The Independent Community Pharmacy Association (‘ICPA’), a body which represents the interests of independent community pharmacies across South Africa, has won its appeal against the Council for Medical Schemes (CMS).
The ICPA has been involved in an ongoing fight for over 5 years against unfair business practices on the part of medical schemes. ICPA challenged the CMS to do away with closed DSP’s and penalty co-payment, as the current structure does not have the interests of the consumer at heart, denying them freedom of choice and hurting their pockets.
“However, the CMS did not move towards correcting these issues with the medical schemes but rather dismissed our challenge”, explains Mogologolo Phasha, chairman of the ICPA. “We therefore lodged an appeal with the Appeal Board, chaired by Judge B M Ngoepe, against the CMS and were successful – thus forcing the Registrar of the CMS to consider having the begrudged practices of closed DSP’s and penalty co-payments declared an undesirable business practice.”
“To further support our cause, the ICPA launched a petition early in 2016 which disputes the practices of closed DSP’s and penalty co-payments. This petition, which is available on the petition website www.avaaz.org (Link: httpCape Times 1 July 2016://bit.ly/1XfaKpV) now becomes very important evidential material in the case as it develops.”
ICPA’s appeal is to encourage medical scheme member to have their say and sign the petition. The beneficiary should have the right to frequent a community pharmacy of their choice without incurring a penalty co-payment.
We believe that DSP’s should be open to all Pharmacies and Healthcare Providers to join on a willing provider arrangement. This will reduce out-of-pocket patient costs, improve adherence to medicines and improve patient care and outcomes.
Notes:The ICPA explain the situation behind closed DSP’s and penalty co-payments:
Closed DSP’s
A Designated Service Provider (DSP) is an appointed healthcare provider (doctor, pharmacist, hospital etc.) by your medical scheme to diagnose, treat or care for Prescribed Minimum Benefit (PMB) conditions of their members.
However, according to the ICPA, medical aid schemes are able to decide who their preferred provider is and usually do not enter into any consultation with their members or the industry at large, and importantly, they often exclude independent community pharmacies from these DSP arrangements.
“This effectively deprives medical scheme aid members of choice when it comes to where they can get their medicines from,” says Phasha. “It also means that independent pharmacies are deprived of a source of revenue from medical scheme aid members who are forced to use a DSP. We believe that DSP’s should at all times be open for other Pharmacies and Healthcare Providers to join if they wish to, in other words a willing provider arrangement.
Certain medical aids, have chosen not to contract provider networks giving their members the freedom to choose their own Community Pharmacy.
Penalty co-payments
Coupled with the issue of closed DSP’s limiting a consumer’s choice, is the fact that if people choose to get their chronic medicines from a provider outside their medical scheme aid DSP pharmacy network they will be charged a penalty co-payment.
Currently, if a person chooses not to use the DSP selected by their scheme, without consulting them, they will have to pay a portion of the bill as a penalty co-payment.
This means that a consumer can end up paying in some cases 30% – 60% of the cost of their chronic medicines out of their own pocket.
“In the end the consumer is inconvenienced because they may use their local pharmacy for their acute medicine but have to use another supplier for their chronic medicines or otherwise they face high financial penalty co-payments. –It’s an unfair system,” comments Phasha.
“We would like the Council for Medical Schemes to address this undesirable business practice soonest,” says Phasha. “It is in the consumer’s best interest to be able to receive their medicines from the provider of their choice without being charged a penalty.”
Consumers also need to be aware that it is not their local independent pharmacy that is charging this penalty co-payment but rather it is the medical aid scheme that they belong to that implements these draconian rules.
About the ICPA
ICPA (Independent Community Pharmacy Association) is an organization which provides independent community pharmacies with a collective strength and a coherent voice that is heard by government, medical schemes, pharmaceutical suppliers and importantly, the consumer.
ICPA represents the largest pool of professionals in the healthcare sector with over 1 100 pharmacies, about 2 500 pharmacists and 20 000 supportive healthcare personnel spread across metropolitan, urban and rural South Africa.
The objective of ICPA is to assist and support its members in securing a sustainable and successful future as independent, owner-managed pharmacies. In addition to this, the ICPA strives to foster an understanding of the role that independent pharmacies can (and do) play in delivering important healthcare services to the communities that they serve.
All ICPA members are committed to high quality pharmacist care and to the restoration and maintenance of the health and well-being of the consumer – the lifeblood of all pharmacies.
Each clients’ goals
Issued on behalf of ICPA by Catalyst Communications:
Contact: Catherine Pate 082 922 1737 / pate@mailzone.co.za