Brian Bigg
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"]
Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => 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.’
[caption id="attachment_31424" align="alignright" width="282"]
Kelly Abbott MPS[/caption]
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.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Morag Horton works alongside clinicians and nurses to ensure seamless IVF medicines supply and patient support.
How did you specialise in assisted reproductive therapy?
In 2013, I purchased a pharmacy involved in IVF and fertility treatment.
At that time, most medicines supply was made by IVF clinics directly to patients, and there was very little pharmacy involvement – other than for non-Medicare funded patients or medicines. I was dispensing medicines I’d never learnt about at university – nor in my career until then.
I struggled to find suitable training material, so I asked questions of IVF clinicians, nurses and pharmaceutical companies whenever the opportunity arose. I came to understand the medicines protocols used and became familiar with all the administration devices. In 2015, funding for the supply of IVF medicines changed to the Pharmaceutical Benefits Scheme (PBS) in the S100 category – meaning all supply now involved a pharmacist. The knowledge that I’d already gained meant I could support patients and their partners, as well as to the IVF clinic team, through and beyond this transition.
What does the role entail?
I help patients process huge amounts of information and complex medicines schedules, and access medicines that may not be available in their local community pharmacy. I also help to reduce or eliminate confusion or issues for patients e.g. insufficient prescribed quantities, missed items or last-minute medicines changes.
How do you help patients navigate their medicines regimen?
Being able to immediately understand the treatment protocol behind a bundle of prescriptions is important. Recognising the individual situation makes the patient feel more comfortable and understood. It also helps me tailor the information provided.
If the patient is anxious about injections and injection technique, I focus on the first item that needs to be used. This helps to ensure they’re not overwhelmed with three or more different products that may require different techniques or devices, and they feel more comfortable before adding in the next injection.
Clear and thorough labelling is also key, with storage information discussed and fridge items provided in a cooler bag with ice. I also provide written information to support verbal and online information, offering further support by telephone.
How do you manage medicines storage, cold-chain and supply?
We’ve increased fridge capacity and back up, built in business continuity planning, and use data loggers on all refrigerators. We also have a dedicated fridge for IVF medicines, as the packaging is bulky and prescriptions can involve large quantities. Ordering is done frequently, with close attention to supplier cut-off times, particularly later in the week.
We carefully balance stock levels, expiry risk and cash flow, while monitoring prescribing patterns and staying in close contact with fertility clinics about upcoming treatment cycles. We also ensure all supporting materials – such as brochures, cooler bags, ice bricks and other consumables – are available.
How do you collaborate with fertility clinics, prescribers and nurses?
In the beginning of my involvement in the IVF field, I asked questions of others with more experience. Now, they often ask me questions. I also encourage clinicians to understand PBS listings and to prescribe in accordance with the criteria.
The IVF clinicians can be hard to reach for prescription queries, so good relationships with IVF nurses and clinic staff are essential. As a member of the Fertility Society of Australia and Fertility Nurses of Australasia, I keep up with the latest information and news, and participate in continuing education events and conferences.
What advice do you have for ECPs keen on specialising in this area?
Build your knowledge and be confident in it, while remaining open-minded and supportive. Fertility treatment can place people under emotional, practical and financial pressure; pharmacists shouldn’t add to that burden.
A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia
| 8.00 am | Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock. |
| 9.00 am | Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity. |
| 10:30 am | Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together. |
| 12.00 pm | Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles. |
| 2.00 pm | Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing. |
| 3.30 pm | Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines. |
| 6.00 pm | Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses. |
| 8.00 pm | Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track. |
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
[post_excerpt] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => 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.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
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.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Morag Horton works alongside clinicians and nurses to ensure seamless IVF medicines supply and patient support.
How did you specialise in assisted reproductive therapy?
In 2013, I purchased a pharmacy involved in IVF and fertility treatment.
At that time, most medicines supply was made by IVF clinics directly to patients, and there was very little pharmacy involvement – other than for non-Medicare funded patients or medicines. I was dispensing medicines I’d never learnt about at university – nor in my career until then.
I struggled to find suitable training material, so I asked questions of IVF clinicians, nurses and pharmaceutical companies whenever the opportunity arose. I came to understand the medicines protocols used and became familiar with all the administration devices. In 2015, funding for the supply of IVF medicines changed to the Pharmaceutical Benefits Scheme (PBS) in the S100 category – meaning all supply now involved a pharmacist. The knowledge that I’d already gained meant I could support patients and their partners, as well as to the IVF clinic team, through and beyond this transition.
What does the role entail?
I help patients process huge amounts of information and complex medicines schedules, and access medicines that may not be available in their local community pharmacy. I also help to reduce or eliminate confusion or issues for patients e.g. insufficient prescribed quantities, missed items or last-minute medicines changes.
How do you help patients navigate their medicines regimen?
Being able to immediately understand the treatment protocol behind a bundle of prescriptions is important. Recognising the individual situation makes the patient feel more comfortable and understood. It also helps me tailor the information provided.
If the patient is anxious about injections and injection technique, I focus on the first item that needs to be used. This helps to ensure they’re not overwhelmed with three or more different products that may require different techniques or devices, and they feel more comfortable before adding in the next injection.
Clear and thorough labelling is also key, with storage information discussed and fridge items provided in a cooler bag with ice. I also provide written information to support verbal and online information, offering further support by telephone.
How do you manage medicines storage, cold-chain and supply?
We’ve increased fridge capacity and back up, built in business continuity planning, and use data loggers on all refrigerators. We also have a dedicated fridge for IVF medicines, as the packaging is bulky and prescriptions can involve large quantities. Ordering is done frequently, with close attention to supplier cut-off times, particularly later in the week.
We carefully balance stock levels, expiry risk and cash flow, while monitoring prescribing patterns and staying in close contact with fertility clinics about upcoming treatment cycles. We also ensure all supporting materials – such as brochures, cooler bags, ice bricks and other consumables – are available.
How do you collaborate with fertility clinics, prescribers and nurses?
In the beginning of my involvement in the IVF field, I asked questions of others with more experience. Now, they often ask me questions. I also encourage clinicians to understand PBS listings and to prescribe in accordance with the criteria.
The IVF clinicians can be hard to reach for prescription queries, so good relationships with IVF nurses and clinic staff are essential. As a member of the Fertility Society of Australia and Fertility Nurses of Australasia, I keep up with the latest information and news, and participate in continuing education events and conferences.
What advice do you have for ECPs keen on specialising in this area?
Build your knowledge and be confident in it, while remaining open-minded and supportive. Fertility treatment can place people under emotional, practical and financial pressure; pharmacists shouldn’t add to that burden.
A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia
| 8.00 am | Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock. |
| 9.00 am | Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity. |
| 10:30 am | Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together. |
| 12.00 pm | Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles. |
| 2.00 pm | Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing. |
| 3.30 pm | Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines. |
| 6.00 pm | Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses. |
| 8.00 pm | Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track. |
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
[post_title] => Safe medicines management during Ramadan
[post_excerpt] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => 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.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
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.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Morag Horton works alongside clinicians and nurses to ensure seamless IVF medicines supply and patient support.
How did you specialise in assisted reproductive therapy?
In 2013, I purchased a pharmacy involved in IVF and fertility treatment.
At that time, most medicines supply was made by IVF clinics directly to patients, and there was very little pharmacy involvement – other than for non-Medicare funded patients or medicines. I was dispensing medicines I’d never learnt about at university – nor in my career until then.
I struggled to find suitable training material, so I asked questions of IVF clinicians, nurses and pharmaceutical companies whenever the opportunity arose. I came to understand the medicines protocols used and became familiar with all the administration devices. In 2015, funding for the supply of IVF medicines changed to the Pharmaceutical Benefits Scheme (PBS) in the S100 category – meaning all supply now involved a pharmacist. The knowledge that I’d already gained meant I could support patients and their partners, as well as to the IVF clinic team, through and beyond this transition.
What does the role entail?
I help patients process huge amounts of information and complex medicines schedules, and access medicines that may not be available in their local community pharmacy. I also help to reduce or eliminate confusion or issues for patients e.g. insufficient prescribed quantities, missed items or last-minute medicines changes.
How do you help patients navigate their medicines regimen?
Being able to immediately understand the treatment protocol behind a bundle of prescriptions is important. Recognising the individual situation makes the patient feel more comfortable and understood. It also helps me tailor the information provided.
If the patient is anxious about injections and injection technique, I focus on the first item that needs to be used. This helps to ensure they’re not overwhelmed with three or more different products that may require different techniques or devices, and they feel more comfortable before adding in the next injection.
Clear and thorough labelling is also key, with storage information discussed and fridge items provided in a cooler bag with ice. I also provide written information to support verbal and online information, offering further support by telephone.
How do you manage medicines storage, cold-chain and supply?
We’ve increased fridge capacity and back up, built in business continuity planning, and use data loggers on all refrigerators. We also have a dedicated fridge for IVF medicines, as the packaging is bulky and prescriptions can involve large quantities. Ordering is done frequently, with close attention to supplier cut-off times, particularly later in the week.
We carefully balance stock levels, expiry risk and cash flow, while monitoring prescribing patterns and staying in close contact with fertility clinics about upcoming treatment cycles. We also ensure all supporting materials – such as brochures, cooler bags, ice bricks and other consumables – are available.
How do you collaborate with fertility clinics, prescribers and nurses?
In the beginning of my involvement in the IVF field, I asked questions of others with more experience. Now, they often ask me questions. I also encourage clinicians to understand PBS listings and to prescribe in accordance with the criteria.
The IVF clinicians can be hard to reach for prescription queries, so good relationships with IVF nurses and clinic staff are essential. As a member of the Fertility Society of Australia and Fertility Nurses of Australasia, I keep up with the latest information and news, and participate in continuing education events and conferences.
What advice do you have for ECPs keen on specialising in this area?
Build your knowledge and be confident in it, while remaining open-minded and supportive. Fertility treatment can place people under emotional, practical and financial pressure; pharmacists shouldn’t add to that burden.
A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia
| 8.00 am | Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock. |
| 9.00 am | Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity. |
| 10:30 am | Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together. |
| 12.00 pm | Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles. |
| 2.00 pm | Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing. |
| 3.30 pm | Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines. |
| 6.00 pm | Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses. |
| 8.00 pm | Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track. |
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[post_content] => Respectful, culturally safe conversations can prevent self-adjusted dosing while supporting informed patient choice.
Each year during Ramadan*, Muslims fast from dawn to sunset, abstaining from food and drink during daylight hours, with this year’s fast taking place from 18 February to 20 March.
For many patients, this practice coincides with the management of acute or chronic diseases, creating medicines-related challenges.
At Emerton Amcal Pharmacy in Western Sydney – an area with a large Muslim community – pharmacist Zara Gul sees these challenges firsthand.
[caption id="attachment_31474" align="alignright" width="255"] Zara Gul[/caption]
Before turning to dose timing or formulation adjustments, Ms Gul emphasises a key message that pharmacists should reinforce.
Health comes first
For patients managing chronic conditions, fasting is not mandatory if it compromises their health.
‘If you're on things like insulin and you need to be eating, you're not obliged to fast,’ Ms Gul said. ‘Or if you're on medications that you need to take at certain times – for example, epileptic medication or Parkinson’s-related medications, you're exempt from fasting.’
People who are pregnant, unwell, sick or elderly are also exempt. ‘You’re not any less of a good Muslim by not being able to fast because of your health.’
However, Ms Gul advised that some patients, particularly older people, may feel compelled to continue fasting.
‘Sometimes the older generation will try to push themselves, and think, “I can miss my dose and take it later,” and then they fall ill,’ she said. ‘So we have to remind them that their health comes first.’
Timing is everything
For those who are medically fit to fast, timing medicine doses becomes the primary challenge. During Ramadan, meals are limited to early morning (suhoor) and evening (iftar) – which makes midday dosing difficult.
In some cases, simple adjustments can maintain therapeutic coverage during the non-fasting window.
‘If patients are taking medicines such as antibiotics three times a day, they can take one while they’re having their morning meal, one when they break their fast and one before they go to bed,’ Ms Gul said.
Approaching chronic disease management
Managing conditions such as diabetes during Ramadan can prove to be a challenge, with patients using insulin or certain oral agents potentially at risk of hypoglycaemia if fasting without modification.
For patients who are highly motivated to fast, collaborating with prescribers can allow for regimen simplification.
‘For example, if someone wants to go on a longer-acting insulin and they’re only taking it at night, that could be an option,’ Ms Gul said.
‘You’re not any less of a good Muslim by not being able to fast because of your health.'
zara gul
But caution is essential.
‘You also don’t want to confuse the patient by changing things unnecessarily. If they switch insulin just for Ramadan and then go back afterwards, that can cause problems. And doctors might not want to change someone’s medicine if they’re already stable.’
But sometimes this may prompt a positive long-term change.
‘Perhaps the patient doesn't actually need to take a medicine three times per day, and they can switch to using it once daily long-term.’
Self-adjusted dosing
It’s common for patients to independently alter or omit doses during Ramadan, Ms Gul said.
‘People will definitely try. They might skip doses, or they’ll say, “My doctor told me to take it at lunch, but I’m fasting, so I’m not taking it”,’ she said.
‘So if you know someone is observing Ramadan, you could ask, ‘How are you going to manage your medication? Are you finding it easy to manage it with the times?” That can open the door for them to have a chat.’
Often, patients raise the issue directly when collecting prescriptions.
‘When we’re handing medication out and we’re talking to the patient about it, they’ll often tell us they’re fasting and ask how to manage it,’ Ms Gul said.
‘That’s a great opportunity for us to look at options – for example, if they’re taking Trajenta at lunchtime, you might be able to move it to the morning when they’re eating their early meal.’
Starting the conversation
While many patients initiate these conversations, others are not always so forthcoming. So, broaching the topic of Ramadan requires cultural sensitivity, acknowledging that not all Muslim patients fast.
‘It’s hard to identify who’s observing Ramadan and who’s not, so it’s good to ask – not just not assume,’ Ms Gul said. ‘Someone might not be fasting because they’re unwell, and you don’t want to make them feel worse by assuming they are.’
Rather than directly referencing fasting, she recommends broader open-ended questions.
‘An easy thing to ask would be “How is your Ramadan going?” Ms Gul said.
This allows patients to disclose relevant information at their own pace.
‘They might say, “I’m not able to fast this month because of my health,” or “I am fasting and I’m finding it difficult to manage my medicine”. Or they might say everything is going well.’
Knowing what invalidates a fast
Understanding dosage forms is another practical consideration, with some patients worrying that using medicines during daylight hours may invalidate their fast.
As a general rule, oral medicines and substances entering through open cavities invalidate fasting.
‘So you can’t use anything oral, or anything inside your nose or ear,’ Ms Gul said.
However pharmacists can reassure patients about non-oral options. ‘Using a topical cream or an eye drop is absolutely fine,’ she said.
For more information on providing care to culturally and linguistically diverse communities, watch the PSA webinar 'Interpreter services – what every pharmacist & GP should know'.
*Australian Pharmacist apologises for the misspelling of Ramadan in our enewsletter.
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[post_content] => The Australian Technical Advisory Group on Immunisation (ATAGI) released its Statement on the administration of seasonal influenza vaccines in 2026 late last week, in the wake of Australia’s deadliest influenza season this century.
In 2025, around 1,701 influenza-associated deaths were recorded, more than those related to COVID-19 – which fell compared to the previous year.
Against that backdrop, improving vaccine uptake, particularly in priority populations, is a clear national focus.
Here are the top takeaways for pharmacists this influenza season.
1. Intranasal influenza vaccine introduced
This year, the live attenuated influenza vaccine (LAIV), FluMist, administered intranasally, is available for the first time.
FluMist is registered for children and adolescents aged 2–17 years and is available as a private vaccine and through selected state programs in:
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[post_content] => PSA has announced the winners of the PSA New South Wales Pharmacist Awards, recognising outstanding pharmacists who have demonstrated excellence in their practice and dedication to improving healthcare outcomes for their communities.
Speaking at the NSW Pharmacist Awards ceremony, held in the Hunter Valley on Saturday night (28 February), PSA NSW President Luke Kelly highlighted the award recipients' dedication to the pharmacy profession and improving patient care.
‘Each of these pharmacists has demonstrated excellence in their practice. Their work drives forward patient care locally, across New South Wales, and beyond,’ he said.
‘With the health needs of our community continuing to grow, it’s important to celebrate innovation, dedication and passion which takes health care to the next level.’
Pharmacist of the Year – Bente Hart MPS
Credentialed pharmacist and community pharmacy owner from Braidwood is an exceptional pharmacist whose leadership, proactive problem-solving, and deep commitment to rural and vulnerable populations has made a lasting impact on both the profession and the community she serves.
Ms Hart has made contributions across Multipurpose Services and Residential Aged Care Homes – supporting medication audits, National Antimicrobial Prescribing Surveys and addressing medication-related quality improvement issues. Her work has strengthened clinical governance and patient safety in rural facilities where such initiatives can be challenging to implement.
Ms Hart delivers targeted education to nursing, medical, and allied health staff to improve medication safety and quality use of medicines, and she has supported pharmacists to transition to updated credentialing requirements for Medication Management Reviews – helping sustain high-quality rural pharmacy services. Ms Hart regularly volunteers her time at local markets, providing health checks, medication advice and health education to community members.
Lifetime Achievement Award – Kate Gray MPS
PSA fifty-year Life Member from Orange, Kate Gray, has been awarded the PSA NSW Lifetime Achievement Award. For over 5 decades, Ms Gray has been committed to advancing pharmacy practice through leadership, mentorship and community service. Her enduring contributions span ownership, governance, education and advocacy, making her a role model and champion for the profession.
Ms Gray earned her Bachelor of Pharmacy and became a registered pharmacist in 1975. She is a proprietor of Peter Smith TerryWhite Chemmart and Orange Compounding Pharmacy. In 2025, Ms Gray received the Pharmacy Guild Life Member Award, marking 44 years of Guild membership. She currently serves on the NSW Pharmacy Council and is in her second elected term.
Early Career Pharmacist of the Year – Mitchell Budden MPS
NSW Early Career Pharmacist of the Year Mitchell Budden is completing a PhD at the University of Newcastle focused on pharmacist prescribing for uncomplicated urinary tract infections in NSW and the ACT, evaluating safety and efficacy outcomes to inform policy and practice. His research has already contributed to shaping expanded scope models that improve patient access and reduce system pressures.
Mr Budden has 8 years’ experience in community pharmacies in regional NSW, which gives him a deep understanding of the realities of frontline pharmacy practice. His clinical expertise and patient-centred approach have informed his leadership in research and policy, ensuring innovations are practical, sustainable and responsive to community needs.
Intern of the Year – Karina Angelucci MPS
As an intern pharmacist, Karina Angelucci has established herself early in her career as a leader in professional services focused on patient care and medicines safety. During her intern year in Balmain, she restructured her pharmacy’s dose administration aid (DAA) service, streamlined processes and grew the patient base by championing the benefits of DAAs to local doctors, carers and patients.
Ms Angelucci has championed vaccination in a community known for not strongly embracing vaccination services. She performed over 1,000 influenza vaccines across her intern year and initiated an outreach vaccination service for local school staff. She also developed a travel health program and point-of-care testing program in the pharmacy.
‘I congratulate all of the award recipients and thank them for their contribution to the profession and to their local communities,’ Mr Kelly said.
[post_title] => PSA NSW Pharmacist Awards winners announced
[post_excerpt] => The PSA NSW Pharmacist Awards award recipients are advancing clinical governance and delivering frontline innovation in pharmacy practice.
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[post_content] => 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.’
[caption id="attachment_31424" align="alignright" width="282"] Kelly Abbott MPS[/caption]
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.”
Reform that matches need with valuePSA’s 2026–27 Federal Budget Submission, released today (25 February) identifies reform of HMRs as a priority under the First Pharmacy Programs Reform Package. Recommendation 1.1 calls for staged removal of monthly provider caps (commencing with an increase to 60 per month), re-basing and applying annual Wage Cost Index indexation to restore service viability, and improved support for rural delivery and complexity. For regions like Gippsland – with high chronic disease burden and limited workforce – these changes are not about expanding scope. They are about restoring access. Read PSA’s full 2026–27 Federal Budget Submission. |
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[post_content] => Morag Horton works alongside clinicians and nurses to ensure seamless IVF medicines supply and patient support.
How did you specialise in assisted reproductive therapy?
In 2013, I purchased a pharmacy involved in IVF and fertility treatment.
At that time, most medicines supply was made by IVF clinics directly to patients, and there was very little pharmacy involvement – other than for non-Medicare funded patients or medicines. I was dispensing medicines I’d never learnt about at university – nor in my career until then.
I struggled to find suitable training material, so I asked questions of IVF clinicians, nurses and pharmaceutical companies whenever the opportunity arose. I came to understand the medicines protocols used and became familiar with all the administration devices. In 2015, funding for the supply of IVF medicines changed to the Pharmaceutical Benefits Scheme (PBS) in the S100 category – meaning all supply now involved a pharmacist. The knowledge that I’d already gained meant I could support patients and their partners, as well as to the IVF clinic team, through and beyond this transition.
What does the role entail?
I help patients process huge amounts of information and complex medicines schedules, and access medicines that may not be available in their local community pharmacy. I also help to reduce or eliminate confusion or issues for patients e.g. insufficient prescribed quantities, missed items or last-minute medicines changes.
How do you help patients navigate their medicines regimen?
Being able to immediately understand the treatment protocol behind a bundle of prescriptions is important. Recognising the individual situation makes the patient feel more comfortable and understood. It also helps me tailor the information provided.
If the patient is anxious about injections and injection technique, I focus on the first item that needs to be used. This helps to ensure they’re not overwhelmed with three or more different products that may require different techniques or devices, and they feel more comfortable before adding in the next injection.
Clear and thorough labelling is also key, with storage information discussed and fridge items provided in a cooler bag with ice. I also provide written information to support verbal and online information, offering further support by telephone.
How do you manage medicines storage, cold-chain and supply?
We’ve increased fridge capacity and back up, built in business continuity planning, and use data loggers on all refrigerators. We also have a dedicated fridge for IVF medicines, as the packaging is bulky and prescriptions can involve large quantities. Ordering is done frequently, with close attention to supplier cut-off times, particularly later in the week.
We carefully balance stock levels, expiry risk and cash flow, while monitoring prescribing patterns and staying in close contact with fertility clinics about upcoming treatment cycles. We also ensure all supporting materials – such as brochures, cooler bags, ice bricks and other consumables – are available.
How do you collaborate with fertility clinics, prescribers and nurses?
In the beginning of my involvement in the IVF field, I asked questions of others with more experience. Now, they often ask me questions. I also encourage clinicians to understand PBS listings and to prescribe in accordance with the criteria.
The IVF clinicians can be hard to reach for prescription queries, so good relationships with IVF nurses and clinic staff are essential. As a member of the Fertility Society of Australia and Fertility Nurses of Australasia, I keep up with the latest information and news, and participate in continuing education events and conferences.
What advice do you have for ECPs keen on specialising in this area?
Build your knowledge and be confident in it, while remaining open-minded and supportive. Fertility treatment can place people under emotional, practical and financial pressure; pharmacists shouldn’t add to that burden.
A Day in the life of Morag Horton, community pharmacy owner, Adelaide, South Australia
| 8.00 am | Set up and check in IVF work fluctuates – some days it’s minimal, other days it’s constant. I check what’s booked/expected, confirm any urgent needs, and make sure there’s space for IVF stock. |
| 9.00 am | Ordering and supply planning Weekly ordering is done on Monday mornings and reviewed again on Wednesday because we can’t reliably order later in the week. This helps to protect continuity. |
| 10:30 am | Dispensary coordination My dispensary manager leads ordering of IVF medicines, support materials and consumables. She also prepares syringe/needle packs for medicines that require separate consumable supply, so patients receive everything together. |
| 12.00 pm | Clinic liaison Phone or email contact with IVF nurses occurs most days to clarify prescriptions, confirm timing and align supply with treatment cycles. |
| 2.00 pm | Prescription collection Our courier collects prescriptions from fertility clinics weekly, as not all clinics use e-scripts. These are processed promptly to avoid delays that could affect treatment timing. |
| 3.30 pm | Patient support IVF supply often includes practical support: ensuring patients have what they need for transport and storage, and that any supporting materials and consumables are ready alongside the medicines. |
| 6.00 pm | Engagement and training Some evenings may include a Fertility Nurses of Australia meeting, or delivering training sessions for fertility clinics for IVF clinicians and nurses. |
| 8.00 pm | Urgent supply Occasionally I’ll get an out-of-hours call from an IVF clinician to arrange emergency medicines supply, requiring rapid coordination to keep treatment on track. |
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