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CMS makes U-turn on large co-payments ban

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The Council for Medical Schemes (CMS) has made a U-turn on its more than two-year process to ban large co-payments for medical scheme members who use service providers outside of a prescribed network, Rapport reports.

The CMS published a notice in June 2017 in the Government Gazette that it plans to declare these co-payments an undesirable business practice in terms of the Medical Schemes Act. However, CMS Registrar Sipho Kabane now says in a circular to medical schemes that the regulator, in concurrence with the Minister of Health, decided to abandon this process. The main complainant that led to the process was the Independent Community Pharmacies Association who said their members and their patients are treated unfairly by exorbitant co-payments for medicines even though they can provide the medicines at the same price as the large pharmacy chains that are part of the medical scheme networks.

Kabane says in his circular the different medical service providers such as doctors and pharmacies have different concerns about co-payments and the medical schemes indicated that co-payments are necessary to curb fraud, waste and abuse. The CMS also conceded that it is “impractical” for medical schemes to appoint every service provider based on a tender process – as the draft notice envisaged.

Rapport report (subscription needed)

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