DISCUSSION PAPER
Analysis of the Impact of Public Hospital Pharmaceutical
Reforms on Discharge Medication Supply
John K Jackson
ABSTRACT
The use of the Pharmaceutical Benefits Scheme (PBS) for dis-
pensing discharge prescriptions in public hospitals and the
implementation of national guidelines to improve the quality
of care of patients in transition between hospital and commu-
nity have been proposed by the Commonwealth. Issues rele-
vant to the implementation of these reforms include the financial
risks to States and hospitals, the impact of PBS procedures on
hospital practices and the availability of pharmacists. If im-
plemented, the dual sources of pharmaceutical funding would
remain, perpetuating the opportunities for cost shifting, and
inequities in access would continue. An alternative reform could
entail the Commonwealth funding all pharmaceuticals in hos-
pitals using a model developed specifically to complement
hospital practices. Support for hospitals to improve the qual-
ity of patient care should be provided regardless of the phar-
maceutical funding model.
Aust J Hosp Pharm 2001; 31: 295-9.
INTRODUCTION
Australia has an equitable and efficient program of com-
munity-based pharmacy services, in the form of the Com-
monwealth-funded Pharmaceutical Benefits Scheme
(PBS). There is also a high standard of pharmacy servic-
es within the State- and Territory-funded public hospi-
tals. However, at the point of transition between the
hospital and community sectors, services are poorly in-
tegrated.12
For over a decade, public hospitals in most States
have transferred drug costs to the Commonwealth by
reducing the quantities of PBS-listed drugs dispensed
on discharge or at outpatient clinics from one month to a
maximum of one week of therapy and often less. Patients
have been advised to visit their general practitioners to
obtain PBS prescriptions for ongoing supply. Some public
hospitals have also devised arrangements to enable the
use of the PBS for high-cost anticancer drugs. These
practices have increased Commonwealth PBS and Medi-
care costs.
Concern regarding the quality of care on discharge
has arisen due to patients being prescribed different
brands of equivalent drugs in the generic-based hospi-
tal system and brand-based PBS system. There is a risk
that this may affect the patients' comprehension of their
medication, their compliance and continuity of therapy.
Other quality of care issues include patient inconven-
ience due to the need to see general practitioners soon
John K Jackson, BPharm, GradDipHospPharm, Integrated Pharmacy
Services, Melbourne, Victoria
Address for correspondence: John Jackson, 40 The Avenue, Windsor Vic.
3181, E-mail: jjackson@interpharm.com.au
The Australian Journal of Hospital Pharmacy Volume 31, No. 4, 2001.
after discharge (if this is solely to obtain prescriptions)
and delays in transfer of information from the hospital to
post-hospital carers regarding changes to the patient's
therapy.
The Commonwealth has stated that the current dual
funding systems have 'the potential to lead to poor qual-
ity health outcomes for patients, inequities in the range
of drugs available in each sector and perverse incen-
tives for cost shifting between the State(s) and Com-
monwealth'. 3 Consequently, it has proposed reforms
aimed at addressing these issues.
Under the proposal the PBS would be used for pa-
tients on discharge, and for outpatients of public hospi-
tals; the States would continue to fund inpatient drug
supply. The Commonwealth would also fund high-cost
anticancer drugs for public hospital day patients and, in
return for the new funding streams, public hospitals
would be required to implement national quality use of
medicines guidelines developed by the Australian Phar-
maceutical Advisory Council (APAC). 4 The offer is based
upon it being cost neutral to the Commonwealth, with
the risk of exceptional growth in costs being shared with
the States.
Whereas the proposal was offered as part of the
Health Care Agreements in 1998, it took until2000 for the
first State (Victoria) to accept in principle. Protracted
negotiations regarding implementation have resulted in
the number of hospitals likely to introduce the reforms
falling progressively, and the proposed commencement
being delayed a number of times.
ANALYSIS OF THE PROPOSAL
In this paper I will analyse the Commonwealth's propos-
al insofar as it relates to the care of patients on discharge
from hospitals. The analysis will consider whether the
reforms, if implemented, would achieve the Common-
wealth's objectives. It will also cover issues related to
implementation and the probable response of the stake-
holder groups.
The Two Sectors
The total Australian hospital pharmaceutical market of
approximately $1 billion per annum is growing at 8%. 5
The State-funded public hospitals operate capped phar-
macy budgets and use a range of strategies to control
pharmaceutical expenditure including formulary restric-
tions, generic drug policies, prescribing guidelines and
active monitoring of drug use. Responsibility for these
controls resides in the hospitals' multidisciplinary phar-
macy committees, which have the capacity to tailor re-
strictions in response to exceptional local situations. 67
By comparison, expenditure on the PBS for the twelve
months to March 2001 was more than $4 billion. 8 It is
295
effectively uncapped and growing at approximately 17%
per annum. 9 The PBS operates a nationwide formulary
and as the Commonwealth has little control over the
number of prescriptions written and dispensed, it has
attempted to limit PBS expenditure growth through re-
strictions on the clinical conditions for which high cost
drugs can be prescribed. It has also enforced rigid pre-
scribing and dispensing regulations and operational
controls such as maximum prescription quantities and
dispensing frequencies. 10
THE COMMONWEALTH'S OBJECTIVES
Quality of Patient Care
The APAC 'quality use of medicines' guidelines have
been shown to contribute to an improved standard of
care at the time of discharge. Problems that arise as a
result of changing between various brands of the same
product are able to be addressed, patients receive a higher
level of counselling regarding their medication and a
comprehensive record of changes to prescribed therapy
is able to be transmitted to the patient's post-hospital
carer.n 12 The guidelines were developed by the Federal
Minister of Health's advisory committee specifically to
address these issues. Although resource intensive, if
proven to be cost effective, they would contribute to the
Commonwealth's objective of improving quality of care.
Equity of Access and Range of Drugs
Issues of equity arise when patients in one sector (hos-
pital or community) do not have access to the types,
brands or quantities of drugs that are available in the
alternate sector.
Some drugs readily available in community practice
are restricted in hospitals. As stated, the quantity dis-
pensed on discharge (or for outpatients) of some public
hospitals has been much less than normal PBS quanti-
ties. Furthermore, public hospitals have, through formu-
lary restrictions, limited the number of brands of
generically equivalent drugs, the options within thera-
peutic classes (e.g. angiotensin converting enzyme in-
hibitor drug class) or the absolute availability of particular
drugs. The objectives of these restrictions have been to
promote rational prescribing and good stock manage-
ment as much as budget control.
The Commonwealth's proposed reforms may resolve
issues of equity relating to the quantity supplied, but
hospitals are likely to find it appropriate to continue the
other restrictions for quality of care and efficiency pur-
poses. Hospitals would be likely to continue to stock
only one brand of each drug and to limit the choice of
drugs with similar therapeutic action.
Some drugs available in hospitals are not readily
available in community practice. Due to their medical
conditions, hospital patients often need a broader range
of drugs than those used in the general community. Some
drugs prescribed at discharge will not be on the PBS at
all (e.g. some drugs for palliative care) and some will be
prescribed for non-PBS indications. Patients will still need
to attend public hospitals to obtain these drugs at sub-
sidised prices.
Inequity of access occurs in both sectors and the
reforms only go part of the way in solving the problems.
Cost Shifting Practices
A number of areas of potential drug-based cost shifting
The Australian Journal of Hospital Pharmacy Volume 31, No. 4, 2001.
would still exist. The proposal would limit PBS funding
to discharge and outpatient supplies and budget restric-
tions will still apply to pharmaceutical use in other sec-
tions of hospitals. One example of where new cost
shifting could arise is in accident and emergency depart-
ments. A patient presenting with a diagnosis of myocar-
dial infarction could be admitted to the emergency
department or coronary care unit and treated at the hos-
pital's expense with the fibrinolytic drug alteplase at a
cost of more than $1500. 10 Alternatively, they could be
registered as an outpatient and receive the same drug on
the PBS for a maximum of $21.50 in a specially equipped
outpatient clinic.
The Commonwealth does not propose funding non-
PBS drugs for discharge (or outpatients) so the public
hospitals would continue to be responsible for their
supply.
Creating two funding sources for the range of drugs
that have historically been prescribed on discharge may
lead to changes in hospital formularies and prescribing
habits. Furthermore, if a hospital reaches its budget limit
for PBS drugs and starts to incur risk-sharing penalties,
the opportunity to revert to the current practice of trans-
ferring drug costs to non-hospital PBS supply would
remain.
ISSUES RELATED TO IMPLEMENTATION
Liability of the State Governments
The Commonwealth has proposed it will meet the cost of
hospital-initiated PBS prescriptions up to the rate of
growth for non-hospital PBS in the State. Growth above
this level would be shared on a 50:50 basis? Similar cost
sharing arrangements exist for oncology drugs.
The New South Wales Health Department advised
the 1999 Senate inquiry on public hospital funding that
it had reservations about the Commonwealth's proposal
as it 'transferred the risk to the States' and that it was a
'take it or leave it offer'. At the time of the inquiry, the
Queensland Government reported it did not think the
'risk sharing arrangements are acceptable' . 13 (Queens-
land signed in principle acceptance of the proposal in
2001 14). Sources in all State health departments have re-
iterated the risk to their State of uncontrolled PBS ex-
penditure as being a major impediment to implementing
the proposal. Some aspects of this risk are more pro-
nounced at the State level, others at the hospital level.
While the States currently carry all financial risks
associated with hospital prescribing, capped pharmacy
budgets and control measures applied by the hospitals'
pharmacy committees dampen expenditure growth. If the
PBS is introduced, hospitals would be exposed to the
growth pattern of PBS expenditure and, as the proposal
is to be cost neutral for the Commonwealth, State au-
thorities would have to agree to share the risk of excep-
tional growth in PBS prescribing within the hospitals.
The cost to the Commonwealth of the PBS grew at
17.6% per annum in the four years to 1996. 9 In compari-
son the total Australian hospital pharmaceutical market
growth was 6.84% to August 2000 and 8.66% to August
2001. 5 Under the PBS funding model, the States would
have a reduced influence over matters that may result in
further growth in expenditure, such as listing of new
drugs on the PBS or changes to reimbursement formu-
lae, but would be exposed to the financial risks of those
decisions, particularly if the pattern of use of the drug
296
related to hospital care was greater than in community
care.
An example of a change to reimbursement formulae
occurred when the Commonwealth took unilateral ac-
tion and announced its intention to reduce the whole-
saler margin for certain PBS-listed drugs in the 2001
federal budget. 15 As the Commonwealth does not pay
wholesalers directly, these changes will be achieved by
reducing the 'price to pharmacist' for these drugs. This
price is the basis for reimbursement to public hospitals
under the proposal and unless addressed, hospitals
would receive a lesser amount when dispensing these
drugs than previously budgeted. 3
Prior to this budget decision, the Commonwealth
had stated that reimbursement at the 'price to pharma-
cist' rate would provide hospitals an 11.1% mark-up on
all PBS prescriptions. This assumes hospitals are able to
purchase all PBS drugs at the 'price ex manufacturer'
(directly from the manufacturer at the price they normal-
ly sell to wholesalers) and while low prices are achieved
through State tenders, particularly for drugs off patent,
there are many items that hospitals must purchase from
wholesalers and for which the resultant 'mark-up' will be
much less than 11.1%. 3
The PBS reimbursement formula for public hospitals
would not include the professional and commercial fees
paid to private pharmacists. Consequently the hospitals
would need to fund from other sources the additional
computing infrastructure, stock and facility costs and
staffing to operate PBS dispensing.
Furthermore, reimbursement from the Commonwealth
would be net of the relevant patient contribution fees
and hospitals would face major issues in attempting to
collect prescription fees at the time of discharge from a
largely pensioner-aged population. If the patient contri-
bution is not collected it may be significantly more cost-
ly to the hospital to dispense the full PBS quantity than
it would under the current supply model.
This can be illustrated using lisinopril 10 mg tablets
with a PBS 'price to pharmacist' of $20.22 for 30 tablets
(Table 1). If the hospital purchases the drug at the 'price
ex manufacturer' of $18.38 it would be able to dispense 7
tablets on discharge under current arrangements at a
cost of $4.29. Under the PBS reform, depending on the
concessional status of the patient and whether the pa-
tient contribution fee is collected, the hospital's posi-
tion for dispensing the PBS pack of 30 tablets would
range from a 'profit' of $3.12 to a 'loss' of $18.38. 9
Table 1. Lisinopril 10 mg 30 tablets
For 30 tablets Concession patient General patient
Patient fee collected Yes No Yes
Patient fee income $3.50 $0.00 $21.50
me rebate* $16.72 $16.72 $0.00
Hospital income $20.22 $16.72 $21.50
Cost of drug $18.38 $18.38 $18.38
Profit (loss) $1.84 ($1.66) $3.12
* 'Price to pharmacist' less relevant patient contribution fee
The only margin on stock a hospital could achieve
would arise from buying the drug at less than the 'price
to pharmacist' via contract purchasing or direct supply
The Australian Journal of Hospital Pharmacy Volume 31, No. 4, 2001.
from manufacturer. There is a risk that pharmaceutical
manufacturers would eventually withdraw preferential
public hospital drug prices for PBS-listed drugs as the
low prices may impede their negotiations with the Com-
monwealth regarding PBS prices. This has already be-
come an issue in private hospitals and would have an
adverse impact on public hospital budgets.
While the Commonwealth has stated funding under
the current Commonwealth-State funding agreements will
not be modified in the light of these reforms, it is not
known how these reforms would affect future agree-
ments and whether States or hospitals will be financially
better off than in their current restricted budget pos-
itions.
Impact of PBS Regulation on Hospitals
PBS regulations become all pervasive in the workplace.
In accepting PBS funding for discharge drugs, public
hospitals would need to recognise the high level of con-
trol the Commonwealth seeks to maintain over PBS pre-
scribing and dispensing practices.
Experience in private hospitals has shown the PBS
prescribing and dispensing regulations are not suited to
hospital inpatient (including discharge) practice. 16 The
PBS defines not only what can be prescribed but how it
is to be prescribed, how much can be dispensed and
how often it can be dispensed. While these regulations
may be necessary for the success of the PBS in ambula-
tory care, they impede the effective provision of hospi-
tal pharmacy services.
Without modification of these PBS procedures to
complement hospital practice plus adequate compromise
by the Health Insurance Commission (the government
department responsible for payments in relation to the
PBS), implementation of the policy has the potential to
adversely affect the functioning of public hospitals. The
extended delay between Victoria agreeing in principle to
the proposal and the scheduled implementation reflects
the difficulties in negotiating acceptable arrangements.
THE STAKEHOLDERS
Impact on the Patients
Although patients stand to benefit from the implementa-
tion of the APAC guidelines, the benefits have not been
forthcoming as a result of the guidelines being linked to
the PBS and oncology aspects of the policy. Patient rep-
resentative groups, particularly those that are members
of APAC, would welcome the implementation of the
guidelines as soon as possible (personal communica-
tion with J Donovan, Consumer Health Forum, 31 May
2001).
If public hospitals dispense PBS quantities (up to
No one month of therapy rather than the current one week
$0.00 supply or less), there would no longer be an imperative
for patients to see their general practitioners for follow-
$0.00
up prescriptions until much later than currently occurs.
$0.00 Some patients may find the process more convenient
$18.38 and theoretically this could result in a reduction in Medi-
care payments by the Commonwealth. In practice, many
($18.38)
patients, particularly the elderly and those on complex
regimens, would still need to be directed to their general
practitioner for early review after discharge.
The Role of the Pharmacist
The Society of Hospital Pharmacists of Australia has
297
expressed its support for changes that improve the con-
tinuum of care between hospitals and the community;
however, it advised the Senate inquiry that the PBS, a
community-based system, is not suitable for use in hos-
pitals, is fundamentally flawed, and would not achieve
the intended improvements. 17
Hospitals may not have the capacity to implement
the proposal, due to the nationwide shortage of pharma-
cists. Hospitals in all States report unfilled pharmacists
positions and the introduction of this policy may exacer-
bate the problem, not only because of the increased
workload but also because of increased attrition. Of the
pharmacists practising in hospitals, the majority have a
strong professional focus, reflected in the high percent-
age who have completed postgraduate clinical pharma-
cy studies (34.2% of hospital pharmacists hold
postgraduate degrees compared with 6.6% of communi-
ty pharmacists). 18 Some have elected to work in a pro-
fessionally satisfying environment rather than
taking financially more rewarding community pharma-
cy appointments. 19
Some of the existing staff would be expected to leave
if the PBS operating procedures are not modified to suit
the hospital environment and they are forced to work
under quasi retail pharmacy arrangements. Industrial
bodies representing hospital pharmacists have expressed
concern about the impact of the reforms on staff. 20
At the same time the Commonwealth must be cogni-
sant of its relationship with community pharmacy through
the Third Pharmacy Government Agreement. The Com-
monwealth has estimated 5% of the PBS could be dis-
pensed in hospitals and a significant transfer of PBS
dispensing from community pharmacists to public hos-
pitals is likely to result in the Pharmacy Guild seeking
redress from the Commonwealth. 3
Prescibers
General practitioners have received little advice regard-
ing the policy but their representatives are adamant that
the prescription funding procedures should not be the
means of manipulating the schedule of medical consul-
tations. Early post-hospital contact with general practi-
tioners, particularly by elderly and debilitated patients,
is seen as essential. While the policy may address is-
sues such as confusion about generic drugs, it has the
potential to increase readmissions to hospital if patients
are not seen by their general practitioners soon after
discharge.
SUMMARY OF ANALYSIS
The policy has the potential to improve quality of care
on discharge; however, it maintains the existing dual fund-
ing model, changing the boundary between the State
and Commonwealth's responsibilities and so creating
new cost shifting opportunities. It also creates a finan-
cial risk that most States seem unwilling to accept.
If implemented, it is likely the lack of compatibility of
PBS procedures and hospital activities would create
workplace problems that would be exacerbated by short-
ages in hospital pharmacy staffing.
It must be emphasised that the conclusions from
analysis of issues in relation to discharge dispensing do
not necessarily apply to the other components of the
proposal.
The Australian Journal of Hospital Pharmacy Volume 31, No. 4, 2001.
AN ALTERNATIVE PROPOSAL FOR
DISCHARGE MEDICATION SUPPLY
To resolve the quality, equity and funding issues raised
by the Commonwealth it will be necessary to formulate
and evaluate alternative proposals compatible with hos-
pital activities.
The Potential for an Alternate Proposal
The delay in implementation of the current proposal and
the decision of most States to wait and see what hap-
pens in Victoria means that negotiation of the next Health
Care Agreement will commence before many States have
made progress on this issue. This provides the opportu-
nity to consider alternative proposals.
Support for modification of the current proposal is
likely to arise if the consumer groups perceive the bene-
fits from the APAC guidelines are being unduly delayed
as a result of being linked to the implementation of the
PBS funding model.
The following matters should be considered in an
alternative proposal.
Quality of Care
Implementation of the APAC guidelines should be in-
corporated into the body of the Health Care Agreements,
rather than being linked to a particular drug funding ini-
tiative in a schedule of the Agreements. The 1998 Agree-
ments include a section on Quality Improvement and
Enhancement. This involves the Commonwealth fund-
ing practices that contribute to healthcare safety and
quality improvement and the guidelines should be fund-
ed under this section. 21
The program should include funding for liaison phar-
macists, able to work between hospitals and the commu-
nity, to ensure drug-related issues during transition into
and out of the hospitals are appropriately managed.
Cost Shifting
Retention of rigid budgets within hospitals while out-
side the PBS remains uncapped will perpetuate cost shift-
ing. Establishing an equitable single funding arrangement
for all pharmaceuticals is the only way to eliminate bound-
aries and stop cost shifting practices in drug therapy
(although boundaries would remain between drug and
non-drug therapies). As the Commonwealth operates the
PBS, it is the only realistic single funding body and
should accept responsibility for all hospital drugs. Suit-
able adjustments to Commonwealth-State health fund-
ing agreements would be required.
Funding Model and Coordination of Care
Because the funding model should complement clinical
practice and hospital procedures, the current PBS regu-
lations are not appropriate. The PBS and HIC should
accept a hospital prescribing and supply process that
results in 'PBS equivalent' outcomes. It is essential that
hospitals retain their cost control strategies and incen-
tives should be introduced for hospitals to continue to
develop cost-effective, evidence-based drug use. At the
same time they must be able to utilise drug distribution
methods appropriate to the care of the patient and the
nature of the drug, rather than be forced to use standard
prescriptions, prescription quantities and dispensing
processes just to obtain funding.
298
 Whatever funding model is established it should
utilise e-commerce and not rely on paper records for
purposes of funding and audit. The audit document for
funding should be the drug therapy chart or hospital
discharge summary, these being the primary documents
for drug ordering in hospitals.
The Commonwealth should also fund the adminis-
trative, professional, education and audit functions of
the pharmacy service that are necessary for drug use
and expenditure monitoring. The supply of medication
on discharge should be considered part of the episode
of care and appropriately funded without the need to
recover contribution fees from patients. This is the mod-
el of funding used by the Department of Veterans Af-
fairs with approved private hospitals and is proposed
for public hospitals.
Additional staffing would be required to manage the
more intensive and higher quality of care on discharge
and remuneration restructured to attract pharmacists.
SUMMARY
The Commonwealth should fund programs to improve
the quality of patient care as an essential and distinct
component of the Health Care Agreements. It should
fund both PBS-listed and non-PBS pharmaceuticals for
all patients in public hospitals at all stages of their care
using a funding model built around hospital drug sup-
ply procedures. Hospitals should be supported and
obliged to maintain cost control strategies and to pro-
mote evidence-based prescribing.
References
1. SHPA discussion paper. Funding of pharmaceuticals in hospitals. South
Melbourne: The Society of Hospital Pharmacists of Australia; November 1995.
2. AHMAC Working Party on Pharmaceuticals. Background paper. Canberra:
Australian Health Ministers Advisory Council; November 1995.
3. Griffin B. Public hospital pharmaceutical reforms associated with the Aus-
tralian Health Care Agreements. Summary of proposed offer. Canberra: Pharma-
ceutical Benefits Branch, Commonwealth Department of Health and Family
Services; May 2001.
4. Australian Pharmaceutical Advisory Council. National guidelines to achieve
the continuum of the quality use of medicines between hospital and community.
Canberra: Commonwealth Department of Health and Family Services; 1998.
5. Wholesale market growth report. Sydney: IMS Health Aust Pty Ltd; Aug
2001.
6. NSW Therapeutic Assessment Group. Manual of indicators for drug use in
Australian hospitals. Darlinghurst: NSW Therapeutic Assessment Group; 1998.
The Australian Journal of Hospital Pharmacy Volume 31, No. 4, 2001.
7. Dartnell J. Activities to improve hospital prescribing. Australian Prescriber
2001; 24: 29-31.
8. Health Access and Financing Division, PBS Prescription Volume. Govern-
ment cost and patient contributions, year ending March 2001. Canberra:
Commonwealth Department of Health and Aged Care. Available from:
www.health.gov.au/pbd/pubs/pbbexp/pbmar01/book0.2htm [Accessed 13 Oct
2001].
9. Pharmaceutical costs an 'enormous' challenge. Australian Pharmacist 2001;
20: 362.
10. Commonwealth Department of Health and Aged Care. Schedule of pharma-
ceutical benefits for approved pharmacists and medical practitioners. Canberra:
Commonwealth of Australia; May 2001.
11. Stowasser D. Medication information and health outcomes - development
and evaluation of a medication liaison service [Doctor of Philosophy]. Bris-
bane: University of Queensland; 2000.
12. Mant A. Final report of the Continuity of Care in Therapeutics from Hospital
to Community Project. South East Sydney Area Health Service; 2000.
13. Senate Community Affairs References Committee. Healing our hospitals.
Report on public hospital funding. Canberra: Commonwealth of Australia;
December 2000.
14. PBS etc. Pharmaceutical Advisory Service, Queensland Health. 2001 (Jun);
issue No. I.
15. Thornton M. How will wholesaler cuts affect you? Australian Pharmacist
2001; 20: 491.
16. Jackson J. Use of the Pharmaceutical Benefits Scheme in private hospitals:
I. Associated problems. Aust J Hasp Pharm 2001; 31: 194-8.
17. SHPA Position Statement. Pharmaceutical funding reforms. Proposed in-
troduction of the Pharmaceutical Benefits Scheme into public hospitals. Aust
J Hasp Pharm 2000; 30: 254.
18. Gysslink P. Community and hospital pharmacists' remuneration survey
report. Melbourne: Salaried Pharmacists' Association; 1997.
19. Health Care Intelligence Pty Ltd. A study of the demand and supply of
pharmacists, 1995-2010. Canberra: The National Pharmacy Workforce Refer-
ence Group; 1999.
20. PBS update. Victoria: Association of Hospital Pharmacists; June 2000.
21. Australian Health Care Agreement between the Commonwealth of Australia
and the State of Victoria, 1998. Commonwealth Department of Health and Aged
Care. Available from: www.health.gov.aulhaf/docslbcalvic/pdf [Accessed April
2001].
Submitted: July 2001
Accepted after external review: November 2001
Editor's note: The proposed introduction of the Phar-
maceutical Benefits Scheme into public hospitals is an
important topic for all pharmacists. This article pro-
vide's one persons perspective on one aspect of the pro-
posed reforms. The Journal would welcome other
readers' viewpoints for publication in the 'Letters to
the Editor' section-submissions of approximately
400 words should be e-mailed to the Editor-in-Chief,
jppr@shpa.org.au .
299