The 19th edition of the Mediscor Medicines Review has just been released, detailing an analysis of the Mediscor medical scheme population, showed that during COVID medicine adherence had decreased, resulting in poor clinical outcomes.
Highlights of the 2020 review included an increase in medicine expenditure of 2.9% per beneficiary in 2020, up from 2.4% in the previous year. This is as a result of a 4.9% increase in item cost but 2% decrease in utilisation.
The top five Chronic Diseases (CDL)
Responsible for 60.6% of CDL costs and 70.5% of item volume, these were hypertension; diabetes mellitus type 2; HIV/Aids; hyperlipidaemia and bipolar mood disorder (this replaced asthma in 2020). A concern during COVID was medicine adherence decreasing, resulting in poor clinical outcomes, however 68.7% of chronic patients had a medicine adherence of 80% or more, up from 66.7% of patients in 2019.
Dispensing doctors versus courier
Claims from dispensing doctors decreased to 12.6% (15% in 2019), with an opposing increase in claims from courier pharmacies. Rationale could be the avoidance of doctors’ rooms and pharmacy groups delivering directly to members.
Speciality medicines
Increased by 10.4%, due to increased utilisation at a cost of R68,949 per patient per annum (used by 51 patients per 10,000 lives). Biosimilars would have been 23.3% cheaper than their originators.
The patient experience
Providers charged 1% above scheme rates and benefit design co-payments were 6.2%. Both indices improved from 2019 and 2018.
Single Exit Price Adjustment (SEPA)
The main factor in per item cost change. Maximum SEPA allowed for 2020 was 4.53%. A basket of medicines (all schedules), increased by 2.4%. Schedules 1 to 8 increased by 2.1%, while unscheduled and schedule 0 by 6.1%, making up 6.3% of the basket.
Why the high item cost increase?
A volume shift from acute to chronic medicines was noted, coinciding with COVID-19 lockdown restrictions and the first and second waves of the pandemic. Movement restrictions but also a reluctance to see the GP for minor ailments and fewer seasonal infections circulating, caused this claiming shift. This also caused a notable OTC claims spike.
Generic utilisation
Increased from 62.7% in 2019 to 63.2% in 2020. Generic uptake also increased to 81.1%, a positive index, reflecting availability and adoption of generics.
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