The cost of dispensing chemotherapy agents is very high.
One thing characterises pharmacy's dealings with government is that anything involving remuneration for services or supply of prescription items is never adequately met.
It may start off as being at a reasonable level but within a two-year time span it is chiselled down to a reimbursement approaching extortion, and quickly becomes marginal.
New methods of stripping pharmacy of any sort of financial return appear in the media on a very regular basis. There is never any let up.
Yet I don't see too many pharmacists driving around in Rolls Royces, more especially since the credit crunch has come upon us.
The latest casualty in the firing line are those pharmacists who have invested heavily in the dispensing of chemotherapy items for cancer patients.
According the the story below that was recently published in Pharmacy e-News, the government is going to only pay for the amount of chemotherapy agent used with the pharmacy having to absorb the cost of the remainder of the drug.
Given that all these drugs are high in price, losses of this nature are not sustainable.
Patients may have to pay privately for this type of dispensing, and few could afford it.
This creates a moral issue that needs to be resolved with a more sensible approach.
James Ellerson comments below.
Pharmacy E-News Item:
"SPECIALIST pharmacists dispensing crucial chemotherapy medications will become unviable if the Government goes ahead with a planned cut to cancer treatment subsidies.
The Guild national president Kos Sclavos said the fate of around 180 pharmacists hangs in the balance as a result of a Government plan to no longer pay for leftover amounts of chemotherapy drugs that had not been used by the patient.
Designed to reduce wastage, the policy is predicted to save the Government around $30 million a year.
Federal Health Minister Nicola Roxon told the ABC that the Government would delay the plan’s implementation by two months from its original start date of 1 July to allow more time for talks."
The investment in an isolator, plus its maintenance and the proper disposal of the residual drugs is exceptionally costly.
Add to this, the staff who are wiling to work with these hazardous substances are usually paid well above average for their services. Females are considered to be at an even higher risk than males when dealing with these hazardous substances, because of possible damage to their reproductive system.
When dispensing cytotoxic material, it is usually handled in the form of a reconstituted vial.
Oncologists prepare their "cocktails" and send them to the pharmacy usually about 12 hours before requirement.
I have actually worked in an environment where the cyto orders are changed on short notice (and sometimes even during the actual dispensing). If the product has been compounded to any stage, it has to be discarded so as to conform to the patient's current requirements.
This is a very heavy overhead and quite a common one.
In an effort to offset the above problem, oncology pharmacists have adopted a practice where partly used vials are stored in the isolator cabinet - a sterile environment and one where any outgassing is efficiently filtered.
These partly used vials are then used in new oncologist orders, and all are usually discarded after a storage interval of approximately 3 days at the maximum.
If no orders for the drugs contained in the partly used vials are received within a three day time span, then there is no "windfall" profit as the bureaucrats love to proclaim.
I would dearly love to stick one of these high-priced decision makers in the proximity of a cytotoxic area and have them bleat to their public service union as to the danger money required for such a hazardous occupation, and the stress of dealing with multiple orders being being changed plus the fear of making a calculation error for a current patient dose.
Nicola Roxon please take note.
The current system has only survived because pharmacist innovation has reduced the wasteful process to a minimum.
Pharmacists do not decide what amount of drug goes into a vial - that is decided by manufacturers and the PBS. The dispensed component is decided by the oncology doctor
If the system is to be changed the following would have to be costed into any remuneration:
1. An allowance for having to purchase equipment above the norm compared to a regular pharmacy.
2. The cost of cleaning and maintenance of this equipment .
3. The cost of disposing of hazardous cytotoxic materials.
4. The premium paid for pharmacists who provide the service.
5. A notional rental cost for the cytotoxic area that has to be set aside whether it is in continual or casual use.
6. A margin on the cytotoxic drug that offsets the fact that a smaller fraction may have to be dispensed.
I am sure if all the above is taken to account, the cost to government would be considerably higher than what is currently being paid.
Accordingly, it is suggested to government decision-makers that they might leave well alone, because a proper reimbursement for this service will certainly be more costly.
On the surface this bureaucratic "penny-pinching" seems quite petty.