals / contacting the GP / GP history 2%

Other 20%

None 5%

Don’t know/ not sure 4% Q17b: What kinds of data could pharmacists provide access to that would support the evaluation of the efficacy of pharmacy programs? Base: Respondents that answered the question n= 643 Table 5: Professional programs and services that pharmacists are well-placed to provide for the benefit of consumers

Responses Total

Medicine review/ checks/ medication regime review services - Home Medicines Review (HMR), Residential Medication Management Review (RMMR), Medscheck, Diabetes Medscheck

66%

Chronic disease management/ care/ monitoring/ medication management services (e.g. INR testing, diabetes and asthma services, medication adherence programs) 40%

Diagnostic/ testing/ screening and risk assessment services (e.g. blood pressure or cholesterol tests, blood glucose, bone density testing, hearing checks, sleep apnoea) 38%

Vaccinations and immunisation information 35%

NET ADVICE/ INFORMATION/ EDUCATION/ COUNSELLING 28%

Other advice/ information/ education/ patient consultation 13%

Treating minor injuries or ailments 10%

Counselling/ mental health 6%

Diet/ exercise/ lifestyle/ healthy behaviours/ preventative health and wellbeing 4%

Medicine specific/ drug interactions 1%

Complementary medicine/ natural/ herbal medicines 1%

Dose/ dosage administration aids (DAAs)/ packaging services (e.g. Webster pack or 18%

119


Responses Total

blister packs for daily dosing)

Preventative health services/ wellbeing programs (such as quit smoking or weight loss programs) 14%

Prescribing certain medicines (like oral contraceptives) 12%

Wound care management/ dressings/ first aid 9%

Triage/ referral to other services (GP, pathology, allied health) 6%

Checking devices / device techniques / needle exchange / disposal 5%

Provision of medication treatment services (treatment programs for drug dependence/ opioid substitution) 5%

Health checks (no further detail) 5%

Hospital post-discharge service/ transition of care 5%

Home based services/ pharmacy outreach services (e.g. pharmacy services in homes, aged care facilities, schools) 3%

Medical certificates 3%

Baby health / clinic / baby & family education 2%

Medication compounding/ preparation of individualised medications for patients 1%

Return of unwanted medicines/ disposal of medicines 1%

Other 15% Q18: As medicine specialists, which, if any, professional programs and services are pharmacists well placed to provide for the benefit of consumers? Base: Respondents that answered the question n= 1,129 Table 6: Non-medicine related services that pharmacists are well-placed to provide for the benefit of consumers

Responses Total

NET ADVICE/ INFORMATION/ EDUCATION/ COUNSELLING 42%

Other advice/ information/ education/ patient consultation 24%

Diet/ exercise/ lifestyle/ healthy behaviours/ preventative health and wellbeing 14%

Counselling/ mental health 8%

Treating minor injuries or ailments 6%

Complementary medicine/ natural/ herbal medicines 3%

Diagnostic/ testing/ screening and risk assessment services (e.g. blood pressure or 35%

120


Responses Total

cholesterol tests, blood glucose, bone density testing, hearing checks, sleep apnoea)

Chronic disease management/ care/ monitoring/ medication management services (e.g. INR testing, diabetes and asthma services, medication adherence programs) 20%

Preventative health services/ wellbeing programs (such as quit smoking or weight loss programs) 19%

Wound care management/ dressings/ first aid 15%

Vaccinations and immunisation information 9%

Triage/ referral to other services (GP, pathology, allied health) 6%

Checking devices / device techniques / needle exchange / disposal 5%

Physical aids/ mobility aids/ supply 5%

Home based services/ pharmacy outreach services (e.g. pharmacy services in homes, aged care facilities, schools) 5%

Medical certificates 4%

Medicine review/ checks/ medication regime review services - Home Medicines Review (HMR), Residential Medication Management Review (RMMR), Medscheck, Diabetes Medscheck

4%

Baby health / clinic / baby & family education 4%

Health checks (no further detail) 4%

Dose/ dosage administration aids (DAAs)/ packaging services (e.g. Webster pack or blister packs for daily dosing) 2%

Prescribing certain medicines (like oral contraceptives) 2%

Provision of medication treatment services (treatment programs for drug dependence/ opioid substitution) 1%

Passport related services 1%

Hospital post-discharge service/ transition of care 1%

Patient support groups 1%

Other 26% Q19: Which, if any, non-medicine related services are pharmacists or pharmacies well placed to provide for the benefit of consumers? Base: Respondents that answered the question n= 867

review of pharmacy remuneration and...

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