HMR waitlists can stretch for months

Home Medicines Reviews (HMRs) are becoming increasingly difficult to sustain, with rising fuel costs and restrictive caps placing pressure on both practitioners and patients.

HMR services remain a vital safeguard for improving health literacy among vulnerable Australians living with chronic illnesses, complex medicine regimens and mental health conditions.

But pharmacists on the ground warn the model is increasingly unsustainable under current funding arrangements. Restrictive caps, rising fuel costs, and extensive travel times are making the reality of HMRs nearly impossible to keep up with.

AP spoke with Mitchell Everlyn, consultant pharmacist, qualified diabetes educator, and locum based in Brisbane, Australia, about the impact of these pressures.

Unsustainability of HMRs

Growing demand for HMRs, increased clinical complexity and systemic constraints are reshaping the extent of the services pharmacists can realistically provide. 

Balancing extreme travel distances with capped funding arrangements has left many questioning how long they can continue carrying the weight of HMR practice. 

When asked about the sustainability of HMRs, Mr Everlyn said that ‘unless funding increases with caps or indexes upwards, I’m better off working in a pharmacy than I am doing consultant stuff.’

With 30-per-month caps set in place, Mr Everlyn said that ‘the time and money you’re getting back from HMRs works out to be about $22 an hour. These financial pressures directly impact which patients pharmacists can realistically afford to fit in.’

At the same time, patient demands continue to climb. HMR waitlists can stretch for months for many pharmacists, particularly in rural areas where these services are a cornerstone in healthcare.

Urgent referrals continue to flood in, yet pharmacists are unable to exceed service limits. 

‘I get follow-up emails asking why I haven’t seen an acute patient… and it’s because I’ve hit my cap and I can’t,’ Mr Everlyn said.

Despite the growing clinical complexity of patients receiving HMRs, remuneration has been at a standstill since 2019, and service caps have remained largely unchanged, creating a widening gap between the work required and the compensation available.

Under PSA’s 2026-27 Federal Budget recommendations, caps have been recommended to increase to 60 HMRs per month from 1 July 2026.

Professional isolation in rural practice

For pharmacists servicing rural and regional areas, the challenges extend well beyond funding, triggering a push towards incorporating telehealth to ease the strain of providing rural HMR services. 

Loading allowance is only extended to $125 per visit, which is designed to contribute towards the costs incurred, not necessarily to cover all costs, ultimately leaving pharmacists out of pocket.

The PSA has estimated that reforming HMR delivery would cost $135.1 million over 4 years, which includes introducing HMR payments linked to rurality (MMM3-7). Such investments would reduce preventable hospitalisations and improve rural access.

Mr Everlyn recently had to reduce the distance he travels due to financial strain. 

‘I’m now needing to prioritise HMRs that are a lot closer to home, which sucks to say.’

Mr Everlyn has been increasingly providing private HMRs, explaining that patients are not prepared to wait 3 months.

Mr Everlyn recalled one HMR consult in a completely isolated area where healthcare access was severely limited, Mr Everlyn said ‘the patient was having an acute schizophrenic attack, and the closest hospital was an hour away.’

It is commonplace for credentialed pharmacists to conduct reviews completely alone, which leaves them with the task of navigating highly complex medical situations without any form of backup.

Patient and practitioner safety

As wait times blow out across the healthcare system, pharmacists are increasingly encountering patients whose conditions have escalated well beyond medicines management.

‘There have been times where I’ve gone to a patient’s house and had to call ambulances because they need acute care,’ Mr Everlyn said.

‘I saw someone recently who’s been in hospital three times this year for suicide attempts, and there is a 6-month wait list for a psychiatrist. So then you’re talking about patient safety.’

Naturally, these experiences have an impact on a practitioner’s emotional wellbeing. ‘After situations like that, who do you call? Where’s the support net? It can be very isolating,’ Mr Everlyn said.

Fuel crisis and a push to telehealth

Fuel shortages and rising petrol costs are putting the longevity of HMR practice in a compromising position, which places vulnerable patients at immense risk. 

Increasing fuel prices have added yet another layer of pressure for pharmacists who are already operating on tight margins. 

With travel taking up large portions of the workday, and an increase in fuel costs, there has been a recent push towards incorporating telehealth into HMR services. 

PSA national president Professor Mark Naunton MPS said ‘the support these patients need, such as medication reviews, is becoming rapidly unsustainable amid the current fuel crisis, unless the government reinstates telehealth.’ 

‘We know telehealth worked effectively and efficiently during the COVID-19 pandemic, so why not now?

‘I did one HMR on Easter Sunday, which was a 120 km round trip, and then with roadworks, it took me two hours to get there. One full day’s work worked out to be $200,’ Mr Everlyn added.

‘The push over to telehealth would alleviate so much time.’ 

While he acknowledges the value of in-person assessments, he argues that not every consultation requires pharmacists to travel hours to gain the required clinical information.

‘You can tell a lot by how someone’s moving… but I don’t need to travel 3 hours one way just to see that.’

For many pharmacists, the reluctance to modernise HMR services feels increasingly behind broader innovation.

‘In this day and age we have AI, but we can’t do telehealth,’ Mr Everlyn says.

The reinstatement of telehealth is included in the reforms PSA is advocating for to ensure that care is accessible for all Australians.

PSA’s 2026–27 Federal Budget Submission advocates for the government to lift the indexation freeze on the management of medications to ensure the longevity of patient care.