April 27, 2023

VIRGINIA TRIOLI, HOST: Mark Butler, good morning, good to talk to you. 




TRIOLI: Let me just quickly replay a bit of Pharmacy Guild President Trent Twomey who addressed the media yesterday, incredibly unhappy about this. 


TRENT TWOMEY, PRESIDENT OF THE PHARMACY GUILD: If those spin doctors down there don't want to believe what I've got to say, get off your a** and go and talk to these guys, right? I've had Labor Party senators and MPs just take their phones off the hook, because I don't give a shit. Right, I'm sorry, I’m a North Queenslander, I don’t mean to swear, but they just don't care. You know, this is supposed to be a government that cares. This is not how one operates. 


TRIOLI: Mark Butler, there doesn't seem to be a pharmacist in the country who is an outraged if not terrified by these changes. Are you happy with that? 


BUTLER: Of course, I'm not and I think part of the challenge has been that the information given to pharmacists over the last couple of weeks has been very different to, firstly, the substance of the discussions I've had with the Guild over the last 4 weeks about what we were planning to do. And secondly, obviously, the announcement I made yesterday. 


The first important thing to say is that these changes, which will be of enormous benefit to about 6 million Australians living with chronic disease, these changes will be phased in over the next couple of years. The Guild was telling their members, they would be introduced on the first of July in one fell swoop, which I've never said to them. The second thing, which I don't think the Guild told their members, is that I've made a commitment yesterday that every single dollar that the Commonwealth saves from this measure - and that will be substantial, it's about $1.2 billion over 4 years - every single one of those dollars will be reinvested into community pharmacy to help both pharmacies get out from behind the counter of deliver the sorts of high quality services I know they want to deliver, they’ve been saying that to me for years, and I know their customers their patients want - whether it's you know, vaccinations, or a range of other services that they can deliver given their training and their experience. In addition to that, the investment of every single dollar we save, I’ve said yesterday that we would be redirecting about $350 million into a really important program to ensure medication compliance in aged care facilities through community pharmacy.  

I think part of the problem here is that there's been quite a deal of misinformation that's obviously really scared pharmacies but I am confident this is the right thing to do, particularly by patients. It's not only going to be good for their hip pocket, obviously, and halve the cost of their medicines. But it's also good for their health because overseas evidence - and this is pretty standard in every other country we usually compare ourselves to: UK, New Zealand, Canada, Europe, all of those countries - show evidence that expanding the number of tablets you can get at once, so 60 days or in most of these countries it's 90 days, improves medication compliance. Your listeners would know the time when people often go off their meds is when their script runs out, they have difficulty getting into a GP or just because of their busy lives they don't organise their medication to ensure a seamless supply. This is going to be good for health, as well as good for hip pockets. 


TRIOLI: Let me get to clarifying, quickly, if I can, just a few of the key issues that were raised yesterday with me from the Guild. But also, in particular, from individual pharmacists who rang in over and over, Minister. You're saying that you did consult with the Guild and you consulted with them repeatedly. I was being told that this came in with very little consultation. You reject that? 


BUTLER: I do reject it. I mean, at the end of the day people make up their own minds about what sufficient consultation is - 


TRIOLI: So, what did you do? 


BUTLER: For four weeks, when I first indicated to the head of the Guild that we were considering this, I wanted to give them the earliest possible notice, and then we had meetings for hours and hours at a time. Both between my office and also between the Department and negotiating team of the Guild. Now, we weren't able to reach an agreement. I understand that that's often the case, but the idea that -  


TRIOLI: Sorry to jump in there Minister, so nothing changed? You told them what you're going to do, but there were no changes made as a result of the consultations.  


BUTLER: The phase in, for example, the idea of sort of phasing it in 3 tranches, so not all 300 medicines will be subject to these arrangements at once. We're going to phase them in in 3 tranches, so a tranche in September then another tranche in March next year, then a third tranche in September next year. We also wanted to talk about whether we could come to a new agreement, so there were very deep discussions. I completely respect that a lobby group like the Pharmacy Guild is there to represent their members. My job is to represent the whole of the system, and in particular, to look out for the interests of patients. It's really important to look to other groups for their view on this as well. Patient groups - to a group - have supported this. They know how important this is. The medicines industry, which is responsible for making sure there's a good supply of tablets and medicines, they have supported it. All of the doctors groups, in spite of the fact that there will be millions fewer consultations for GPs because of this. Just think about this, every one of these 6 million patients must see their GP at least twice a year just to get a script, often for medicine they've been on in a very stable way sometimes, not just for years, but for decades. They've got to find a GP appointment, often shell out a gap fee and then go to the pharmacist 12 times a year for something that is a very stable need for them. But all of the doctors’ groups have come out in support of this as well.  


TRIOLI: What would you put in place or ask off the drug companies - you just alluded to them being supportive of the idea there - in order to ensure that we don't have medication shortages? Because that's been a key concern of the pharmacies as well, people will come in they get two lots, rather than one from their script. It allows them you know X many repeats and they may run out. What are you going to ensure to make sure they won't? 


BUTLER: I think this has been a bit of a red herring, Virginia, again, not another group has suggested there's going to be any concern around shortages here, the medicines authority’s that have recommended this to me - and frankly recommended it to the former government 5 years ago but they chose to do nothing - they are responsible for ensuring a proper supply of medicines to patients. You just have to think about this for a few minutes to realise the number of tablets that will be dispensed between now and Christmas for example or now and Christmas next year is not going to change one bit because of this. Yes, there will be a change, maybe to the delivery arrangements between wholesalers and pharmacies - 


TRIOLI: Well yes, the supply demands will change - 


BUTLER: They will to a degree but it's not as if every single patient or customer of a particular pharmacy is going to come in on the 1st of September and demand 60 days of medicines. This is going to take a while to work through the system, people will have to go to their GP after their existing scripts come due - go to the GP, consult with the GP, the GP will take a clinical decision about whether that patient is stable and suitable for a 60-day dispensing arrangement. That's the criteria that has been recommended by the Pharmaceutical Benefits Advisory Committee, so this will roll out over time. Frankly, the idea that this is going to create some, I think they use the words “Hunger Games” is really a bit of hyperbole. No other group has indicated that is going to be a problem. I don't pretend there are not some medicine shortages in Australia and everywhere else in the world. A lot of this is an overhang from COVID, which as your listeners would remember all too well, really shot some of our supply lines and global manufacturing operations. We're keeping a very close eye on some of those shortages, as is every medicines authority across the world.  


TRIOLI: Mark Butler is with you, Federal Minister for Health and Aged Care, talking about the pharmacy changes that have been announced and that of course, so many pharmacists and chemists angrily responded to yesterday. You estimate that the out-of-pocket losses for pharmacists is going to be about $1.6 billion over four years, but the Pharmacy Guild says it's modelled that at $2.3 billion. Who's right here? 



BUTLER: We are, but because, with all respect to the resources of the Pharmacy Guild, and they are substantial, as I think you're seeing right now. I have at my fingertips the advice from the experts that have access to every bit of data around this. 


TRIOLI: But can you be sure, with this change, if your figures are right, can you ensure that this change won't result in pharmacies closing, losing family and community pharmacies and also then consolidation of the big national chain pharmacies instead?  


BUTLER: Obviously we've been concerned to make sure that there is a sustainable community pharmacy sector into the future, which is why I have made the commitment that every dollar the Commonwealth saves will be reinvested into community pharmacy programs. 


TRIOLI: From dispensing fees? 


BUTLER: And some more from dispensing and handling fees. Now, as to the money that consumers will save from not having to shell out a fee every month instead of every two months to a pharmacy, we estimate that will be around $1.6 billion dollars over four years. That's the hard modelling that we've put in place. To give that some context, the group that monitors pharmacy revenue says that this year, pharmacy revenue is about $26 billion. So, over the next four years, even if there were no growth - and over the last four years there's been about 30 % growth, there's been huge growth in pharmacy - if there were no growth, that means pharmacy revenue would be over $100 billion over the next four years, and we're talking about $1.6 billion. Now, that's not nothing, but it's in the order of 1 to 1.5% of their revenue, assuming there is no growth.  


TRIOLI: Okay. 


BUTLER: This idea that this is armageddon, we just don’t accept. It is going to have an impact on the bottom line of pharmacies. We recognise that we want to work with them to ensure that community pharmacy remain sustainable, but this is so overdue. The former government has had this recommendation for five years. And because it did nothing, millions of your listeners - well, including your listeners - have been shelling out a payment every single month for medicine they might have been on for years or even decades, when the medicines authority that oversees the system has said that is unnecessary. Hundreds and hundreds of millions of dollars. Leave aside the inconvenience, leave aside the pressure on our general practice system by these unnecessary appointments to get repeated scripts.  


TRIOLI: Mark Butler, I just wanted to ask you another question before I let you go, and that's about the very big review that our migration system is going to undergo, seven-month review led by Martin Parkinson, the Former Secretary of both Treasury and the Department of Prime Minister and Cabinet. What, in particular, as Health Minister, do you want to see out of this review to ensure that we have the health workforce that we need? Your government has made big promises about registered nurses in aged care settings and we all know that we actually don't have the workforce here to fulfil that requirement, as well as every other empty workforce space there is. What specifically do you want to see coming out of this for your health workforce? 


BUTLER: We want to see what health employers want to see, whether it's state governments running the hospital systems, or private health employers – the big private hospitals, GP practices, they're all telling me that the migration system isn't working for them, it's pretty chaotic, it’s too slow. We found visa processing times when we came to government for example, for registered nurses, as you say, or for GPs from overseas were ridiculously long. We've been able to get those visa processing times down dramatically because of the resources that Minister Andrew Giles has put into the system. But there are still real problems with the way in which we recruit nurses and doctors and other health professionals from overseas. It’s a much more competitive market than it used to be. It's not just: if we ask them people of course want to come to Australia. We’re getting a lot of competition from Canada, from the UK, from other countries as well, so we're thinking very deeply from end to end, not just visa processing, but how we recruit health professionals. And when they arrive in Australia how do we make sure that their registration – the sort of formalities- are gone through in a safe way, but a quick way so we don't have registered nurses sitting in apartments for months, often working as baristas instead of getting on the hospital floor delivering clinical services. This Friday there will be a really thorough review that was commissioned by the National Cabinet, delivered to all of the Premiers, Chief Minister, and the Prime Minister. We've had a briefing on that as a group of Health Ministers, including your Victorian Health Minister. We're confident that is going to improve the speed with which we can get highly qualified health professionals coming to Australia. They often really want to come here, it's a great country to work in and live in. But it's just too clunky a system and Clare O'Neil today will outline in a broad sense, not just health, but in a broad sense what we propose to do to fix it.  


TRIOLI: Mark Butler, good to talk to you, thanks for making time for us.  


BUTLER: Thanks very much.