Medicare funds the more expensive pathway and not the cheaper one
Medicare pays for a consultation with a doctor. It does not pay for the same protocol-driven assessment by a pharmacist, so the patient pays or the state does — and a patient who could be treated at a pharmacy has a financial reason to see a GP instead.
Steps this would change
Rationale
The pharmacy pathway models at one day — the shortest care pathway in this database, against 4 for a Medicare Mental Health Centre, 282 for Better Access and 665 for adult public dental. Pharmacies are the most geographically distributed health infrastructure in the country, open longer than general practice, and present in towns with no GP.
And the assessment they perform is not Medicare-rebated.
The medicine may be subsidised through the PBS. The clinical work of deciding to supply it is not. So where states have created a scope, they fund the service themselves or the patient pays — and the patient who could be treated in a pharmacy in ten minutes has a financial reason to wait for a bulk-billed GP appointment instead.
The Commonwealth is funding the more expensive pathway and not the cheaper one. That is not a claim about relative clinical value; it is arithmetic about a rebate that attaches to a profession rather than to a service.
The Cormack Scope of Practice Review found this shape of problem across primary care: virtually every profession facing restrictions unrelated to their education and competence, with funding rules among the barriers. This site recorded that in the hospitals section and it has taken until now to find the sharpest instance.
What would change. Rebates that attach to a defined service delivered against a defined protocol by a practitioner qualified and authorised to deliver it, rather than to the professional category of the person delivering it. The national women's health trial from 1 January 2027 does exactly this for two conditions, which is why it is the precedent rather than the counter-example.
Filed as an idea, and it will stay one until the trial reports. Whether funding pharmacist assessment increases total system cost, substitutes for GP visits, or does both in proportions nobody can predict is an empirical question, and it is the whole question.
What is being traded away
Paying for a service twice over is the obvious failure mode. If pharmacist assessment is funded and the patient then sees a GP anyway — because the protocol excluded them, because the treatment did not work, or because they wanted a second opinion — the Commonwealth has paid for two consultations where it previously paid for one. Substitution is the assumption on which the whole economic case rests, and supplementation is at least as likely in some conditions.
Fee-for-service funding shapes clinical behaviour, reliably. A rebate for assessing and treating a UTI creates a financial interest in finding UTIs. That is true of every fee-for-service item in Medicare, and it is managed through protocols, audit and the Professional Services Review — machinery that exists for doctors and would have to be built for pharmacists. Community pharmacy also has a commercial retail model attached, which general practice does not, and the interaction between a dispensing margin and a prescribing decision is the objection doctors' organisations make most forcefully.
It is a substantial new Commonwealth expenditure with an uncertain offset. Every entry in this database that proposes new spending should say so plainly. This one does: a rebate for a common condition delivered at 5,000 pharmacies is not a small program, and the saving depends on behaviour nobody has measured at scale.
And a pharmacist is not a substitute for a GP, only for a GP visit. The consultation that surfaces something unrelated — the blood pressure, the mole, the thing the patient mentions on the way out — is a real feature of continuity of care, and it is the strongest clinical argument for the current arrangement. This project has weighed continuity against access before, in telehealth, and reached the same uncomfortable conclusion: they genuinely trade off.
Precedent
The national women's health pharmacist prescribing trial, commencing 1 January 2027, funds pharmacist assessment for two conditions. The Commonwealth has already accepted in principle that it can pay for this service; the trial establishes the mechanism.
Sources
- National women's health pharmacist prescribing trial announced 13 March 2026, commencing 1 January 2027, covering assessment and treatment of uncomplicated UTIs and initiation and resupply of selected hormonal contraceptives
- Scope of Practice Review (Cormack): virtually all health professions in primary care face restrictions or barriers unrelated to their education and competence
- Queensland Extended Practice Authority from 1 July 2025; NSW expanded scope services; Victorian statewide pilot across more than 760 pharmacies