New pharmacy ownership laws in Queensland, passed by the State Parliament on 19 March and expected to take effect in late 2025, are putting the interests of community pharmacy owners above the needs and rights of Aboriginal and Torres Strait Islander peoples, according to Associate Professor Sophia Couzos, Public Health Medical Director of the Queensland Aboriginal and Islander Health Council.
“The new pharmacy ownership laws are anti-competitive, inequitable, and restrict options for proven successful models of care desperately needed to support the provision of culturally appropriate, comprehensive healthcare to Queensland’s Aboriginal and Torres Strait Islander peoples,” she writes below.
Sophia Couzos writes:
In 2020, all Australian governments committed to ‘overcome the entrenched inequality faced by too many Aboriginal and Torres Strait Islander people so that their lived outcomes are equal to those all Australians” in the National Agreement on Closing the Gap.
Further cementing their commitment to First Nations’ health, the governments agreed to ‘build the Aboriginal and Torres Strait Islander community-controlled sector’ (Priority Reform 2) and implement measures to increase services delivered by Aboriginal and Torres Strait Islander organisations.
These commitments were forgotten when Queensland Parliament recently passed new pharmacy ownership laws that prevent Aboriginal and Torres Strait Islander community-controlled health organisations (ACCHOs) from owning pharmacies.
An ACCHO is a primary healthcare service operated by the local Aboriginal community to deliver holistic, comprehensive and culturally appropriate healthcare to its residents. In line with their holistic health approach, ACCHOS support the social, emotional, physical and cultural wellbeing of Aboriginal and Torres Strait Islander peoples, families and communities.
Under the new laws, an ACCHO can own and run all parts of a collaborative health service except the pharmacy. Only a pharmacist or a close family member can own a pharmacy. Yet, big corporate entities can exist with hundreds of outlets across Australia as multibillion dollar corporations, but an Aboriginal medical service, that is intimately connected with its community, is not permitted to own a community pharmacy.
The new pharmacy ownership laws are anti-competitive, inequitable, and restrict options for proven successful models of care desperately needed to support the provision of culturally appropriate, comprehensive healthcare to Queensland’s Aboriginal and Torres Strait Islander peoples.
Frustrating
What is frustrating is that the decision was made despite strong advice from the Queensland Aboriginal and Islander Health Council (QAIHC), AMA Queensland, the Royal Australian College of General Practitioners (RACGP), Productivity Commission and community groups to reject the laws.
The fact of the matter is that we already have remote area ACCHOs in Queensland that can dispense Pharmaceutical Benefit Scheme (PBS) medications directly to their clients under Section 100 of the National Health Act (1953) if they employ or have a contract with a pharmacist.
S100 specifically relates to remote areas with no pharmacy and is designed to lower barriers to access for Aboriginal and Torres Strait Islander patients. Indeed, S100 prescriptions form the bulk of PBS expenditure for remote area Aboriginal and Torres Strait Islander patients right now. ACCHOs are already providing the benefits of on-site medicines dispensing in remote areas, and yet, according to the legislation, they are not suitable to own and run community pharmacies.
The Pharmacy Guild, whose vast members will become the main beneficiaries of this legislation, has stated that Australia’s ownership rules are, “to ensure that pharmacies maintain a strong health focus, through a competitive small business sector, which is a key reason for the high level of patient satisfaction.”
It is highly unlikely that ACCHO ownership of a pharmacy business can ever pose a threat to the pharmacy business sector.
Access to medicine is a significant barrier to many clients of ACCHOs, be that through cost, distance or barriers around cultural safety and stigma. Aboriginal and Torres Strait Islander people have less than one-third the access to PBS medicines compared to non-Indigenous Queenslanders. However, this gap is considerably reduced wherever there is on-site dispensing of PBS medicines from within ACCHOs.
The reason for this success is due to the one-stop shop model of comprehensive primary healthcare service delivery that is culturally safe, of high quality, coordinates healthcare provision, is accessible, and community-owned. Most of Queensland’s Aboriginal and Torres Strait Islander patients choose to use ACCHOs for their primary health care needs. Dispensing medications to those same patients makes sense and enables ACCHOs to support patient medication adherence and a suite of quality use of medicines initiatives utilising a multidisciplinary workforce including pharmacists.
An onsite pharmacist benefits Aboriginal and Torres Strait Islander chronic disease patients. The IPAC Trial found that First Nations peoples’ uptake of medication management reviews (which enhance medication adherence, reduce medication errors, reduce inappropriate prescribing etc) increased four-fold (400 percent) if the pharmacist was located on site within the ACCHOs compared with the uptake from current models within community pharmacy.
Step backwards
The new pharmacy ownership laws are a disappointing step backwards for Queensland, with the State Government continuing anti-competitive arrangements and delivering no genuine progress towards the priority targets outlined in the National Agreement on Closing the Gap.
These laws do not protect the right to self-determination at the heart of Priority Reform 2 of the National Agreement. Indeed, they actively fly in the face of the National Agreement on Closing the Gap. The commitment of ‘building the community-controlled sector’ apparently does not include community-controlled pharmacies, even if doing so would help Queensland’s efforts to close the gap.
The Miles Government has stated that maintaining the ‘community’ in community pharmacy is its strong belief.
If that were really the case, why is a primary healthcare sector, which is owned and run by local Aboriginal and Torres Strait Islander communities, forever locked out of providing culturally safe care to those Australians who need medicines the most?
See Croakey’s archive of articles on the Aboriginal community controlled sector
