‘Unethical’ for GPs to charge to prescribe Covid antivirals, Australian charity says

Failing to bulk bill pensioners who require life-saving Covid-19 antivirals is "morally bankrupt" and "unethical", the head of the national peak body for older Australians has said.

The Council on the Ageing chief executive, Ian Yates, said as growing numbers of general practitioners stop bulk billing, citing rising costs and low Medicare rebates, he is hearing "more and more examples of pensioners not being bulk-billed, especially people with the seniors healthcare card."

"This is a major issue which the government needs to address," he said.

In response to Guardian Australia's series on the decline of bulk billing, more than 300 readers wrote in to describe the challenge of accessing affordable healthcare.

Seventy-year-old pensioner Chris Sitka, who lives in Melbourne's northern suburbs, said she "begged" her GP to bulk bill her when she caught Covid-19 and needed a script for antivirals.

While those aged 70 and older do not have to pay for the drugs, they may have to pay for the appointment. These appointments are often longer than a standard 20-minute consult because the antivirals can interact with other drugs, making it necessary to obtain a comprehensive medical history before prescribing.

"[After] being diagnosed with Covid as an older person you are in a fairly anxious frame of mind to have to be asking whether the doctor will bulk bill you," Sitka told Guardian Australia. "You have to be fairly assertive or desperate."

The pensioner said she worries for her friends who are in more difficult situations.

"I have older friends who live on the pension paying rent, and to suddenly discover they have to pay $45 [for an appointment], some people may have made the decision to not get the antiviral and take their chances," Sitka said.

"If you're financially strapped you will wait until you're very sick before you go and pay that money and basically that will be a life-shortening thing. If you let things go they'll get worse and basically you see that your life expectancy will decline."

Sitka said it is "frightening" to feel as if the "health system is collapsing around you" while entering old age, especially as she has no children to advocate on her behalf.

Yates said no pensioner should need to beg to be bulk billed for a life-saving treatment. If GPs charge patients for an appointment to access antivirals "I think that is appalling and unethical," he said.

"These antivirals have been shown to significantly reduce the risk of death and severe symptoms. To place that at risk for a $40 copayment is morally bankrupt, unethical and should be publicly called out. I also think it should be treated as a breach of professional standards."

GP and president of the Royal Australian College of General Practitioners, Adj Prof Karen Price, said Yates's comments "are unhelpful and sadly reflect upon why we have a workforce shortage, when such a complex issue as healthcare funding is reduced to a simple issue of blame".

"Mr Yates is sadly falling into the common trap of blaming GPs for years of underfunding by the commonwealth," she said. "I am surprised he has done so given his own sector in aged care has suffered the same fate, which resulted in a royal commission showing decades of poor policy, cost cutting and failing standards.

Price said GPs are doing their best to run practices amid rising costs and inadequate Medicare rebates.

"Each GP has to make difficult billing decisions based on their individual circumstances. The college would be more than willing to meet with Mr Yates and talk through the pressures being faced by GPs and general practice teams across Australia. But now is not the time to criticise GPs or threaten them with expulsion or any other punishment."

Asked if all GPs should be required to bulk bill patients needing antivirals, given it is vulnerable people who are eligible for them, the Australian Medical Association vice-president and Sydney GP, Dr Danielle McMullin, said: "GPs do everything we can to make sure that our vulnerable patients in particular don't have cost barriers to access."

"But GPs have been required throughout this pandemic to repeatedly put their hands into the pockets of their businesses to keep their practices running," she said.

"There were a number of occasions where for vaccines we are required to bulk bill, for a long time for telephone consults we were required to bulk bill, and it's an unsustainable plan to constantly require and to force general practitioners to discount their services."

She said patients concerned about the price of an appointment should discuss it with their GP.

"It is challenging to have to have a conversation about money with your doctor, but if finances are a barrier, then do talk to your GP and sometimes on a case-by-case basis bulk billing can be discussed. GPs really do want to help."

RACGP vice-president and GP, Dr Bruce Willett, said while pharmacist groups may point to the cost of GP consultations as a reason why Covid-19 antiviral treatments should be available from community pharmacies without a prescription, this would be "a recipe for disaster".

"Covid-19 oral antiviral treatments are not without risk," he said. "GPs are the key to safely prescribing these treatments to all patients. We have a strong and, in many cases, longstanding connection with our patients and we know their health history, including existing health conditions or other factors which may impact their eligibility for the treatments."