HMR caps lead to dire medicine review gaps in regional Australia

This in-demand credentialed pharmacist can’t adequately service her community due to restrictions on the Home Medicines Review (HMR) service.

As a credentialed pharmacist in regional Victoria, Kelly Abbott MPS provides medicines reviews to patients with complex health needs. But strict monthly caps and stagnant fees mean she can’t see everyone who is referred to her – even when the need is clear.

And sometimes, the call comes too late.

‘I’ve knocked on a door to have the [patient’s] husband tell me, “oh, she died”,’ Ms Abbott said. ‘That’s happened multiple times.’

There’s no way to prove whether an earlier HMR would have changed those outcomes. But for a pharmacist trained to identify medicine-related risk, these moments stay with you.

‘It’s heartbreaking, it’s wrong and it shouldn’t be that way,’ she said.

Knocking on doors

Ms Abbott practises in Gippsland, Victoria – recently labelled  ‘Australia’s unhealthiest region’ in the media.

The statistics are confronting: high smoking rates, significant socioeconomic disadvantage, and high burden of chronic obstructive pulmonary disease and cardiovascular disease. ‘If you look at a map of heart attacks in Victoria,’ Ms Abbott said, ‘Gippsland is just red.’

In a region like this, preventive medicines care matters. Yet access is rationed.

Ms Abbott consistently hits the 30-HMR monthly cap.

‘I have not had a month under 30 [HMRs] since September 2023,’ she said.

Demand far exceeds what she’s allowed to provide. Referrals have to wait, clinics juggle priorities, and some GPs even stop sending patients her way because they know she’s hit her limit. 

Like many credentialed pharmacists, Ms Abbott’s wait list is about 2 months long.

‘Currently, if I received your referral today [28 January], I might see you in March at the earliest.’

A workforce running on goodwill

Gippsland is not remote in the traditional sense. It sits within reach of Melbourne. Yet Ms Abbott describes a thinning workforce of credentialed pharmacists.

‘There are only four of us in the Latrobe Valley, an hour in either direction,’ she said. ‘Only one of us has come on board in the last few years.’

Others have retired and some have simply stopped.

Ms Abbott is unsurprised by this. ‘Why would you bother becoming accredited financially right now?’ she asked. ‘You’re going to earn more and [have] a stable pay cheque in hospital or community pharmacy. Why would you pay to go through a course when you’ve got an absolutely capped income in that work stream?’

‘I have not had a month under 30 [HMRs] since September 2023.’

kelly abbott mps 

The 30-service cap, introduced in 2014, limits how many HMRs a provider can claim per month. HMR fees have not been indexed since July 2019, eroding their real value over time.

For credentialed pharmacists like Ms Abbott, that combination sends a clear message that their work is undervalued.

‘What other specialist is limited like this?’

The cost of saying no

Ms Abbott described refusing some distant referrals because travel makes them financially unviable.

‘I am refusing to go to certain places because it’s just too far,’ she said. 

Pharmacists can’t charge for travel as part of an HMR so the system means ‘those people are missing out’.

‘This means entire towns are not serviced by HMR providers in Gippsland, Ms Abbott said. ‘In an area with an ageing population, some of these towns would benefit enormously from medication reviews by a local pharmacist face-to-face.’

It’s not how she wants to practise.

‘I hate thinking that way. I hate being that way. 

But the financial reality is that she can’t afford to make a loss on referrals.

Her frustration is about sustainability, not about status.

When remuneration doesn’t reflect the complexity and levels of responsibility, fewer pharmacists choose to become credentialed. And in high-need areas, that has real consequences.

Let pharmacists do what they are trained to do

Despite the challenges, Ms Abbott still believes in the value of HMRs.

‘We have great evidence that they reduce hospitalisations and they reduce healthcare costs,’ she said.

‘And patients and GPs absolutely love them. The demand alone tells you that.’

But she can’t meet that demand under current restrictive settings.

‘I love what I do,’ she said. ‘And there’s so many pharmacists like me who want to do more here.  Just let me loose.”