‘They’re the ones who need it most’: at-risk patients denied HMR access

For some of Australia’s most vulnerable patients, a Home Medicines Review (HMR) is not just delayed, it never happens.

Wollongong-based credentialed pharmacist Esther Hernandez MPS said the people most at risk of medicine-related harm are often the hardest to reach. In her experience, the issue is not a lack of need, but a system that struggles to overcome distance.

When calling to arrange an HMR, Ms Hernandez said the first issue to address is often logistical rather than clinical.

Some patients live significant distances from available providers. Others require additional time and coordination due to disability, mobility issues or complex needs. And for those living outside major centres, distance adds another layer of complexity.

‘It’s not that the service doesn’t exist,’ she said. ‘It’s that the distance between the service and the patient becomes the barrier.’

And for time-critical medicine safety services, this puts patient lives at risk.

Rigid model of care

HMRs are designed to bring medicines expertise into the home. But for patients living further away, or those requiring additional time and coordination, the model can become difficult to deliver – especially as credentialed pharmacists are not reimbursed for travel time.

‘If I’m driving 1 hour each way, that means I can’t see two more patients [in a day],’ Ms Hernandez said.

Ms Hernandez sees patients who would benefit from a review but are difficult to reach under current settings, particularly for follow-up appointments, which she describes as ‘essential’.

Recalling one patient who required only a straightforward change, Ms Hernandez said the follow-up review ‘could have been done via telehealth’.

But this is not an option, with all HMRs and follow-ups conducted after 1 January 2023 required to be face-to-face and no exceptions provided.

In some cases, timely follow-up can prevent serious harm. A patient with hypertension and cognitive impairment stopped taking one medicine after another was added post-HMR, believing it had replaced the original therapy.

‘If I didn’t do this follow-up visit, the patient could have been hospitalised because their blood pressure was through the roof,’ Ms Hernandez said.

Patients at risk of being overlooked

Many of the patients who struggle to access HMRs are those living with multiple conditions, disability or limited support.

They may see several prescribers, take numerous medicines and experience ongoing symptoms yet still miss out on a comprehensive review.

‘Without physically reviewing the medication and how they live their life … people just keep adding more medicine,’ Ms Hernandez said.

When there’s no intervention, risks can compound – often leading to deterioration, hospitalisation or loss of independence.

One patient she visited had recently been diagnosed with heart failure and was struggling with persistent coughing and breathlessness despite multiple consultations with GPs and other specialists.

‘She said, “If I had a gun, I would just pull it… I can’t live like this,”’ Ms Hernandez recalled.

The issue, Ms Hernandez found, was not a lack of treatment, but a lack of compliance driven by low health literacy.

‘If I didn’t do this follow-up visit, the patient could have been hospitalised because their blood pressure was through the roof.’

Esther Hernandez MPS 

‘She was not taking her [diuretic] tablet,’ she said.

Once the treatment was optimised, and some advice given on the importance of compliance, the patient’s symptoms improved rapidly.

‘The cough went. Quality of life improved,’ Ms Hernandez added.

Caps compound disadvantage

These access gaps are compounded by the monthly cap on HMRs, which limit how many patients Ms Hernandez can see regardless of need. She sees them as arbitrary, out of step with other health professions and not reflective of actual workload or demand.

‘It’s just so unfair that we are so restricted,’ Ms Hernandez said, ‘there’s no other profession that has this restriction.’

With demand already exceeding capacity, the cap forces difficult decisions about which patients are prioritised and when care can be delivered. In a system where distance and complexity are already barriers, these limits further constrain the ability to respond to patients at risk, reinforcing the very gaps HMRs are designed to address.

Reform that matches need with value

PSA’s 2026–27 Federal Budget Submission, released 25 February 2026, identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package.

Recommendation 1.1 calls for removal of monthly provider caps, re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity.

For vulnerable patients at risk of medicine-related harm, these changes are not about expanding scope. They are about ensuring the service can reach those who need it most.

Read PSA’s full 2026–27 Federal Budget Submission.