CMS backs patients’ rights to independent healthcare providers

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The Council for Medical Schemes has banned the imposition of excessive co-payments on patients who choose health-care providers outside the designated service providers (DSPs) chosen by their medical schemes, reports BusinessLIVE.

While the move has implications across the private health-care sector, it will bring particular relief to independent pharmacies shut out of these networks. Medical schemes have used DSPs to help manage costs, but have drawn criticism for steering patients to courier and retail pharmacy chains at the expense of independent pharmacies.

Some schemes have also drawn fire for levying stiff penalties of up to 40% of the total cost of a prescription on members who opt to use pharmacies that do not belong to a DSP, according to the Independent Community Pharmacy Association.

In a Government Gazette notice on April 23, the CMS declared two business practices as undesirable in terms of the Medical Schemes Act. With immediate effect, it bans schemes from levying penalties greater than the difference between the rate charged by a health-care provider belonging to their approved network and one that does not. It also prohibits the appointment of a DSP without engaging in a procurement process that is “fair, equitable, transparent, competitive and cost-effective”.

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