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OPINIONPoliticsNovember 2, 2023

How fees-free prescriptions changed my patients’ lives for the better


The removal of prescription charges has been transformational for many of those coming through the doors of Te Awamutu pharmacist Gemma Perry. But now the new government is planning to reinstate fees, and she’s dreading the impact.

At Sanders Pharmacy in Te Awamutu, Clive, aged 88, has been coming to us for 70 years. He’s been a patient at the pharmacy since it was founded in 1953 by pharmacist Bill Sanders, who described himself as “mad keen on helping people”.

We have a long history of looking after Clive. Our whole team has built relationships with him over decades. As a result, he says he has a “special spot” in his heart for me and my team.

This is what pharmacy is all about. Getting to know our patients and their needs. Helping them to understand their medical conditions and the often complex medicines they require. Supporting our patients to navigate the health system, with an increasing focus on preventative medicine.

All this work was boosted by the removal of “patient co-payment” prescription charges in July of $5 per item. It happened after long years of health sector advocacy and in the wake of compelling new University of Otago research about the benefits of removing prescription charges, such as people spending fewer days in hospital.

We’ve already seen the difference that’s been made by fees-free prescriptions. As pharmacists, we’re keeping people out of hospitals. We’re getting people through our doors again: Young parents who just didn’t have the money for an unexpected bill on the day. Families with teenage children needing asthma inhalers. People dealing with anxiety, for whom the stress of a potential Eftpos decline had been too much. Low-wage workers – some literally crying with relief. Patients with high health needs, who had been driving long distances and waiting long times to get their various medications from discounters, often served without vital medication advice. We no longer have the heartbreak of patients asking which of their list of important medicines they can leave until payday. We no longer see the upsetting consequences of patients with chronic conditions and pain trying to eke out their medicines by taking less than the prescribed daily dose.

And we’re having more face-to-face conversations, allowing everyone the chance of having a meaningful relationship with their healthcare provider. That’s where the magic of pharmacy happens.

A lot of that magic is at risk. National plans to reinstate the $5 prescription charge for most people over 13 years old; Act wants to reinstate it for everyone. We’re pleased New Zealand First have promised to keep prescriptions fees-free; as their MP Jenny Marcroft has said, “Access to medicines is not only about increased funding of medicines but removing and keeping barriers to access down.”

But even if it turns out on November 3 that the National-led government does not need NZ First’s votes, we urge the government not to bring back prescription fees.

Increasing fees for medicines for most people will be a step backward – for patients, for pharmacists, and for our community. Pharmacists’ conversations with patients will be taken up with concerns about cost, rather than care – even for those who can pay. People, even on reasonable incomes, are struggling. Medicines add up: an unexpected bill of $40 or more, if the whole family gets sick, or if someone is dealing with multiple health issues, can put people off dealing with health issues until they get worse. It’s the shame, the embarrassment of not being able to pay.

a $5 note on a blue background, with blue and white capsules dotted around
National wants to bring back the $5 charge for adult prescriptions. Act is pushing for everyone to pay. (Image: Archi Banal)

Prior to the fees removal, a group of pharmacists, the Prescription Access Initiative, carried out a survey on the fallout of the fees, and one responding pharmacist summed up the problem well: “I spend more time managing patients fiscally than medically.” We’ll be back in that position if the new government follows through on its plans – particularly during the current cost-of-living crisis. At a time when people are facing high food prices, steep petrol costs, and rising rents, it doesn’t seem sensible or fair to ask people to pay for medications they need. There are plenty of people without Community Services Cards or SuperGold Cards (National’s proposed exemptions) who are still in need. Anytime we add in layers of targeting, there will be vulnerable people who will fall through the cracks.

Putting prescription charges back on the table also turns pharmacists into tax collectors for the government. The fees don’t go to us. This wastes our time and it’s not our role. It risks putting more strain on pharmacists when we’re already having trouble filling our workforce.

National put out a whole policy on cutting red tape. But asking pharmacists to deal with targeted exemptions, requesting proof of eligibility, and then collecting tax for the government all creates more red tape for small businesses that are part of the beating heart of our communities.

National and Act have also promised tax relief. But putting fees on vital medications is essentially putting a tax on sick people.

National’s also refused to rule out loosening the rules on ownership of pharmacies – and Act has definitively said they want to loosen these rules. Removing the requirement for pharmacies to be majority-owned and effectively controlled by pharmacists would open up more pharmacies to corporate control, including in supermarkets, and risk closure of independently-owned pharmacies. We know the corporate focus is keeping costs down to provide shareholder returns, rather than building relationships and going the extra mile to support patients.

These kinds of political footballs wear down and demoralise the community pharmacy sector. They make us feel like the forgotten profession.

A rural Northland pharmacist wrote in our survey: “It’s free to go to hospital, why can’t it be free to come collect medicines from the pharmacy that can keep you well and out of hospital?”

Pharmacists in New Zealand have a clear message for our new government leaders: we ask that they at least delay reintroducing prescription fees during a cost-of-living crisis. We ask that they stop and consult the sector that has to implement their policies before storming ahead. Giving us all some time to share what we do, and why fees should stay off medicines, would give us breathing space – and time for the new government to pause and reflect on the best way forward.

I think that’s the sort of thing that 88 year-old Clive would really appreciate.

Gemma Perry is a pharmacist and founding member of advocacy group Prescription Access Initiative.

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