Confusion over prescription fees waiver extension; displaced people only

Pharmacists will need to judge whether a customer has been “displaced” due to damage inflicted by Cyclone Gabrielle and so be eligible for a prescription fee waiver.

This requirement comes with the recent extension to the prescription fee waiver, though it was not initially clear that displacement was the key requirement.

The $5 prescription fee was initially waived following the cyclone for all residents in Northland, Tairāwhiti, Hawke's Bay and Tararua, and people displaced from these areas, until 19 March.

On 17 March, Te Whatu Ora responded to questions from Pharmacy Today as to whether the waiver would be extended, with the following statement attributed to the agency’s group manager primary health care system improvement and innovation, national commissioning Adeline Cumings:

“We acknowledge that support is still needed for those affected by Cyclone Gabrielle. The prescription copayment waiver has been extended until midnight Monday 10 April 2023, to support people who have been displaced within and from Northland, Coromandel, Tairāwhiti, Hawke’s Bay and Tararua. For whānau who have been isolated in small communities in Hawke’s Bay, they will also be covered. For background, displaced means people who cannot live in their usual home or residence.”

Pharmacy Today took this to mean the existing waiver had been extended until 10 April and published an article stating this, which has since been corrected.

The Pharmaceutical Society of New Zealand also believed the waiver for all residents had been extended and published a notice stating this on its website, which was corrected this morning.

PSNZ policy and practice manager Chris Jay says via email that PSNZ was told the waiver was extended but did not initially “click” that its terms had also been changed, which is what caused the incorrect notice to be posted.

Over the weekend starting 18 March, Te Whatu Ora sent out updates informing pharmacists that the waiver applied to displaced people within and from Northland, Coromandel, Tairāwhiti, Hawke’s Bay and Tararua, as well as some people living in small communities that are still isolated in the Hawke’s Bay.

Pharmacy Today has today confirmed with Te Whatu Ora that the extension was intended to apply only to displaced people, not to all residents in the regions damaged by the disaster.

Lanny Wong, who owns Mangawhai Pharmacy in Northland, believes the change to the waiver should have been communicated much more clearly and says the messages from Te Whatu Ora were confusing.

Ms Wong says unclear communication from the Government to pharmacies about health system changes that affect them has been a constant problem since the start of the COVID-19 pandemic and “something needs to change”.

In this case, pharmacies needed to be told clearly how to define if a person was displaced and also how they are meant to find this out, she says.

When Ms Wong asked her Te Whatu Ora pharmacy portfolio manager about this, he responded that pharmacy staff would just need to take patients’ words they were displaced and that it was a “high-trust model”.

Green Cross Health regional manager Bronwen Shepherd, who has been assisting with the pharmacy response in the Hawke’s Bay, believes it is not appropriate or practical to be asking patients if they were displaced by the floods.

The local Hawke’s Bay PHO, Health Hawke’s Bay has produced a map showing areas affected by flooding for pharmacies to use. When a pharmacy staff member asks the patient their address while dispensing the script, they can look it up on the map and if it lies within a highlighted area they can waive the fee without having to ask the patient if their home was inundated.

Ms Shepherd says this system is not perfect and can result in people missing out on free medicines if the address they are currently staying at is outside the regions highlighted on the map, but it does avoid the risk of potentially retraumatising someone who lost everything.

She thinks it would have been better if Te Whatu Ora had extended the existing waiver for all residents.

“It came as quite a shock when we heard it was only extended for displaced people.”

Ms Wong says there seems to be a gap in understanding about how things should work between the pharmacists doing the work and the people at the top making decisions.

“Just because someone is not displaced doesn’t mean they are not distressed,” she says adding that many residents who can still live in their home will still be facing financial hardship due to the storm impacting their property or work and could still benefit from free prescriptions.

“It [the new waiver] does not really work for the region.”

“When we didn’t have the charge, it was just simple, everyone comes in, they know they can get free prescriptions and didn’t have to worry about it, but now they need to worry do I qualify or do I not.”