Putting an end to a seven-year saga, the Appeals Board of the Council for Medical Schemes has found in favour of the Independent Community Pharmacy Association of SA. Daily Maverick reports that the Council for Medical Schemes has now been ordered to complete the process of declaring certain medical scheme practices as undesirable.
South Africans lucky enough to be members of a medical scheme are increasingly accustomed to being pushed by their scheme to purchase their medicines from a designated service provider (DSP), often a select group of pharmacies or courier services arbitrarily selected by medical schemes. Daily Maverick reports that if this does not suit members, and they opt to buy from their preferred pharmacy, a punitive co-payment is levied on the medicine, up to 40% in some cases.
This applies particularly to the dispensing of chronic medication – used for the management of long-term illnesses like diabetes, high blood pressure and epilepsy, among others.
In theory, the practice of using DSPs helps the medical scheme manage the cost of chronic medicines dispensed in South Africa and in the process helps to keep a curb on medical inflation, which is out of control in the country. But theory and practice are two different things, and this practice is being challenged and is likely to change following a recent judgment that found in favour of the Independent Community Pharmacy Association (ICPA).
The report says Judge Bernard Ngoepe, who chairs the Appeals Board, supported by two other members of the Board, found that the Council for Medical Schemes’ (CMS), decision to stay the process in terms of section 61 of the Medical Schemes Act was irrational and the process should be continued, and finalised. This is because in the process, other pharmacies, who are able to provide the same medicines at the same price and provide as good or better service, are cut out of the loop, which is financially detrimental to them.
Daily Maverick reports that patients who build up a relationship with their local pharmacist are often forced to obtain their chronic medicines from a different scheme-selected pharmacy, often a courier service, or pay exorbitant penalty co-payments, which is an infringement of their right to choose a healthcare provider and is adversely affecting their care.
[link url="https://www.dailymaverick.co.za/article/2020-07-20-consumers-retain-the-right-to-choose-their-pharmacy/?tl_inbound=1&tl_groups%5B0%5D=80895&tl_period_type=3&utm_medium=email&utm_campaign=Business%20Maverick%20Tuesday%2021%20July%202020%20-%20ENS&utm_content=Business%20Maverick%20Tuesday%2021%20July%202020%20-%20ENS+CID_649fc52b5bbc8b9acbff2daa2026d713&utm_source=TouchBasePro&utm_term=Consumers%20retain%20the%20right%20to%20choose%20their%20pharmacy#gsc.tab=0"]Full Daily Maverick report[/link]
[link url="https://www.medicalbrief.co.za/wp-admin/post.php?post=111315&action=edit"]Full appeal judgment[/link]