The Sax Institute Report

Community pharmacist prescribing outcomes in Australia and beyond

The Sax Institute Report

Community pharmacist prescribing outcomes in Australia and beyond

The RACGP commissioned an independent evidence review to examine the evidence for independent pharmacist prescribing.

The Sax Institute brokered the report written by Leeder Centre for Health Policy, Economics and Data (University of Sydney).

The report found that evidence has not kept pace with policy. Across Australia, states and territories have announced or commenced pharmacist prescribing for around 20 common and minor conditions, yet only a small number of conditions had been formally evaluated at the time of the review.

For many conditions, no Australian evaluation was identified, no report was publicly available, or the evaluation status was unclear. Where international evidence was available, it was often limited and, in some cases, reported only the number of prescriptions supplied rather than clinical, safety or health system outcomes.

What the report found

Australian evidence

The following tables are an RACGP overview of the available evaluation identified in the Sax Institute Report.

Table 1: Published Australian evaluations for community pharmacist prescribing programs by jurisdiction
Jurisdiction Published evaluation evidence identified by this review
QLD UTI pilot evaluation only
(published evaluation available; no published evaluations identified for other prescribing conditions)
VIC Pilot evaluation for UTI, oral contraception and selected skin conditions
(published evaluation available; evaluation status unclear for additional conditions)
NSW/ACT UTI and oral contraception evaluation became available after completion of this review and was not included in the evidence synthesis
SA No published evaluation identified
WA No published evaluation identified
TAS No published evaluation identified
NT No published evaluation identified

Australian and international evidence

Table 2: Overview of the evidence base for pharmacist prescribing conditions
Metric Count High quality evidence
Common/minor conditions reviewed 19 0
Chronic conditions reviewed 3 0
Other conditions reviewed 7 1**
Conditions with Australian evaluation evidence 5* 0
Conditions with international evaluation evidence 12 1**
Conditions with any clinical outcomes reported 2 0
Conditions with any safety outcomes reported 2 0
Conditions with any economic outcomes reported 3 0

*Includes NSW conditions where evaluation activity was identified but no public report was available at the time of the review.

** 1 RCT (Sandhu et al. 2024) for atrial fibrillation. This was the only Level II study identified. It was a collaborative model, reported improved guideline-concordant anticoagulant prescribing, , but limited safety outcomes, no significant differences in ED visits or hospitalisations and no clinical or health service outcome reported

Table 3: Evaluation evidence by condition and prescribing model

Evidence level key
● No clinical outcomes — limited evaluation evidence (prescription counts, service activity, process measures, limited quantitative outcomes or unpublished evaluations)
● Low quality evidence — some evaluation evidence (clinical, safety, health service and/or economic outcomes reported), not considered high quality evidence
✕ No evidence identified for this condition
Condition AusTRALIAN EvalUATION IntERNATIONAL EvalUATION
Mild plaque psoriasis No clinical outcomes ✕
Minor wound management ✕ ✕
Nausea and vomiting ✕ ✕
Otitis externa (swimmer’s ear) ✕ ✕
Otitis media (middle ear infection) ✕ ✕
Allergic/non-allergic rhinitis ✕ No clinical outcomes
Eczema No clinical outcomes ✕
GORD (acid reflux) ✕ No clinical outcomes
Herpes zoster (shingles) ✕ No clinical outcomes
Hormonal contraception No clinical outcomes No clinical outcomes
Impetigo No clinical outcomes ✕
Overweight/obesity management ✕ ✕
Musculoskeletal pain/inflammation ✕ ✕
Acne ✕ ✕
Atopic dermatitis No clinical outcomes No clinical outcomes
Smoking cessation ✕ No clinical outcomes
Asthma ✕ No clinical outcomes
COPD ✕ No clinical outcomes
CVD risk reduction ✕ Low quality evidence
Atrial fibrillation ✕ 1 small RCT (Level II)
Conjunctivitis ✕ Low quality evidence
Lyme disease prophylaxis ✕ No clinical outcomes
Opioid-related conditions ✕ No clinical outcomes
Urinary tract infection Low quality evidence Low quality evidence
URTI ✕ Low quality evidence

RACGP position

The RACGP supports improving patient access to care, but prescribing reforms must be based on clear evidence that they are safe, effective and do not fragment care.

Governments should not expand pharmacist prescribing across additional conditions without demonstrating positive outcomes through high quality evidence.

Patient safety, continuity of care and evidence-based prescribing must come before convenience.

Full report
Community pharmacist prescribing: outcomes in Australia
Sax Institute — Evidence Check
Read report

Pharmacy Guild's response to the Sax Institute report

Following the publication of the Sax Institute report on 6 July 2026, the Pharmacy Guild of Australia ("the Guild") released a referenced media response challenging the report's findings. As an organisation committed to evidence-based healthcare, the RACGP reviewed the references cited in the Guild's response.

A link to our analysis is below.

Guild response
Pharmacy Guild Responses to the Sax Institute Report
racgp.org.au
Read our findings