The Pharmaceutical Journal
Vol 279 No 7482 p683
15 December 2007

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• NHS (2)
• Retention fees (5)
• Postgraduate education
• Independent prescribing
• Registration
• The profession (2)
• Pack sizes
• Retirement

Letters to the Editor

Pack sizes

Adopting a PHARMAC-type model

From Mr C. F. Johnson, MRPharmS

Neville Cameron raises some interesting points (PJ, 17 Nov 2007, p565) regarding pack sizes and costs. As an independent professional it is important to “consider and act in the best interests of individual patients and the public” and “make sure that your professional judgement is not impaired by commercial interests”.¹

The comments may also indicate an underlying lack of diversification of some community pharmacy businesses to embrace other schemes for income generation, eg, medicines use review, smoking cessation, minor ailments, etc. Some of these activities may encourage customers to use their pharmacy, enthuse staff, be performed during work-load down times and increase productivity.

Many UK pharmacists may not be aware of PHARMAC,² which dictates prices and limits products available via the public health system in New Zealand. Special authority (SA) applications must be approved before supplies of new and high cost medicines can be made, eg, clopidrogel, candesartan, seretide, etc. This tries to assure evidence-based prescribing.

Proprietary omeprazole is not covered by the SA and is in the top three highest cost items for most district health boards (DHBs), with 94 per cent of those prescribed PPIs receiving treatment doses or higher in some DHBs. Direct-to-consumer advertising influences medicines use inappropriately, eg, fluticasone.³

NZ service users pay for the majority of health services, from a cost of NZ$3–15 per prescription item and NZ$15–40 per GP visit. This has positive and negative effects on the health service, but negative effects on poorer members of society.⁴ Average hourly take home pay rates are $12.75/h and $20.80/h for women and men respectfully.⁵ All public health systems have problems.

Mr Cameron may have indirectly highlighted a potential need for patient and GP education to encourage better use of the health care team. In some regions emergency hormonal contraception may be free of charge via pharmacies, under local protocols or from family planning clinics and over-the-counter at a cost.

Mr Cameron’s employers fail to see the big picture and probably fail to take up new opportunities to improve overall health quality. As part of this picture some UK hospital pharmacies have tried to reduce their use of loss leading medicines, which cost 3–5 per cent of their real cost in secondary care and then are charged at full costs to primary care.

No major political party will develop a PHARMAC-like Government department due to the pharmaceutical industry, uneducated public opinion and prescribers cries of “clinical freedom”. All health care professionals and public employees have a responsibility of stewardship for our public funds, to allow the greater vision of free health care for all to continue.

Chris Johnson
Christchurch, New Zealand

References

1. Royal Pharmaceutical Society of Great Britain. Medicines, ethics and practice — a guide for pharmacists and pharmacy technicians. 2007;31;98.

2. PHARMAC – Pharmaceutical Management Agency. (accessed 10 December 2007)

3. Toop L, Mangin D. Industry funded patient information and the slippery slope to New Zealand. BMJ 2007;335;694–5.

4. Craig E, Jackson C, Han DY, NZCYES Steering Committee. Monitoring the health of New Zealand children and young people: indicator handbook. 2007. Auckland: Paediatric Society of New Zealand, New Zealand Child and Youth Epidemiology Service
(PDF 5.4 MB) (accessed 10 December 2007)

5. Statistics New Zealand. (accessed 10 December 2007)

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