Editorial

The "Pharmacy of Your Choice" scheme (POYC) was launched in the summer of 2007 with the aim of enabling people entitled to free medicines to collect them from a pharmacy in their locality. The scheme was intended to reduce the number of persons queuing for medicines at health centres and at the hospital's outpatient pharmacy. It was estimated that 140,000 entitled persons would benefit from it.

The scheme was initially piloted in Mosta and was meant to be rolled out to the entire country. Despite many years of discussion, it has had extensive problems from its inception, since it is inherently flawed in concept. While the notion of having people picking up medicines without queuing is admirable, problems are certain to arise in an arrangement wherein two competing systems, free and paying, are run from the same premises. Problems also arose as the majority of pharmacists felt that they had not been sufficiently informed or consulted.

The POYC was rolled out too quickly, to too many pharmacies and without adequate staff manning the distribution system. It had been estimated that it would require at least 10 trained staff to help in the preparation of medicine packages along with a supervising pharmacist, and yet the system was rolled out with far fewer. Retail pharmacies found themselves loaded with extra work and with a pittance in compensation.

Other problems included inadequate storage space since with the free drugs supplied by the health service, their stock effectively doubled. And this is as nothing compared to the stocks that pharmacists will eventually have to keep, as patients are entitled not only to medicines but also to certain bulky, non-pharmaceutical products. Abuse is heaped on the pharmacist when patients attempt to pick up their medicines and find they are out of stock. The latter include drugs for depression, hypertension and cholesterol. The large number of important items permanently out of stock is an indirect and hypocritical form of health rationing.

The system has also been burdened by members of the public who, although entitled to free medicines, had never bothered to collect them as this meant queuing for many hours. However, with the POYC, these individuals had nothing to lose and everything to gain by registering with the system. This was another added cost to an unsustainable system.

The system rollout was, therefore, suspended in July 2008 pending re-evaluation and is still a pilot project! It currently only caters for 31,000 patients in 27 localities. The government claims that it is focusing its energy on boosting "key determinant factors" such as the IT software systems, workforce capacity, office infrastructure and the operational process, along with enhancing manpower. Moreover, pharmacists have been given a list of medicines for chronic diseases which can only be picked up from the pharmacy at Mater Dei Hospital, undermining the entire concept of the system.

The proposal by the associations that clients buy directly from a private pharmacy and are then reimbursed may sound fine but is financially impossible. The government is "dragging its feet" simply because even the current medicines bulk buying and tendering system is unsustainable - and this despite the rock bottom prices that the government acquires its medicine for.

All in all, the POYC has been poorly rolled out and managed. It may be doomed to failure if sufficient funds are not allocated to it. Are these monies available?