The Hunter family has no choice but to live by the hour.
Their four-year-old daughter, Isla, has a rare condition called Batten disease – a terminal genetic disorder that affects the brain and nervous system, affecting one in 100,000 children.
“We strive to live day by day, and hour by hour, because with Isla’s condition you just don’t know what tomorrow may bring,” Isla’s mother, Nikita Hunter, says.
“She’s the only one left in Australia with her sub-type so the support is minimal.”
The Hunters live in Smythesdale, 20 kilometres south-west of Ballarat. Due to Isla’s condition, she is on a stringent regime which includes five different seizure medications.
Luckily, Smythesdale is home to its own independent pharmacy, so the family can pick up medication and seek advice.
Hunter says the country pharmacy has proven itself much more reliable than those in the city, and treats her like “more than just a number”.
“I rely heavily on [the pharmacy] for stock, better communication and understanding,” she says. “[Isla] is a little girl that can’t go without these medications and my boys are both medicated for ADHD so they also can’t go without.”
This month, the federal government unrolled its new Pharmaceutical Benefits Scheme dispensing policy, meaning customers can buy 60-days’ worth of medication for the cost of a single prescription.
The changes are happening in three stages over 12 months, and will apply to more than 300 medicines. While some of Isla’s medications are listed as part of the scheme, Hunter says there are other more expensive ones which are not, including those she requires for the boys.
“It’ll be much of a muchness for us,” she says.
Smythesdale pharmacy co-owner Julian Daffy says the changes are likely to have a negative effect on business operations and services offered, with his pharmacy set to lose tens of thousands of dollars within the first year.
Instead of receiving the typical dispensing fee from Medicare, pharmacies receive half the payment, which accounts for a major portion of their revenue. That affects their ability to pay staff and keep their doors open, Daffy says.
“At this stage we are going to take a wait-and-see approach and won’t be making significant changes to our staffing, pricing or charging for services,” Daffy says.
“Smythesdale is a single-pharmacist operation. There is always one pharmacist there spending time with patients, offering medication packs or identifying problems, and [this policy] can eat into the quality of that service.”
Smythesdale pharmacy’s pharmacist Briddon Hardwick says pharmacies may need to increase the price of services such as medication packs and over-the-counter medicines in order to make up the lost revenue.
“A more concerning change could be that the pharmacy would have to reduce hours and cut staff to remain viable,” he says. “This would see vulnerable patients without a community pharmacy and would lead to negative health impacts.
“I’m 100% for cheaper medicines, however I feel like the government could have gone about it in a better way.”
Pressure off for patients, pressure on for pharmacists
Mina Ghobrial owns Trentham pharmacy. He says the 60-day policy will worsen already critical stock shortages, decrease footfall and reduce patient access to health advice.
“Country pharmacies provide a readily accessible point of care without the need for an appointment,” he says.
The Department of Health and Aged Care has said every single dollar saved by the government from lower dispensing fees would go back into community pharmacies.
Over the next four years, about 1,000 pharmacies in regional, rural and remote Australia will benefit from new payments to help them transition and provide a broader range of services. Pharmacies in a large rural town will receive the most funding, at $396,909 over four years, while pharmacies in very remote communities receive $198,263 and pharmacies in a regional centre or outer suburb receive $50,032. Smythesdale is located less than 20km from Ballarat and therefore doesn’t qualify for as much funding as some other rural pharmacies. Hardwick says his pharmacy will not receive enough to offset projected revenue loss.
The federal health minister, Mark Butler, has said every Australian would benefit from the changes, which would free up millions of GP visits and provide relief during the cost-of-living crisis.
“As well as being good for the hip pocket, it will also be good for the health of Australians,” he said. “Overseas evidence tells us that medicine compliance increases by 20% with longer prescriptions.
The Royal Australian College of General Practitioners president, Dr Nicole Higgins, said the change “just makes sense”.
“With the big increases to cost-of-living we are seeing, this will really help take pressure off many of our patients,” Higgins said. “This reform was recommended years ago by the independent Pharmaceutical Benefits Advisory Committee, and brings Australia into line with similar countries like New Zealand, the United States, France and Canada.”
But many pharmacists remain unconvinced. Earlier this month, a group disrupted question time in protest at the 60-day dispensing rules.
Hunter says rural pharmacies are being undervalued.
She says the family prefers to avoid travelling to Ballarat for supplies, particularly with the increase in fuel prices and the unacceptable level of customer service at larger pharmacies.
“[Country pharmacies] are doing their best to provide a high level of care and services,” she says. “The government has a lot to answer for within all aspects of healthcare and I find it more and more frustrating every day.”
