The Medical Council of Thailand has filed a lawsuit in the Administrative Court against the National Health Security Office (NHSO) and the Pharmacy Council of Thailand over a new initiative which would allow those covered by the Universal Coverage Scheme (UCS) to get free medication for common illnesses from pharmacies.

A pharmacy participating in the initiative with an NHSO "quality pharmacy" label at the door.

The initiative allows people covered by the UCS to get free consultation and medication from registered pharmacies for 32 minor conditions. The list included headache, nausea, fever, cough, joint pain, and stomach ache.

The initiative is designed to reduce the workload of doctors at public hospitals and increase access to healthcare for patients with minor conditions, NHSO Secretary-General Dr Jadet Thammathat-aree told Matichon Online. He explained that people with minor illnesses are already buying their medication from pharmacies, and the initiative would mean that their expenses will be covered by the NHSO. Pharmacies participating in the initiative are to follow up on patients and refer them to their primary care provider if their condition does not improve within 3 days.

Dr Jadet did not comment on the lawsuit. He said, however, that the NHSO is moving forward with the initiative until there is a verdict.

Meanwhile, the Pharmacy Council issued a statement insisting that pharmacists put their patients’ safety first and refer patients to doctors if their condition is something that needs a doctor’s attention. Every pharmacy participating in the initiative has been vetted, said the statement, noting that the medications to be distributed under the initiative are non-prescription drugs under the Drug Act. Pharmacists are also required to question patients on their medical history, including pre-existing conditions and allergies, to ensure that their condition is indeed minor and so they can safely use the medications.

The statement noted that at least 1.74 million people have visited a pharmacy and received medication under this initiative, which helps reduce overcrowding at hospitals and expenses for patients. Most people who received medications from a pharmacy improved, said the statement, while around 1.57% were referred to a doctor.

The Administrative Court originally dismissed the lawsuit on the grounds that it needed to be filed within 90 days after the policy was implemented. The Medical Council then appealed to the Supreme Administrative Court on the grounds that the lawsuit was filed to protect public interest and so there is no time limit. The Supreme Administrative Court ruled in favour of the Medical Council and accepted the lawsuit.

The Medical Council issued a statement on Tuesday (19 November) saying that it had sued the NHSO and the Pharmacy Council so that the two organizations would “stop and rethink” their policy in the name of public safety after discussions between the Medical Council, the NHSO, and the Pharmacy Council were not successful. The Medical Council believes that allowing pharmacists to diagnose and prescribe medication would endanger patients, since minor symptoms can also be the beginning of a serious illness and not being seen by a doctor could delay proper treatment. It is also not a pharmacist’s job to conduct physical examinations or order tests, said the statement, which claims that the NHSO and the Pharmacy Council did not exclude severe conditions from minor conditions for which a pharmacist can safely prescribe medications.

In response, the Pharmacy Council issue another statement noting that pharmacists participating in the initiative follow guidelines designed to keep patients safe and that there has been no case of serious complications or death since the initiative was launched on 31 October 2022.

The statement said that according to their professional standards, pharmacists always take a patient’s medical history before prescribing medication. This is also in line with the Drug Act and the Medical Profession Act. It then claimed that a number of Medical Council board members posted on social media that the lawsuit is not about stopping pharmacists from prescribing medications, which could mean that the Medical Council has no problem with people buying medications, leading to questions whether the lawsuit is really about public safety.

The Pharmacy Council reiterates that pharmacists are required to conduct initial screening and refer patients at risk of a major condition to a doctor. They are also required to follow up on patients to ensure that their condition has improved. The initiative therefore acts as a screening procedure to reduce the workload for doctors, allowing them to spend more time with patients suffering from more complicated conditions.

The Pharmacy Council asks the Medical Council to pay attention to drug safety problems in the entire system, including that of clinics prescribing medications with information missing from the labels, which makes investigation difficult in cases of complications.

Somsak Thepsuthin, Minister of Public Health, has proposed that a joint committee be formed between the Medical Council and the NHSO to come up with a list of conditions for which pharmacists in the initiative are allowed to prescribe medications.

Somsak said that he previously met with representatives of the Medical Council to discuss possible solutions, and that the representatives agree that the initiative is useful in reducing overcrowding in hospitals and makes it easier for the public to receive care. However, they said they were concerned about medications prescribed for some conditions without a diagnosis from a doctor.