A Look at the Community Pharmacy Structure in Australia
Key takeaways:
Australia’s healthcare system consists of both public and private funders. Medications that are funded publicly are listed on the country’s Pharmaceutical Benefits Scheme (PBS).
Like the U.S., community pharmacists in Australia give vaccines and provide services very similar to what U.S. pharmacists call medication therapy management (MTM).
Australian pharmacists as a whole are widely respected, trusted by the public, and highly trained, but pay can vary significantly depending on the geographic area of practice.
Community pharmacies are those that dispense medications to patients who are not hospitalized or in nursing facilities, and this series explores how community pharmacy practice differs around the world. This gives us the opportunity to view the American pharmacy system in a new light and potentially find opportunities for improvement.
So far, we have looked at Japan’s pharmacy system as well as that of Finland. In this post, we’ll look at one of the most-studied healthcare systems from an American perspective: Australia’s.
To better understand pharmacy practice from Down Under, I’ve interviewed Gabi Matthews, who graduated with a bachelor of pharmacy degree in 2017, has worked in both public and private hospitals as a clinical pharmacist, and is currently completing a 2-year residency program at a tertiary hospital in Victoria.
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How Australia’s pharmacy system works
All Australian residents who hold are cardholders of Medicare, the name given to Australia's public universal healthcare system, are eligible for benefits through the Pharmaceutical Benefits Scheme (PBS), Australia’s national formulary.
According to Matthews, drugs on the PBS are currently covered at $6.60 Australian for concession patients, which includes several categories like pensioners and those with low incomes, and $41.30 Australian per month for everyone else. Dentists and optometrist prescriptions are not covered under the PBS but fall under their own separate dental and optometry schedules.
Like in Finland, and unlike in the U.S., only pharmacists can open and operate pharmacies in Australia. Pharmacists providing medicines under the PBS must apply to the Australian Government Department of Health to open a pharmacy and must meet rules regarding pharmacy location. Australian pharmacies do sell front-end merchandise, and, according to Matthews, there are both independent and chain pharmacies.
Medications are scheduled from 1 to 10 according to where and how they can be sold, much like the U.S.’ Drug Enforcement Administration’s scheduling system, but there are currently no medicines in Schedule 1.
Schedule 2 medicines must be sold in a pharmacy; Schedule 3 medicines must only be sold by a pharmacist (similar to the American “behind-the-counter” classification of pseudoephedrine), and Schedule 8 drugs are controlled substances that sometimes require a special permit to prescribe. Unscheduled drugs may be sold outside of a pharmacy and are commonly sold in supermarkets and convenience stores.
Australian community pharmacy practice
Australian pharmacists provide a range of services that could fall under the American model of medication therapy management (MTM), including home medicines reviews, MedsCheck, and Diabetes MedsCheck. Pharmacists are also able to to give vaccines, including for flu and COVID-19, to patients, although vaccine authority varies by state.
While the U.S. uses large stock bottles, often of 500 or 1,000 count, the majority of medicines in Australia are dispensed in their original containers. This is typically either a bottle or blister pack. Adherence packaging is also used, especially for patients with multiple medications, those who are elderly, and residents of nursing homes. (Matthews says that Webster-pak is a popular brand.) According to Matthews, pharmacists can substitute a generic without the doctor's permission, provided the doctor has not ticked the “brand-substitution-not-permitted” box on the prescription.
One major difference between this packaging and adherence packaging common in America is that these packs include a headshot of the patient, which aims to reduce both dispensing and administration errors — especially when patients have the same or similar names.
To determine coverage under the PBS, the pharmacy submits a claim to its online portal. The portal checks if the patient is a concession patient, lets the pharmacy know how much they will be paid, checks for errors and omissions, and lets the pharmacy know if the claim is payable. The pharmacy is then paid each week for the claims submitted during the claim period.
Aussie pharmacist job satisfaction
Like the U.S. and Finland, pharmacists rank among Australia’s most trusted professions. Matthews reports that pharmacists in cities are paid quite a bit less than in rural areas, due to the differences in demand. The standard workweek is 40 hours but, depending on the job, might either require or have the opportunity for overtime.
Similar to what’s happened in the rest of the world, Australian pharmacists have been stretched thin to take care of the public throughout the COVID-19 pandemic. This includes working long hours, being furloughed due to coronavirus exposures, and even primary care practitioners using telehealth while asking the pharmacist to check vital signs.
Matthews does feel that some patients do not respect pharmacists’ time and expertise. As pharmacists often hear in the U.S., she has heard numerous times, “How long does it take to put a label on a box (or a vial)?”
Becoming a pharmacist in Australia
Licensing in Australia consists of both formal education and experiential training, just like in America. After high school, students apply directly to a pharmacy school. Applicants are assessed according to their Australian Tertiary Admission Rank (ATAR) score, a system in Australia used for undergraduate admissions. Some schools — but not all, Matthews says — also require a personal interview.
After graduation, an internship consisting of 1,824 hours must be completed with a provider accredited by the Australian Pharmacy Council. Once at least 75% of the internship is complete, pharmacy graduates are able to take the final licensing exams. This includes both a written and an oral exam. Pharmacy graduates may apply for registration as pharmacists once they pass both.
Australia uses a Continuous Professional Development (CPD) model rather than a continuing education model to maintain licensure. (The former has been debated for some time in the U.S. but has not yet been implemented.) In the CPD model, pharmacists complete a variety of different educational activities that are categorized based on level of involvement, from group 1 (reading journal articles) to group 3 (providing education to peers and staff or launching a new service in the pharmacy). It could be described more as a portfolio of your development, rather than a transcript of activities.
There are also streamlined licensing paths for graduates from specific countries, including the U.S. While America also offers pathways for foreign graduates, most states do not have streamlined routes for pharmacists from certain countries.
The bottom line
Australia enjoys a reputation as one of the world’s highest-performing healthcare systems, and Australia’s community pharmacists play a key role in it. While pharmacists do face challenges, like long hours and pay disparities in metropolitan areas, they also enjoy a strong level of public trust.
Lastly, their simple PBS, listing all medications covered under the public system and the indications they are covered for, prevents Australian pharmacists from experiencing the significant insurance and administrative burdens that American community pharmacists face in their daily practice.
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