Mini-Hoon: A shocking plan to deregulate pharmacies

I spoke with Mangawhai Pharmacy owner Lanny Wong today to about plans barely-announced or covered this week by Associate Health Minister Casey Costello to deregulate the nation’s pharmacies.

Lanny said she was shocked at the details revealed in full in Cabinet papers released proactively on Monday, particularly because there had been no consultation with the pharmacy sector, which would be upended by the removal of its current regulatory model. Costello barely mentioned the likely industry transformation in a release on Tuesday titled: ‘Medical Product Bill taking shape.’

Costello characterised the deregulation as “allowing for more flexibility and innovation that will improve safe access to medicines and healthcare,” but Lanny, who is the spokesperson for the Independent Community Pharmacy Group (ICPG), said the reforms risked creating a US-style sector dominated by big corporates, where turnover and profit are prioritised over the health of customers and communities served by pharmacists, who own the businesses and live in those communities.

“This means that pharmacy are no longer needed to be owned by pharmacists and pretty much means anyone can own a pharmacy if you’ve got enough capital. It means every supermarket can have a pharmacy, every corner dairy, and it no longer needs to have majority ownership by a pharmacist.” Independent Community Pharmacy Group (ICPG) Lanny Wong in the interview above.

Currently, pharmacies are a regulated facility where only a pharmacist licensed with Medsafe is allowed to own the pharmacy, and can’t own stakes in more than five pharmacies. Pharmacists operate under a code of ethics and the patient’s code of rights.

“So there’s a lot of law that govern what we do in the pharmacy and the activity that happened in pharmacy. That’s why we’re different from a retail, from a vitamin shop.

“Pharmacists actually provide clinical care. So when you go into a pharmacy, you have the right to receive the care that you request and have the right to understand your medicine. That’s why pharmacists always have to be present in a pharmacy to be able to provide a patient with that care The pharmacist is actually a health professional that you can see every day, anytime, for free.” Lanny Wong

Lanny gave the example of a pilot she is working on with Te Whatu Ora-Health NZ to screen for rheumatic fever in her practice, which would not be profitable.

“That is something that I do because I want to have a good relationship with Te Whatu Ora and that’s in my community. If a pharmacist is no longer in effective control of a company, then decisions like that can become quite challenging to make when it’s not churning out the profit or the margin that you desire.” Lanny Wong

Lanny said the reforms appear designed to enable a ‘Hub and Spoke’ model of pharmacies where pharmacists making the key decisions are centralised and the workers serving customers in stores are not enabled, incentivised or expected to provide independent advice or decisions that might reduce sales and profits.

“When pharmacists no longer have business and financial control of a pharmacy, it means the corporates can call the shot on how a legislation should be written.” Lanny Wong.

Lanny gave the example of the hub and spoke model enabled by deregulation in Taiwan, where medicines are allowed to be distributed that way without the supervision of a health professional, often online. She also referred to the way the oxycodone crisis developed in the United States, where ‘pill mills’ distributed pills in large numbers to swathes of customers without supervision.

“The overseas evidence definitely show in deregulated environments, for example the United States with its oxycodone crisis, that’s precisely the type of risk that can happen when profit basically is more important than care.” Lanny Wong.

Lanny also contested comments in the Cabinet paper that deregulation would encourage innovation, or that consolidation and economies of scale would result in lower prices. Examples of innovation in New Zealand often began with independent pharmacies working with doctors and hospitals in their areas to try things out.

“In the short term, there might be some that type of benefit, but I think everyone in Aotearoa will probably understand in the long term once a monopoly or duopoly situation that has been established, prices go back up and service drop.” Lanny Wong

Lanny also referred to the loss of regional and provincial pharmacies in remoter communities after a similar deregulation in the UK.

I have requested an interview with Casey Costello.

She said in the release the reforms would introduce a new role of supervisory pharmacist, which would be required in all companies that operated more than one pharmacy. The supervisory pharmacist would be responsible for compliance with pharmacy standards and regulation for the company as a whole. Costello said the bill would be introduced next year. It would also include “allowing unapproved medicines to be advertised and promoted in some circumstances.”

Chapters

00:00 Introduction to Pharmacy Deregulation

03:01 Understanding the Role of Pharmacists

05:48 The Impact of Deregulation on Pharmacy Ownership

08:50 Risks of Deregulation: A Global Perspective

11:46 Innovation in Pharmacy: Independent vs Corporate

14:55 Legislative Process and Industry Consultation

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Ka kite ano

Bernard

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