November 2001 issue Pharmacy Today magazine

NRT TURNAROUND

Quit Group backs down after threat of legal action, but pharmacy will be removed as exchange card providers when contracts expire.

Quit Group and the Health Ministry are finding it difficult to extract pharmacy from its role in the NRT exchange card programme. At the request of its funder, the Ministry of Health, the Quit Group terminated its 12-month renewable contract with 80 pharmacists in September.

The decision was reversed six weeks later, after pharmacist Warren Flaunty began legal action, claiming costs due to a breach of contract. Exchange card co-ordinator Steve Cook says after Warren Flaunty's claim, the charitable trust accepted legal advice to complete the contracts of all 80 pharmacies. When these contracts expire, pharmacy will be removed from providing the cards.

The original decision to drop pharmacists was based on Pharmac and Health Ministry recommendations to separate prescribing and dispensing because of the potential for pharmacies to make a "small" financial gain - the $7.15 dispensing fee.

Budget blowout

The decision to remove pharmacies came at a time when the Ministry of Health voiced concerns over a potential $1.5 million blowout of the subsidised NRT budget. At the same time Associate Health Minister Tariana Turia launched the "It's about Whanau" media campaign. The associate minister signed off the decision to dump pharmacy from supplying the cards.

Some pharmacists suggest they created excessive demand for a programme that has become too popular for its budget and were removed to make way for Maori providers. Although the Associate Health Minister's office refused to give the number and breakdown of NRT exchange card providers, Tariana Turia says the decision was based on separating prescribing and dispensing.

Money was not saved by removing pharmacy, she says, and "It's about Whanau" was funded from a separate budget.

Provider numbers up

Quit Group figures show the number of registered exchange card providers has risen from 251, when the pharmacy decision was made, to 274. Of the changes, three pharmacies have opted out, one IPA has joined and Maori providers have risen from 35 to 52.
In July, a ministry background paper informed Tariana Turia that a budget deficit would occur next year if $1.5 million was not added to the $6.18 annual NRT funding.

If no additional money was provided, the ministry recommended looking at removing the subsidy for the second four-week treatment, or imposing age restrictions.

Tariana Turia declined to say if extra funding would be made available.

In July, Pharmac and the Health Ministry recommended pharmacists be withdrawn because their dual prescribing and dispensing roles had set an "undesirable precedent.

Tax guardians

While pharmacy has not erred, Pharmac general manager Wayne McNee says, when it comes to taxpayer subsidised medicines, prescribing and dispensing need to be divided.

"The broad issue is based on prescribing, dispensing and then making a claim (to the Ministry of Health for reimbursement). As a general principal it's something we don't support& that's also the case with doctors and nurses."

Guild president Murray Burns says the decision has implications for doctors, nurses and even family planning clinics. He says the guild will "await further developments with interest".

"It also implies pharmacists will be swayed by a $7.00 dispensing. It's hard to fathom the ministry's logic."

One pharmacist says he believes the prescribing and dispensing issue could have ramifications for pharmacy's role in supplying the "morning-after" emergency contraceptive pill.

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