Implementation of NHI in jeopardy as Medical Scheme network practices threaten Independent Community Pharmacies and Patient Care countrywide.
Independent community pharmacies are under imminent threat of closure countrywide, due to changes in the dispensing fees structures and increasing pressure from medical aid schemes on members to transfer their prescriptions from independent community pharmacies to corporate and courier pharmacies, which has left many of these community pharmacies in a position where they are unable to continue operating as viable businesses.
“The squeeze is on privately owned pharmacies,” says Mogologolo Phasha, Chairman of the Independent Community Pharmacy Association (ICPA), who goes on to state that the ICPA has launched a petition on the petition website www.avaaz.org (Link: http://bit.ly/1XfaKpV). The petition is also available at participating independent community pharmacies and will be served on the Department of Health calling for changes to the legislation that allows for unfair business practices, which are harming community pharmacies and patients.
The ICPA explains that one of the main reasons that community pharmacies are under threat, is closed DSP’s (Designated Service Provider’s), whereby medical aid schemes decide who your service provider is and often exclude independent community pharmacies from these arrangements. “Closed DSP’s limit the patient’s choice and imposes large penalty co-payments on the consumer even if the pharmacy charges the same rate as that of the DSP,” says Phasha. We call on the Minister of Health and the Registrar of Council for Medical Schemes (CMS) to investigate how medical schemes appoint their DSP’s.
While we accept that co-payments may be necessary to ensure rational drug use, which protects schemes from paying for inappropriate medicines, we challenge the penalty co-payment that is imposed to use pharmacies outside the DSP arrangements. “It is important to recognise that it is not the independent pharmacy charging the medical scheme or patient more, but the medical scheme charging a penalty co-payment,” says Phasha.
ICPA believes that closed DSP’s and penalty co-payments infringe on the rights of the patient to patient care. In addition, medical schemes continue to collaborate with big business rather than the Governments imperative of support for SMME. At this point we are calling on the Department of Small Business Development to take note and realise that Independent Community Pharmacy is an integral part of their key mandate, to support and ensure that Small Businesses and SMME’s thrive in South Africa. Community Pharmacies provide training and skilled jobs to many South Africans.
We therefore call on Minister Lindiwe Zulu to intervene urgently. According to the ICPA, in addition to a lack of access to medicines, the closure of independent community pharmacies results in widespread job losses as is evident in the 700 closures of pharmacies since 2003. This goes against government’s intention to create 5 million jobs by 2020. Independent community pharmacies are responsible for the creation of more than 20 000 jobs, mostly within the communities they are located in. “Medical schemes’ bully tactics force patients to go to specific corporate pharmacies or use courier services. This practice negatively impacts the independent pharmacy which contributes to a downfall of an essential community pharmacy service. It ultimately denies the patient choice, comments Phasha. “I believe this practice is unfair to both the consumer and the independent community pharmacies.”
“If 2000 independent community pharmacies shut shop South Africans will have to reach the superstores to get their medicines. In a country where many people do not have access to transport or the funds to pay for such transport to get them to major centres this is an unrealistic expectation and will mean many people in outlying and rural areas will be left without options and without medicines,” says Phasha. Community pharmacies also service about 30% of public sector patients with minor ailments and often with their chronic medicine. “We will not lie down and be trampled. We are aware that the medical scheme member would like to support their own pharmacy. If you pay private medical scheme contributions, you should be able to visit a health care professional of your choice. It has been reported that as a result of Medical Scheme Provider Networks, out of pocket payments incurred by members rose by 11.9% to R20.7 billion in 2014.
The question then arises why member’s contributions still continue to increase astronomically, year on year, since the medical schemes claim they are trying making healthcare more affordable? How do medical schemes justify a member paying a premium contribution and still being “forced” into the DSP or to use generic medicine, otherwise incur a co-payment? What happened to the money the scheme “saved” through these draconian practices? In a bid to also protect community pharmacies, the ICPA is currently challenging the Council of Medical Schemes (CMS) to do away with closed DSP’s, and to also remove penalty co-payments. “We have over the past two years addressed this issue with both the CMS and the National Department of Health (NDOH). While the NDOH clearly has the same interpretation as ICPA, the CMS has not moved to correct the issue with the schemes.
The ICPA is therefore calling on consumers to sign this vitally important petition online or at their nearest participating independent community pharmacy. “The aim is to receive one hundred thousand signatories and petition the Department of Health and the Council for Medical Schemes to pronounce on this legislation. We will further seek redress in the courts to challenge this inequitable business practice.” In the face of the Government’s National Health Insurance plan, that intends to provide everyone in South Africa with access to quality health services, it is imperative that local health infrastructures such as independent community pharmacy is protected to ensure ease of access to quality medicines and pharmaceutical services in the future.
“Given the current problems associated with the already overburdened state health facilities, independent community pharmacies will continue to play an important role in the South African healthcare system going forward, especially with the advent of NHI fast approaching. However – in the face of these external pressures community pharmacies face their ultimate demise, unless things change soon. Medical aid schemes are quick to justify the savings for members and medical scheme, but at what long term cost to the South African healthcare system?” says Phasha.