Elizabeth Dodd wrote:
That's what Regulation 24 is for.
From AusPharmList ....
----------
... We've been doing a survey since early this year on the 20-day rule
in our outback pharmacy. Our brief deomographics are: Population 4500 or
so spread over an area the size of a medium sized European country,
generally LSE with some genuine poverty, 40% Aboriginal, 100,000+ grey
nomads and other visitors passing through each year stopping on average
"one-point-something" days in our town. We have become very strict about
the 20 day rule and believe we're doing as well as anyone in eliminating
'illegitimate' 20-day breaches which means that we're sure that most
hoarding is confined to supplies at greater than 20 day but less than 30
day dispense intervals.
Our survey results: We do approx 35000 PBS scripts a year - that's 600+
per week of which 57 per week (approx 9%) are <20 days and require
"Immediate Supply Required (ISR)" endorsement.
Around 40% of these 'ISR' scripts are due to simple dosage:quantity
anomalies e.g. Coversyl 2mg 1 bd m30 5R
Almost as many again are due to access problems, including: remote
dwellers who get to town only infrequently (e.g. 5 or 6 times a year)
and get their dispensing done 'opportunistically'; pensioners and
concessionals who might get their scripts done at say 18 days on pension
day "because I won't have any money again until next pension day";
tourists who have left medication behind; people who are 'going bush'
for extended periods for work or recreation; access problems related to
disability; etc.
A further 10% are due to Irwin's 'pack ahead' DACs The remaining ones
are "miscellaneous" and will no doubt include quite a few where despite
our best efforts we get 'conned' by the patient.
But the key finding is that there are 50+ scripts per week that are
fair-and-square 'legitimate' 20DR breaches, where the pharmacist can
initial the "Immediate Supply Required" with absolute confidence.
We've also identified our "genuine hoarders" (GHs - about 15 of them)
and have worked out that over the course of a year they 'legally' get
away with around 16 extra scripts each at a cost to the govt. of about
$34 each. Thats 240 scripts (0.68% of total annual PBS volume) totalling
$8160 (1.1% of total annual govt. claimable). Wish we could do something
about it but it's practically impossible as listers will well know.
Incidentally, these 'GHs' are in 'equilibrium hoarding state' which is
to say that most of what they hoard in 2005 will be used in early 2006
with true wastage occuring only with regimen changes, expired drugs and
death.
Even so, if our 240/$8160 p.a. is extrapolatable (if "extraoplatable" is
a word!) to 'pharmacy at large', these are significant potential
savings, but not earth shattering. But also bear in mind that THIS
hoarding is NOT in breach of the 20-day rule. We reckon breach of the
20DR for hoarding purposes is (in our pharmacy) actually quite less and
so the potential savings are quite less, . . . .
. . . UNLESS HOWEVER the govt. regards our 50+ per week LEGITIMATE 20DR
breaches (dose:quantity anomalies, access problems, pack ahead DACs,
etc.) as potential savings.
Mmmmmmmmmm!
Let's hope that the instruments chosen to reduce hoarding aren't so
blunt as to penalise the innocent or cause such collateral damage &
costs as to wipe out any benefit gained
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