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CMRP-200; No. of Pages 2

Current Medicine Research and Practice xxx (2016) xxx–xxx

Contents lists available at ScienceDirect

Current Medicine Research and Practice

Short communication

Can the New Pharmacy Bill safeguard patient’s right in healthcare?

A R T I C L E I N F O A B S T R A C T

Article history: Globally, safeguarding patients’ wellbeing is the cornerstone to any healthcare system. Recent changes
Received 29 May 2016 to Malaysia pharmacy legislation aims to protect the rights of patient in addition to address the present
Accepted 5 July 2016 lacunae and challenges faced in pharmacy legislation. A New Pharmacy Bill is slated for tabling in
Available online xxx
Parliament session by the end of 2016. The proposed bill is to replace four pre-independence bills,
namely the Poisons Act (1952), Sale of Drugs Act (1952), Registration of Pharmacists Act (1951) and the
Keywords: Medicines (Advertisement and Sale) Act (1956). Passing such legislation to protect patient right is not
Legislation
uncommon. For example, the Patient Rights (Scotland) Act 2011 was passed by the Scottish Parliament in
Medicine pricing
Medicine affordability
February 2011, to safeguard patient right in obtaining optimum benefit from using health services by
Health policy considering their needs and encouraging participation as fully as possible in decision making as well as
providing sufficient information and support to uphold their rights.
ß 2016 Sir Ganga Ram Hospital. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights
reserved.

1. Introduction 2. Empowering the patient with itemized billing

Globally, safeguarding patients’ wellbeing is the cornerstone to The proposed bill will provide a mandatory provision to grant
any healthcare system. Recent changes to Malaysia pharmacy patient the right to obtain itemized billing. Under the current
legislation aims to protect the rights of patient in addition to practice, itemized billing is not mandatory and are given whenever
address the present lacunae and challenges faced in pharmacy requested by patient,2 therefore shrouding the charges behind
legislation. A New Pharmacy Bill is slated for tabling in Parliament each healthcare activities provided. Malaysia healthcare system
session by the end of 2016. The proposed bill is to replace four pre- does not impose dispensing separation, therefore allowing
independence bills, namely the Poisons Act (1952), Sale of Drugs physicians to dispense medicines to their patient, charging them
Act (1952), Registration of Pharmacists Act (1951) and the for both consultation fee and medication. The consultation fee for
Medicines (Advertisement and Sale) Act (1956). Passing such physician is regulated under the Private Healthcare Facilities and
legislation to protect patient right is not uncommon. For example, Services (Private Hospitals and Other Private Healthcare Facilities)
the Patient Rights (Scotland) Act 2011 was passed by the Scottish (Amendment) Order 2013. For general medical practitioner,
Parliament in February 2011, to safeguard patient right in consultation fee per session is fixed at Malaysian currency (RM)
obtaining optimum benefit from using health services by 30 to RM 145 (US $1 = RM 4) while specialist consultant charges
considering their needs and encouraging participation as fully as between RM 40 and RM 235 per session. However, prices for
possible in decision making as well as providing sufficient medicines are not regulated, whereby individual medical practi-
information and support to uphold their rights.1 tioner and private hospitals are free to determine the prices of
medicines. Without itemized billing, patients faced the possibili-
ties of incorrect charges and unfair or unreasonable prices. Medical
Billing Advocates of America reported that eight out of ten medical
bills containing errors.3 Few patients will request for itemized
* Corresponding author at: Unit for Medication Outcomes Research and billing as the awareness of patients’ right is considerably low.
Education (UMORE), Pharmacy, University of Tasmania, Private Bag 26, Hobart
Patients are unable to question the charges as they lack of
7001, Australia. Tel.: +61 3 6226 2190; fax: +61 3 6226 7627.
E-mail addresses: [email protected] (K.S. Lee), [email protected] information on the charges.4,5 Exorbitant medical charges may
(Y.W. Lim), [email protected] (L.C. Ming). leads to bankruptcy due to high medical debt. Malaysia Credit

http://dx.doi.org/10.1016/j.cmrp.2016.07.004
2352-0817/ß 2016 Sir Ganga Ram Hospital. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.

Please cite this article in press as: Lee KS, et al. Can the New Pharmacy Bill safeguard patient’s right in healthcare? Curr Med Res Pract.
(2016), http://dx.doi.org/10.1016/j.cmrp.2016.07.004
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CMRP-200; No. of Pages 2

2 K.S. Lee et al. / Current Medicine Research and Practice xxx (2016) xxx–xxx

Counselling and Debt Management Agency reported that 26% of Malaysia, patients have the choice to obtain the medicines directly
loan or credit card repayment failure was due to high medical from the physician treating the patient or to fill the prescription at
expenses.6 Therefore, the proposed bill is viewed as a vital a local pharmacy. Without a prescription, patients are unable to
instrument to empowered patient with their right for itemized obtain their medication from pharmacies, which is usually sold at a
billing. competitive price compares to the physician clinics. Moreover,
such system put patients in a helpless position by indirectly forcing
3. Patient’s safety elements in the New Pharmacy Bill patients to purchase repeat medications from the similar physi-
cian. Pharmacists question the rationale behind such action,
The Malaysia Pharmaceutical Society and the Malaysia Commu- whether the policy makers expect patients to inform the
nity Pharmacy Guild opposed the notion of non-mandatory to state pharmacist verbally the medicines they are supposed to buy.
diagnosis on prescriptions. The pharmacy fraternity has called for Pharmacists were baffled by such event, with the Ministry of
total rejection of this proposed bill as it failed to prioritize patient’s Health backtracking from the initial instruction by the Director
right to obtain safe healthcare. Opponents argued that without General of Health in a letter dated on 18th November 2015,
diagnosis or indication on prescription, pharmacists are unable to requiring all physicians to issue prescription to patients. Patients
perform audit on medicines prescribed, as such additional must be given the options to either purchase the prescribed
information is not available to them. Furthermore, nearly all medicines from the clinic where treatment is given or to purchase
prescription in Malaysia is handwritten and the likelihood of from the community pharmacies.9 The paramount concern is not
medication errors due to poor or illegible handwriting exists. Study on the locality where patients obtain his medications but more
in Switzerland shown that the readability of handwritten prescrip- importantly is that patients are not deprived of the right to choices.
tion was generally bad and almost 65 (3.5%) errors were detected in Undeniably, the tabling of the New Pharmacy Bill in Parliament
1934 prescribed agents.7 Notwithstanding that, stating diagnosis on is timely to replace the current outdated pre-independent
prescriptions in not mandatory in most countries but were viewed legislation. This is necessary to bring forth the advances in
by many organizations as vital to safeguard patient’s safety. The pharmacy practice, in accordance to the Malaysian healthcare
American Pharmacists Association supports the notion to include transformation plan.10 However, it is imperative that patients’
diagnosis information as it makes more sense. The United States right must be preserved at all cost and should be the upmost
Office of the Inspector General for the Department of Health and priority in any legislation passed by policy makers.
Human Services reported that diagnosis information on prescrip-
tions reduce inappropriate reimbursement and increase patient Conflicts of interest
safety. For Malaysia, healthcare system transformation is underway
to provide universal healthcare coverage via the establishment of a The authors have none to declare.
healthcare reimbursement system.8 However, this provision to
exclude mandatory stating of diagnosis on prescriptions is indeed a References
major setback, as diagnosis information can be used to make sure
1. The Scottish Parliament. Patient Rights (Scotland) Act 2011. The Scottish Parliament;
medicines are prescribed for the intended indication to qualify for 2011.
reimbursement. 2. Director General of Health Malaysia. Addressing Health Care Costs in the Private
However, proponents to the notion argued that the exclusion of Sector. Putrajaya, Malaysia: Ministry of Health Malaysia; 2010.
3. Palmer P. Why You Need a Hospital Bill Review. Roanoke, VA: Medical Billing
diagnosis on prescriptions is meant to protect patient confidentiali- Advocates of America; 2014. Available from: http://billadvocates.com/
ty. It is indeed vital to uphold patient’s confidentiality at all time, but need-hospital-bill-review/ [accessed 28.05.16]
not at the expense of patient’s safety. On top of that, prescriptions 4. Malaysia private hospitals charge excessive prices for donated blood: donors. The
Straits Times. 2014.
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errors in a Swiss university hospital due to the handwritten prescription process.
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Meet Future Needs. Putrajaya, Malaysia: Ministry of Health Malaysia; 2015.
The New Pharmacy Bill took a turn for the worse by included a 9. Director General of Health Malaysia. The Need to Issue a Prescription for the Supply of
provision that makes prescription issuing by physician not Medicines for Treatment. 2015. Available from: http://www.mma.org.
mandatory. Prescription will only be issued if patient demand my/announcement/667-keperluan-untuk-mengeluarkan-preskripsi-bagi-
pembekalan-ubat-ubatan-untuk-tujuan-rawatan [accessed 29.05.16]
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pharmacist is for individual patient to obtain medicines. In Res Soc Adm Pharm. 2016. http://dx.doi.org/10.1016/j.sapharm.2016.05.047.

Please cite this article in press as: Lee KS, et al. Can the New Pharmacy Bill safeguard patient’s right in healthcare? Curr Med Res Pract.
(2016), http://dx.doi.org/10.1016/j.cmrp.2016.07.004