In a battle spanning several years, the Independent Community Pharmacy Association (ICPA) has challenged the Council for Medical Schemes to do away with closed designated service providers and penalty co-payments, which they believed didn’t have the interests of the patients and pharmacies at heart, reports The Sunday Independent.
ICPA represents a pool of more than 1,100 pharmacies, about 2,500 pharmacists and 20,000 supportive healthcare personnel spread across the country.
The report says the Council for Medical Schemes, via Board Notice 435 of 2017, recently invited the public to make written representations concerning their intention to declare certain practices by medical schemes in selecting designated service providers and imposing excessive co-payments on members as irregular or undesirable practices. Submissions have now closed.
A designated service provider is a healthcare provider network (doctor, pharmacist, hospital) appointed by medical schemes to diagnose, treat or care for their members.
“The ICPA believes that this practice violates the constitutional right of medical scheme members to choose where they wish to have their medicines dispensed, to choose which doctors they wish to consult, and to choose to which hospital they would like to be admitted.
“This is an opportunity to stop this undesirable practice and everyone had until the end of June to make comment to the Council for Medical Schemes and the Minister of Health,” Jackie Maimin, the ICPA CEO, said. “Many South Africans have been inconvenienced by closed designated service providers, which force them to get their medicines only from certain pharmacy channels or face penalties.”
Maimin said in the report that by imposing the “very restrictive” closed designated service providers, medical schemes were effectively depriving their members of the choice as to where they could get their medicines.
“Coupled with the issue of closed designated service providers is the fact that if people choose to get their PMB chronic medicines from a non-designated service provider pharmacy, they will be charged a hefty penalty co-payment.
"While we accept that some co-payments may be necessary, we are challenging how these co-payments are calculated, as we believe the penalties are too high and often patients end up paying as much as 40% to 100% of the cost of their medicines out of their own pocket.
"It is also critical that a patient’s history of medicine taking, acute or chronic, is managed in a single environment to avoid the possibility of dangerous drug interactions.”
[link url="http://www.iol.co.za/news/south-africa/anger-over-medicines-supply-scheme-10095890"]The Sunday Independent[/link]