Pearls and Irritations

And “location laws” mean individual pharmacies are protected from each other.

In larger urban areas, a new pharmacy cannot be opened closer than 1.5 kilometres from an existing pharmacy.

The new pharmacy also has to be within 500 metres of a full-time prescribing medical practitioner and a small supermarket, or within 500 metres of a large supermarket, in which case you don’t need a doctor.

These distances are straight lines, and there are plenty of other requirements as well — we’re barely scratching the surface.

“I’ve heard it sometimes comes down to the most ridiculous minutia of how to measure it,” Ms Doggett says.

“I have heard examples of where doors have been moved, because I think the measurements go from the front door of one to the front door of the other, so by just shifting a door a few metres, or having the door on one corner instead of the other corner, you can meet those restrictions.”

The Guild says the rules benefit patients “wherever they live”.

“The location rules ensure that community pharmacies are established where there is a genuine community need, creating a viable network across the country where patients need timely and equitable access to medicines,” reads a statement posted on its website.

But Ms Doggett says there is “certainly good evidence” that the restrictions mean we pay more for medicines than we should.

“Collectively we’re paying about half-a-billion dollars a year more than we should for prescription medicines,” she says, citing research by the Grattan Institute.

And consumers, she says, also lose out on convenience.

“There has been a whole range of evidence to show that the benefits to consumers of being able to fill a prescription at a supermarket, where you go and do all the rest of your shopping, would far outweigh any negatives,” she says.

“To have to go and make a special trip to a separate location to fill a prescription … only benefits pharmacists.”

She says successive inquiries and reviews have “almost unanimously identified the anti-competitive regulations as not being in the consumer interest and recommended that they be disbanded over time”.

These include the Wilkinson competition policy review, the Harper review, a National Commission of Audit inquiry and a Productivity Commission review.

But the Pharmacy Guild has seen off attempts to make the multi-billion-dollar sector more competitive.

It has also successfully resisted moves to restrict the sale of natural and complementary medicines in pharmacies, or at least to display them in a designated place within the pharmacy.

“They have been very effective in engaging in that political process to influence the outcomes of those decisions,” Ms Doggett says.

An ‘extraordinarily potent weapon’

So where does all that power come from?

Pharmacists are one of Australia’s most trusted professions, and that trust is perhaps the most critical weapon in the guild’s arsenal.

“There’s a bit of a perception by politicians that if you upset that group they will bad-mouth you to every single person they encounter,” says Crikey political editor Bernard Keane.

And with a vast network of 5,700 community pharmacies across Australia, they are encountering a lot of people.

“And who are they talking to? They’re talking to the elderly,” Keane says.

“So the Coalition in particular is vulnerable to a scare campaign from the Pharmacy Guild to say, ‘We don’t like this so we will tell all of our customers. And we will put up posters telling our customers that the government has made a terrible decision that will hurt them.'”

And whether it is a matter of perception or reality, it is a huge threat.

“[It is an] extraordinarily potent weapon to wield in discussions,” Keane says.

“This is why you can’t walk into a Woollies or Coles and go to the pharmacy section, because the Pharmacy Guild would go nuts and say, ‘We will destroy you if you did ever allow that.’ It happens.”

In 2015, Chris Walton from the Pharmacy Coalition for Health Reform told The Sydney Morning Herald: “There’s always been a fear that if they ran a campaign they could bring a government down.”

The Guild has also campaigned against individual politicians, such as federal Liberal National MP Andrew Laming.

When Dr Laming called for reform of the PBS in 2006, the Guild reportedly wrote to its member chemists in his electorate, warning of a secretive government plan to “decimate community pharmacy”.

“Your local member Dr Andrew Laming is one of the key people proposing this structural change,” said the letter, according to a report in The Age.

Dr Laming went on to criticise Australia’s drug prices, and the Guild, according to The Age, responded by warning chemists: “If your pharmacy can’t afford to lose $100,000 plus from the bottom line then you need to start doing something about this. Your patients need to be informed that Dr Laming is trying to close community pharmacies.”

Dr Laming told ABC RN that as a first-time MP in 2006, the “sense of trepidation from colleagues regarding the Guild was palpable”.

“But the potential savings from my PBS reform proposals were so large that change was inevitable,” he adds.

“It was clear there was sufficient [measures] on the table to compensate the Guild and wholesalers on the way through, which then-health minister Abbott achieved.

“A decade on, departmental estimates show $13 billion saved to the public purse; industry say closer to $20 billion. While the Guild didn’t hold back change, they succeeded in protecting member interests at a time when cuts might have been faster and more damaging.”

Political donations: ‘Like a facial tattoo in the mafia’

When you want to get something in Canberra, it also helps if you can give something.

“Anyone can donate as much as they like to political parties at the Commonwealth level,” explains Danielle Wood, an economic policy expert with the Grattan Institute.

“There’s no restrictions on the size of donations, nor is there any restriction on the amount that the Commonwealth parties can spend in election campaigns.

“So it’s a bit of a free-for-all at the Commonwealth level.”

The Pharmacy Guild made headlines earlier this year for its $15,000 in donations to One Nation, but its donor power stretches far beyond that.