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Prescribing or Selling? Smoking Cessation and all that!

Issue: Issue 81: April 2009
Author: John Dunlop

In New Zealand the Ministry of Health is changing the way pharmacy is being funded for supplying product for smoking cessation.
The latest bright idea is that pharmacies, rather than selling Nicotine Replacement Therapy (NRT) with normal on cost margins, is to fund it as for other prescription items i.e. a basic cost price for the product plus a 4% margin plus the dispensing fee.
This would provide a slightly smaller margin than pharmacies are currently receiving for handling this product, but not a dramatic change.

What is a dramatic change however, is that pharmacists have been excluded from the wide range of people such as nurses, social workers and other health care workers able to provide smoking cessation strategies to the public.
These people write prescriptions for the product by filling out “Quit cards” allowing subsidised NRT patches to be dispensed by a pharmacy.
The basis of the Ministry’s argument appears to reside in the historical aversion to health care professionals undertaking both prescribing and dispensing roles.

This has prevented not only retail pharmacists from engaging in this very important health prevention activity, but prevents all pharmacists whether they are working in primary care, hospitals or wherever.

The fact that NRT and other pharmacist only medicines are ‘sold’ by community pharmacy may well have contributed to the current government viewing pharmacists as sellers/retailers which seems to have contributed to their negative attitude of pharmacists’ competence to provide smoking cessation relief.

Most pharmacies handling pharmacist only products ‘sell’ the product.
Even though the legislation surrounding the provision of pharmacist only products such as the ECP require the pharmacist to have undergone some extra training, and spend a dedicated amount of time with the patient we don’t charge a professional fee.
Rather we add as much mark-up to the product as we feel the market will stand and provide our professional advice for free!

The failure to ensure the patient recognises the professionalism of the pharmacist by having the patient pay a professional fee, commensurate with other healthcare professionals, leaves us isolated and ‘different’.
It marginalises us and reinforces the public’s and other health carers’ impression that we are really just shopkeepers purveying our trade in various guises.

I have long maintained that pharmacists’ time needs to be funded, and the provision of pharmacist only medicines is a wonderful opportunity for pharmacists to be paid in a similar manner to other health care professionals.
Hiding our professionalism behind a profit margin is not only foolish but a cowardly thing to do.

As more medicines move from prescription only to pharmacist only and become more readily accessible to the public, pharmacists who have better knowledge and skills than most other retailers, should position themselves as health professionals and charge a proper fee for their advice.
Failure to do so is likely to continue to foster the current and real impression that we don’t have anything worthwhile to offer other than selling a product which legislation has dictated is only available from a pharmacy.

While I have some strong reservations about certain types of pharmacists prescribing, the opportunity to prescribe pharmacist only medicines exists now for community pharmacists to engage in with no need for new legislation or lobbying.
What is it going to take for community pharmacists to step up and grab this opportunity – and do it professionally?
Wouldn’t that be a nice change to continually being pinged by our Consumer magazine and Target programme for not giving appropriate advice?

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