Industry policy or health policy?
Researchers evaluate Australia’s Community Pharmacy Agreement
A team of researchers, led by Monash University, have conducted a policy-based evaluation of all seven Community Pharmacy Agreements (CPA) to determine whether or not the CPA is primarily a public health policy or an industry policy.
The CPA is the dominant policy affecting community pharmacy in Australia and supports the public’s access to medication. Concurrently, the core elements of the Agreements have been remuneration for dispensing and rules that limit the establishment of new pharmacies.
Published in the Journal of Pharmaceutical Policy and Practice, the researchers used a range of policy theories to establish what purpose the CPA is serving, its evidentiary base and its future as public policy.
The study’s lead author, John Jackson from Monash’s Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences, said their evaluation concludes the Agreements can be characterised predominantly as industry policy, rather than health policy.
“With each new CPA incremental changes have been made to dispensing fees and margins, and to pharmacy location rules, however no true structural changes have been made to the Agreements relevant to modern concepts of pharmacy practice, or with developments in health care funding and delivery,” said Mr Jackson.
“Whilst much has changed in pharmacists’ practice over the 30 years since the Agreements were introduced, the focus of the CPA has remained on dispensing as opposed to any meaningful support for other professional services.
“As such, with pharmacy owners so heavily reliant on dispensing funding and other CPA practice limitations, it raises the question whether the Agreement is still fit for purpose.”
The authors predict that without a full and effective review of the CPA, major disruptive change would likely occur within the foreseeable future.
Since completion of the study, the Australian Government has introduced the 60-day dispensing (60-DD) policy. “With such a high reliance on dispensing funding, the government's proposed 60-DD policy comes as a real challenge to pharmacy proprietors,” said Mr Jackson.
“The 60-DD policy will impact all community pharmacies and while the government’s compensatory funding envelope will support limited expansion of professional services, access to opioid dependence therapy, support for remote/rural pharmacies, and outreach to aged care facilities, it will not fall equally. The government’s objective to reduce patient co-payments should not be at the expense of some pharmacy proprietors who remain locked in the historic CPA funding model.”
Study senior author, Professor Carl Kirkpatrick – also from CMUS – said the disruption and conflict associated with 60-DD may be a portent of things to come.
“Our analysis of the CPA indicates the lack of a robust evidence base, the extended use of incremental adjustments, and the absence of renewal arising from comprehensive policy review, is likely to lead to disruptive change to bring the policy framework of community pharmacy up to date with practice and the wider health care system.”
“The fall-out for the profession of the government’s desire to reduce patient co-payments and the growing disjunction between the CPA and contemporary practice, indicates the need for a comprehensive review of the Agreement. This should include its purpose and nature, the requirements of its intended beneficiaries and interests of other stakeholders, and it should align any future agreement with modern health care needs and systems,” Professor Kirkpatrick concluded.
Mr Jackson said: “In the absence of such a review, our analysis of the CPA predicts more major disruptive change may occur within the foreseeable future.”
Ends
An evaluation of the Australian Community Pharmacy Agreement from a public policy perspective: industry policy cloaked as health policy?
John K. Jackson, Shane L. Scahill, Michael Mintrom and Carl M. Kirkpatrick.
Journal of Pharmaceutical Policy and Practice (2023) 16:71
https://doi.org/10.1186/s40545-023-00571-y