Magazine article Drug Topics

Pharmacy Practice in Other Lands: It's Different, but . .

Magazine article Drug Topics

Pharmacy Practice in Other Lands: It's Different, but . .

Article excerpt

"What you are about is what we are about. Your problems are incredibly similar to the ones we face." With those words, Tim Astill bridged the miles between the pharmacists in his homeland and those in America. Astill, a lawyer/pharmacist who is group director of the National Pharmaceutical Association of Great Britain, was among six association executives invited to share their experiences with an audience of U.S. pharmacists.

They were guests of NARD, at the independent pharmacy group's annual meeting last year. They spoke at a symposium sponsored by Du Pont Pharmaceuticals. Represented in addition to Great Britain were Australia, Canada, Ireland, New Zealand, and South Africa. Here is a sketch of the way pharmacy is practiced abroad:

Great Britain

Can you imagine a pharmacy without years' worth of curling, yellowing prescriptions crammed in old files? Having no record on hand that you had actually dispensed a specific Rx? Trusting the government to reimburse you?

Well, that is pretty much the situation in the 12,000 pharmacies scattered about the British Isles. Only about 3% to 4% of the Rxs dispensed are paid for by patients. Almost all are covered by the National Health Service, the country's universal health-care coverage plan.

"The really interesting thing for the pharmacist is that the doctor doesn't keep a copy of the prescription, nor does the pharmacist have to keep a record," Astill explained. "There is absolutely minimal bureaucracy. At the end of a month, the pharmacist gathers up all his prescriptions in a parcel and posts them off to the government pricing office and that's the last he sees of them. There is no audit trail and no record. He trusts the government pricing department to pay him, and, generally speaking, they do."

And a good thing, too, given pharmacy's dependence on prescriptions. The average British pharmacy has sales of about $627,000 (in U.S. dollars, which vary because of exchange rates). NHS Rxs account for 70% of sales but only 65% of profits. "That is a very heavy dependence on the government purse," Astill observed. "A most unhealthy situation. We are at the mercy of the politicians in a very real economic sense."

Astill also mentioned a drug classification American pharmacists would love to see transplanted into the colonies. "We have an interesting category called 'pharmacy medicines,'" he said. "These are an extensive range of over-the-counter medicines that can be bought only from a pharmacy, and they must be sold by a pharmacist or under the personal supervision of a pharmacist."

Australia

Unless you've been there, you might be surprised by more than a few things in the Land Down Under. It is vast (the size of the U.S. minus Alaska). Given that space, the 17 million people (about as many as California) could be pretty scattered.

But Australia is very urbanized, said Robert Davies, executive director of the Pharmacy Guild of Australia and a community pharmacist for 20 years. The Melbourne and Sidney areas each have populations exceeding six million. All told there are some 5,600 pharmacies, or one for every 3,000 people--but all that is about to change. There will be fewer pharmacies, and the survivors presumably will be better off.

Here's the background, as Davies explained it: Like Great Britain, Australia has a National Health Service, which covers 76% of Rxs, and a veterans program for another 8%.

The Australian government and drug manufacturers negotiate Rx prices. Pharmacists had been getting a 25% markup plus a $2.13 dispensing fee, set by an independent panel. Under a new agreement, the markup falls to 10%. The dispensing fee goes up to $2.80/Rx, but the rate is frozen for 18 months. Afterward, it will be indexed to account for inflation.

The agreement with the government also contains economic incentives for pharmacists to merge stores or to retire and close for good. (Ownership is restricted to pharmacists, and there are no real chains. …

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