One evening, a friend and I entered a local pharmacy. I handed a PBS prescription for “Oestradiol Valerate 2mg Tablets” (brand name: Progynova) [a Hormone Replacement Therapy (HRT) medication often used as part of medical gender affirmation] to one of the pharmacists on duty. After several minutes, a different pharmacist (self-identified as the “supervising pharmacist”) called me to the counter and told me that she could not fulfil my prescription under PBS because she “assumes the doctor had prescribed it for an off-label use”, and according to her, fulfilling the prescription would constitute “PBS fraud”.
She said I would need to pay the full non-PBS price for the medication. I asked her how this could be the case when my specialist who often prescribes this medication for patients had assured me it was covered by PBS, and her response was that Progynova is only available on PBS for treating “some conditions”.
When I asked the supervising pharmacist to print a list of these conditions, she spent several minutes typing on a computer before showing me a printed A4 page briefly listing various conditions (I recall seeing “oestrogen deficiency” and “hormone replacement therapy” listed). The page did not appear to be a Consumer Medicine Information print-out, nor an official page from the PBS website – it resembled a blank Word document with a couple of sentences typed or pasted in.
I again asked the supervising pharmacist why I was not eligible to receive Progynova on PBS, pointing to “hormone replacement therapy” on her list, and she said “this medication is prescribed for women”, to which I responded “yes, I know” and asked again why she thought I was not eligible, pointing out that neither my prescription, Medicare card, nor Healthcare Card contained any gender marker. She said that I was not eligible “based on your name” but that she would “phone PBS tomorrow” to clarify, and I could come in later to get a refund if necessary.
At the time I had not yet changed my legal name from the masculine name I was assigned at birth, but I was wearing a dress and presenting unambiguously femininely. After paying the full (non-PBS) price, I left the store in tears. I felt humiliated, dehumanised, and suicidal. Other customers waiting for prescriptions overheard the exchange with the supervising pharmacist and were staring at me as I walked out, adding to the sense of humiliation.
The prejudice displayed by the supervising pharmacist in her actions (presumably on the basis that I am transgender), indicated a lack of proper pharmacy training, poor understanding of the PBS rules, little to no understanding of gender identity, and negligence in conduct of her professional role. Furthermore, her actions appeared to be in violation of the Australian Government Sex Discrimination Act 1984.
The following morning, I called the PBS information line to inquire about the rules, and was informed that the supervising pharmacist’s actions were “illegal” (i.e. refusing to fulfil a PBS prescription under PBS). That afternoon, she called to say she was wrong, and that I could return to the store to collect a partial refund, but I cannot bring myself to re-enter that store due to the trauma I experienced.
Although I filed a formal complaint about this incident with the relevant government body, they informed me in their decision letter that they “agreed to take no further action”.
Until the supervising pharmacist has undergone proper training on PBS rules and discrimination, I firmly believe that her continued practice as a registered pharmacist is a detriment to the community.
Pharmacists need to undergo training on gender identity and anti-discrimination laws, and pharmacy recruitment processes reviewed to avoid hiring pharmacists with insufficient training or knowledge of PBS rules.