The Hon. Greg Hunt MP
Minister for Health and Aged Care
20 May 2021
SPEECH – AUSTRALIAN PHARMACY PROFESSIONAL CONFERENCE
Topics: Pharmacy of the Year Awards; handling of COVID-19 in 2020; 7th CPA; COVID-19 vaccination rollout;
Thanks very much. To Johnny for that magnificent acknowledgement of country and just the history that you wove into and the stories of Indigenous Australia and the pride that you give all of us in the role of Indigenous Australians.
To Rebecca, representing all pharmacies. Obviously speaking for your own pharmacy which was acknowledged last year, but not like this, but in a way which was appropriate to the times. But you spoke to all pharmacists with your passion for what you do.
And then of course to our presidents, to newly elected Trent, 009, I think is how you call yourself. To George, 008, and it’s been- it’s just a privilege working with both of you over the years. And George, thank you for everything from last year. And, of course, to Kos who just says: call me 007. More Johnny English than 007, but you get the idea.
But then to all of them, I didn’t know before I came here that the Pharmacy of the Year was every pharmacy in the year, and I could not think of a wiser, fairer, nor more appropriate choice, Trent.
I think it is inspired. 31,000 pharmacists, 5900 community pharmacies. Coming up in a few years to your 100th anniversary. And I mentioned at previous APPs that one of those earliest pharmacists, one of the first female pharmacists in Australia was my grandmother, Phyllis Grant.
She lived through the Spanish flu as a young girl and then through the ‘30s and ‘40s as a pharmacist. And I think without doubt, 2020 has been the finest peacetime year in the history of pharmacy in Australia, certainly in the last 100 years.
I want to start by saying one thing, and that’s thanking. You were on the front line, you were there, you were dispensing medicines, you were providing that emotional support, that mental health support, you were providing the services. But as I mentioned last night, when I popped into one of the dinners that above all else, you gave people a sense of hope and of belief and of possibility, that if our pharmacists are staying on the frontline, we can do this. We can really do this.
So, this was the reason that you came into the profession. Sure, it’s a business, but it’s more than that. It’s a vocation and a profession and a calling. And I think it’s very important to look at this incredible room, look at this nearly full room, as full as the seating plan will allow, and to see people gathered together now.
But they can only be gathered together now because last year, in the height of the pandemic, at the moment of greatest risk, you were there and providing the support and providing the medicines, but also teaching people how to stay safe. And it’s an incredible thing you have done. So, I just want to acknowledge and thank you for that.
So, today I want to take you briefly through three things. Firstly, COVID and some of the initiatives we’ve struck upon together and those that will allow us to change the face of pharmacy. Secondly, the 7th CPA. And thirdly, the future as we work on that together.
Now, in terms of COVID, let me begin with the point about the doors staying open. They did, right across Australia. Other businesses faced immense challenges. There was an immense challenge to your business model.
Whilst there was a hike in scripts and pharmacy demand in March of last year and that spilt over to April and normalised, that wasn’t the case for every pharmacy. Pharmacies in the city centres, pharmacies in some of the shopping centres struggled, and so JobKeeper stepped in to help with those that needed it.
And it wasn’t even, and that framed much of our thinking around the 7th CPA. George and Trent and Suzanne played an immensely important role in that thinking.
But at the same time, when we looked at those doors staying open in March, you know that whether it was children’s Panadol, whether it was Ventolin, Epi-Pens or other products, there was a rush and there were shortages. And so, within a 24-hour period working with George and the team, we struck the anti-stockpiling agreement and the measures and the pharmacists implemented it.
And it was difficult. I realise that. We know that people were criticised and sometimes abused and threatened, and I’m deeply sorry that that was the case. But you soldiered on in the best of all possible spirits and ways, and that protected the medicines for those that truly needed it.
And we were able to continue our supply lines and to bring in masks and to bring to bring in sanitisers. And then we see the story of the gentleman from Wagga Wagga on your video who was producing his own sanitiser.
And that Australian spirit meant that we partnered, and people produced. We made masks in Australia. We set up manufacturing businesses in Shepparton and elsewhere, and we brought in the army to take businesses that were already under operation, but to multiply them many times over in terms of their size and their capacity. And we kept those supply lines going.
When we saw in other countries, in Spain and France, in Italy, in the United States, New York initially, shortages on a catastrophic scale, and that didn’t happen here in Australia. And your innovation and your resilience, but also those anti-stockpiling measures that, I remember those conversations in March, George, where we acted together immediately. And it made the difference.
Equally when it comes to what we were able to do with regards to support and programs for the pharmacies and for the public together to operate in a way which was COVID-safe. The first of the things, of course, was the home medicine service.
This was such an important part of particularly allowing our elderly to stay safe at the critical moment and keeping the pharmacies and the pharmacists safe. So far, over 2.6 million deliveries have been made by so many people in this room. Over 4800 pharmacies who participated in that program, an initial $20 million has now grown to over $35.5 million.
And this program continues on and continues to keep people safe. But it also works for those who are immobile. It could be a young mum with a sick child, it could be an elderly patient, it could be somebody with a disability. All of these things come together.
And so, I think this is a profoundly important program. We are going to review it on a- the capacity to make it permanent. And it’s something to which I am very, very drawn. I think it’s a national change in the way that telehealth has been a national change which has come out of the pandemic.
The second thing, of course, continuous dispensing. It started with the bushfires, but it’s now travelled through COVID and is a fundamental change and reform in the way in which we deliver medicines for those that most need it. It recognises the scope of practise. It recognises and implements that scope of practise.
And then, of course, we have the e-Prescribing. A permanent change, hastened forward in place where now we’ve already seen 97 per cent of pharmacies participate in e-Prescribing. 97 per cent. 3 per cent we still have to find. But that’s an extraordinary and transformative take up.
I think it’s an improvement in safety. It’s an improvement in convenience, as well as it’s an improvement in record keeping and data for all of us. But above all else, it’s safe and it’s convenient. And in many ways, we have taken the opportunity of a once in a century challenge to grasp the initiatives that we’ve been working on and to bring them forward and to make them permanent. And to do that together, I think is an extraordinary outcome.
So, then that brings me to, related to COVID, is flu. And so, Trent mentioned the pharmacy figures. We’re well up on where we were two years ago. Even since you were given those figures, the figures that Sam has given me this morning is we are now 690,000 pharmacy flu vaccinations, including my own last week at the Amcal in Mount Martha Village.
John-Paul administered it almost painlessly. And it was just a little too much enthusiasm with John-Paul. He took the needle and Anthony decided he was there, and Anthony, I think, said just a little bit firmer to make sure it all gets in.
But to see the pharmacist doing that, part of now a five million dose regime so far, well up on two years ago, and today I am officially opening, officially opening the national flu season. We have not done this because we didn’t want to interfere with the COVID program, but it’s well underway.
The supplies are out there. Our pharmacists are delivering. And I think I sent the strongest message I could about the role of pharmacy by rolling up my sleeve and sending that message out nationally last week.
I’ll come to COVID vaccination as we look to the future. The next big thing beyond COVID, of course, was and is the 7th CPA, and this was negotiated in the height of the pandemic. And so, we all had day jobs and then we all had an evening job. And it also came at the same time as we were working with the states on a five-year hospitals’ agreement.
And what is very interesting is that even though these are difficult negotiations, but ultimately, ultimately a fundamentally successful outcome for, I think, everybody, for patients, for pharmacists, for Australia, there was never a story from either side, as Trent said last night, in the public domain about the negotiations. And so, for me to be able to work with Suzanne and George and Trent, and Katherine and all of your team, meant that we could do it, Sam and Richard and myself, with absolute faith. And to have good faith negotiating partners in an environment like that was just a privilege.
So, then that brings me to the outcome. Trent mentioned all up, it’s over $23 billion of remuneration to pharmacists, of which the government program is $18.35 billion. And that itself is broken down into three large components.
$16 billion of that is PBS remuneration, and of that, we know that there’s over 200 million scripts a year to be delivered, but we have now backed that in with the increase in the handling fees with, in particular, a $43 billion commitment over the next four years to PBS medicines, which includes the very significant payments to pharmacists for doing extraordinary work.
And then as part of that, we’ve put in place a $2.8 billion new medicines guarantee. And that new medicines guarantee means that we can bring on, without having to offset, new medicines, which means more medicines at an earlier time, better outcomes for patients, but additional opportunities for our pharmacists. So, all of those things kind of came together through the CPA and then were backed-in in this budget from our side as the show of good faith in the counterpart.
In addition to that, we have $1.2 billion in program funding; that’s an increase of over $100 million. And those programs, you know, you know them better than anybody, whether it’s the Dose Administration Aids programs, whether it’s quality, use of medicines checks, whether it’s work in relation to diabetes or other programs, they’ve been extended and expanded and they provide the support for our patients.
And then there’s $1.15 billion, again an increase of well over $100 million, for the community service obligation and for the NDSS, so for our diabetic patients. And the CSO has a very important element for the wholesalers, because we know that there are challenges, even though they’re large businesses, they still have to operate profitably.
And so working in design, we put in place a floor and a ceiling on the amounts that they could receive. One of the things that many of the wholesalers – and so many of you are engaged with them deeply – were worried about was the idea that low-cost medicines would mean that they were losing on the margin for each delivery.
And so, by putting in a floor and by putting in a ceiling on the high-cost medicines, we were able to average the payments, increase the total volume of payments and give them much more certainty, and therefore you much more certainty. And it was that same principle we took into revenue and certainty for pharmacists right across the board.
So, the revenue adjustment mechanism is in its own way, a firm floor and a flexible ceiling for the payment of pharmacists. And this, I think, along with the changes with regards to the location rules, removing the sunset clause which we negotiated a few years ago, is probably the most important structural reform within the agreement and within my time.
And so just to remind you, you’re probably all very familiar with it, but in case you’re not, what it means is that we’ve agreed between us on the trajectory of new medicines and pharmaceutical scripts that we’re expecting each year. For example, in the second half of 2020, there was an expectation of 109 million scripts.
But we put downside protection. So, for the first three full years of the agreement – for ’21, ’22, ’23 – what you see is that there is a barrier, that if the amount of scripts were to fall below what was expected – and this was such a big issue with the 6th CPA – we would make up the difference by adding a supplement in subsequent periods to the handling fees.
So, if it fell below that threshold by even 0.1 of a per cent, that would subsequently be made up. So, there was a zero for tolerance and then in the final year, a two per cent tolerance – had to give something back to Treasury and Finance.
But that’s a really important income and guaranteed protection. As Trent says, it is bankable. And there is virtually no other agreement that I’m aware of anywhere across the Australian government where the major industry sector which provides that revenue guarantee. Because of businesses, because of the risk of the pandemic or of waves coming back, we’ve consciously built that in, and it was an acknowledgement of the contribution of pharmacy.
And the flexible ceiling is you can increase, so whereas I said, 109 million scripts was expected in the second half of last year, 113 was delivered. So, 3.4 per cent above what was the expected amount. But that comes as additional revenue to pharmacists. It’s only if we get above the 5 per cent over expected that we would then normalise the payment.
So, there’s a clear band, with downside protection and with upside flexibility. And I think that – I don’t see that ever being taken away from future pharmacy agreements. When Trent is negotiating the 2040 agreement, I’m thinking it will – it will still be there and he’ll still be there. So, that is systemic reform.
All of that then brings me to the future. And when I look at the future, I think of this in terms of programs, aged care and COVID. And in terms of those programs, we start with our rural areas. As part of the agreement, we’ve negotiated and agreed that our rural classification system would move to the modified Monash system. So, the triple M.
And what that means is that 400 additional pharmacies will qualify for rural programs. And the first of those programs commenced on the 1st of January this year. The other programs commenced on the 1st of July of this year. So, for 400 pharmacies in rural areas, better access and more remuneration and that will only be good news for the patients and for everybody involved in those pharmacies.
The second of those programs is the work which is being done in relation to Indigenous Australia. And so, from the 1st of July, a $40 million Indigenous dose administration aid program will commence and that will be a payment of $11.60 per patient, per week. And it’s a very significant and important initiative. It’s a $40 million initiative, but it’s not the money, it’s the service and the recognition of the need.
And then in terms of our international engagement, I’m really delighted to be able to announce that the International Pharmacy Scholarship and Exchange Program will commence with the first exchanges next year between here and New Zealand.
We know that they’re COVID safe, but we’ll extend that out in other countries. And ultimately, that’s about best practise lessons, taking them overseas- our people overseas, bringing people here, giving the opportunity for our best and brightest young trainees, but taking the knowledge from elsewhere and sharing ours and bringing theirs here. And I think that’s a really important initiative.
And with regards to the next of the future area is aged care. We’ve already invested $25 million in increasing, as part of the royal commission response, the quality use of medicines and the protections within aged care facilities, doubling the fees that are available.
Now, we work together on implementing what’s known as recommendation 64. What does that mean? We now- we’ll now focus on the additional steps for further quality use of medicines support within aged care. You’re the other ones that have called out on many occasions the overuse of chemical restraints, and we can’t have that.
Now, there will be cases for appropriate use of medicines, but they have to be clinical and, in many ways, our pharmacists are our watchdogs. You’re our early alerts and you can see the impact on patients, you can see what’s appropriate, you can be engaged in that. It’s a deeply and profoundly human role and we will have you more engaged on that front.
And finally, Trent mentioned the COVID vaccine program. And I am delighted to announce that in partnership with the Queensland Government today, the first pharmacies have been approved, 56 rural pharmacies and the Queensland Government will provide the details of those, for rolling out of the COVID vaccine in coming weeks in rural and remote areas where they’re filling gaps.
That was actually a proposal that Trent himself put to me I think on the first day we spoke of the new presidency. And we’ve worked through that. We’ve got National Cabinet agreement; we’ve got Queensland’s agreement. Now, we’ll work with other states and we need your help to work with other states and territories on that.
On the general rollout, the changed advice from ATAGI had an impact on the whole country where we had to stratify between over-50s and under-50s. And so, we have good supply of AstraZeneca now and that’s rolling out. But then as we move to the under-50s program and the whole of country mRNA component, that’s when we get to expand out to the pharmacy sector.
Now, that’s in the latter part of the year, want to be sort of very clear and open about that. And so, that will be October, November, December, potentially September. And that’s based on supply. So, the whole of the world is dealing with the challenge of supply and supply dictates the rollout.
But there is an absolutely clear position – an absolutely clear position that as we have that supply and as we have another critical thing to which Trent alluded, a likely change in refrigeration requirements. So that will be the third iteration of refrigeration requirements for the mRNA vaccines and for Pfizer in particular, which will see a fundamentally important thing happen. Presuming that the TGA adopts the European standards, then we’ll be able to have long term, up to 30-day refrigeration of the Pfizer vaccine in ordinary refrigeration, subject to temperature monitoring. And that will, that’s a game changer.
And so, we have supply and we have refrigeration, which means that we will able- be able to have a dual track program of our general practices and community pharmacies. And I’m committed to that, I believe in that, I fought for that and I can be absolutely certain that pharmacies will be a fundamental partner in that third stage of our vaccine delivery right around the country.
And then there’s next year. And this may well be the case that we have booster and variants required as we do with an annual flu vaccine program, and we will take the medical advice on that. But we have already purchased 25 million Moderna units and subject to the medical advice, subject to the refrigeration requirements, I think that there’s a very real possibility that we will move to a replicated program for boosters and variants as we do with flu around the country in terms of multiple points of presence.
But supply has dictated the rollout. The conditions obviously change. Every day we change in terms of the things we face. But the one thing that hasn’t changed is you look at this country, you look at this hall, you look at this group of people that’s here, 89 days – and I haven’t got today’s figures yet – in 2021 of zero cases of community transmission.
There’s no other country in the world that has the double, at 89 cases of zero community transmission in a world of almost 600,000 cases a day, 600,000 cases a day and more people in employment now than a year ago. That’s us. To the best of our knowledge, no other country has achieved that double and certainly no other advanced economy has achieved that double.
And so, I want to finish where I started. We would not be where we are without you. So normally, it’s about pharmacy and the business. But this year, it’s about your role as fundamental custodians, not just of the nation’s health, but fundamental custodians of the nation’s spirit and of the willingness to fight through. And in the hour of greatest national peacetime need, Australian pharmacists stood up.
And so, I think every pharmacist rightly should be declared and has been declared as pharmacist of the year. It’s my honour to address you. I thank you. I wish you all the best and I am delighted to officially declare open APP 2021.