Fairer pay for better medication outcomes
Strong advocacy for better reimbursement for comprehensive medication management services starts with a precise account of the work pharmacists do beyond dispensing. Comprehensive medication management is the clinical process of finding medication-related problems, agreeing on goals, coordinating treatment, monitoring response and safety, and reviewing progress as the patient’s circumstances change. For people taking several medicines or moving between hospital, primary and specialist care, that continuity can be as important as the medicine itself.
Australian payment arrangements often treat this clinical work as incidental. A Pharmaceutical Benefits Scheme (PBS) subsidy may cover the medicine, while a pharmacist’s time to reconcile a discharge summary, assess adherence and side effects, and contact a prescriber is absorbed without a fair service fee. The advocacy task is to show what that unpaid work prevents, document who benefits, and press for durable public funding rather than relying on goodwill.
What comprehensive medication management delivers
Comprehensive medication management gives fragmented care a clinical owner. A pharmacist can identify duplicate therapies, interactions, adherence barriers and goals that have drifted from the prescription. The care plan can then record agreed actions, monitoring dates and communication with prescribers, followed by another review to check whether the changes worked.
Australian pharmacies are accessible local health destinations, including in places where a GP appointment, hospital pharmacy or specialist service is harder to reach. Many people call their local pharmacist the chemist and expect help with a repeat script, a side effect or a medicine left behind after a hospital stay. Medication review is a natural extension of that trusted, informal contact, provided consent and privacy are respected.
Reviews also need to address products that may not appear on the PBS. If someone asks whether a CBD product could help pain or anxiety, the pharmacist can consult a CBD evidence review and discuss uncertain benefit, interactions and Australian regulatory status. The aim is to make the review comprehensive and evidence-informed while taking the patient’s experience seriously.
Where Australian reimbursement falls short
Australia’s funding architecture divides medicines, clinician services and state programs across several streams. The Commonwealth administers the PBS and Medicare Benefits Schedule (MBS), while the states and territories commission some community services. Home Medicines Reviews are MBS-funded when eligibility and referral requirements are met, yet many medication management activities sit outside a defined item or are funded through time-limited pilots.
The result varies by jurisdiction and provider. A pharmacist in regional Queensland may have a different funded pathway from a colleague in outer-western Sydney or a small independent pharmacy in Bendigo. Telehealth can extend reach, but it does not resolve uncertain payment, workforce shortages or the absence of a reliable follow-up. State funding can support good ideas without creating a stable national service.
For consumers, the distinction is practical. The PBS helps with the price of medicines, yet a low or zero copayment says nothing about whether someone can afford the pharmacist’s time to make those medicines work. Chronic disease, mental ill-health, substance use and transitions after hospital discharge increase the need for clinical review. Rural and remote living, transport barriers and a thinner workforce can turn an unfunded review into an avoided appointment that never happens.
Build an evidence case decision makers trust
Start with a simple service dataset. Count eligible patients, completed reviews, medication problems identified, recommendations made, recommendations accepted, follow-up completed and referrals generated. Record the time spent on each activity, including preparation, documentation and communication. These operational measures show workload and reach; they do not automatically prove fewer admissions or better control.
Add outcomes that matter to patients and funders: medicine adherence, resolved adverse effects, fewer duplicate or unnecessary medicines, confidence in the treatment plan, reduced emergency department use and avoided hospital admissions. Use de-identified data and obtain consent for linkage where possible. A small independent pharmacy can still contribute meaningful evidence by documenting a few complete care episodes rather than making broad claims without denominators.
Estimate the cost of the service and the cost of the problem, then state assumptions plainly. Evidence from a regional Victorian pharmacy or a metropolitan clinic may be combined with published Australian safety data and findings from the Australian Commission on Safety and Quality in Health Care. An independent evaluation is valuable, but transparent local data, consistent definitions and honest limitations can make a persuasive case during a budget consultation.
Make patient value impossible to overlook
Data establish scale; a carefully documented patient account establishes consequence. With informed consent, describe the care gap, the pharmacist’s actions and what changed for that person. Avoid dramatic claims and identifiable details. A composite case from a consumer in Newcastle can illustrate a common sequence without exposing anyone: repeated antibiotics during an unresolved UTI, several sedating medicines after a fall, or confusion after a hospital medication change.
Clinical complexity is often the strongest argument for the service. A patient receiving antidepressants, antipsychotics and medicines for physical conditions may need coordinated review of dose, timing and interactions. A psychiatric pharmacokinetics guide can support a pharmacist’s explanation of how medicines move through the body, why adherence and timing matter, and why changes should be communicated with the treating team.
Invite the patient or carer to say what the review made possible. That might be leaving home confidently, understanding when to seek help, or having one agreed medication list instead of several conflicting versions. Consumer organisations can help test the language of consent, privacy and outcomes. Decision makers often remember the practical effect on a person, provided the account remains accurate and connected to the economic evidence.
Build a coalition beyond the dispensary
Pharmacists should not carry the reimbursement argument alone. General practitioners, aged-care providers, mental-health teams, Aboriginal Community Controlled Health Organisations, hospital clinicians, consumers and private insurers may all see the consequences of fragmented medication care. Each group has different evidence and political influence. A shared position is stronger when it identifies common outcomes rather than asking every partner to endorse every service design.
Use the right channels. The Australian Pharmacists Association represents the profession, the Australian Pharmacy Guild has a central role in community pharmacy policy and negotiations, and state associations can carry a campaign into local advocacy. Submissions to government consultations, budget papers and pharmacy reviews should include the funding gap, patient impact, service volume and a clear model. Individual pharmacies can provide verified examples, while peak bodies can connect them to national discussions.
Regional and remote services need a deliberate voice. Outreach programs, Aboriginal health partnerships, interpreters and relationships with local primary health networks can improve access, but they also create costs that a standard fee may not cover. Consultation with Aboriginal health professionals should be led by local organisations, with pharmacists supporting rather than appropriating community expertise. A funding model that works in one Australian community but leaves a rural pharmacy unable to sustain staffing is not equitable.
Design funding built for continuity
Advocacy becomes credible when it names a workable payment model. Options include a fee per completed episode, an annual payment for ongoing management, bundled hospital-discharge follow-up, or shared savings where reduced hospital use is genuinely measured. Any model should cover assessment, care planning, coordination, follow-up and documentation. A single consultation payment may create activity without continuity, while a capitation model needs clear safeguards against reduced access.
National consistency is the central goal. The Commonwealth could establish a defined CMM benefit within the MBS, or create an equivalent national service linked to primary health and hospital care. State agreements could then support additional local needs without duplicating payment. Reimbursement should follow an agreed scope, credentialing and clinical governance, with digital documentation that reaches the GP and other relevant providers.
Patients should not face a surprise gap or be forced into lengthy cash payments. Direct billing, transparent fees and a simple referral route can improve uptake, particularly for people with complex regimens. Risk stratification can prioritise people with polypharmacy, recent hospital use, mental-health conditions or addiction concerns, while preserving access for others who need one thorough review. Rural loading, protected time and workforce support should be part of the design, not left for each pharmacy to absorb.
Turn advocacy into a funded pathway
Move through a defined sequence: establish the baseline, agree on the service specification, collect service and outcome data, develop a public case, seek cross-sector support and enter the relevant funding consultations. Keep one core message in view: comprehensive medication management is ongoing clinical care, and Australian payment should reflect its value. A concise policy brief should identify the gap, the proposed benefit, eligible patients, delivery sites, costs, safeguards and measurable outcomes.
Pilot the model where the need and partnership are strong. A regional Victorian hospital catchment, a primary health network or an aged-care provider could support a time-limited evaluation with agreed referral, data and follow-up arrangements. Publish the method as well as the results, including where savings were not realised. Evidence that survives scrutiny can then travel into national policy; a pilot without evaluation remains another fragile program.
Begin by choosing one service gap and gathering a small, defensible evidence set: activity data, a cost estimate and one consented patient account. Bring it to the Australian Pharmacists Association, the Australian Pharmacy Guild or the relevant state association, and ask them to connect the case to national advocacy. Coordinate with local GPs, consumers and care organisations so the message carries professional and community authority.
Pharmacists have already shown what sustained medication care can do. The next step is to make that work visible, fundable and available across Australia. Add your pharmacy’s evidence to the campaign, support a nationally consistent CMM benefit, and press for payment that sustains better prescribing, safer use and stronger health outcomes.