Pharmacy goes the distance for patients’ RIGHT TO CHOOSE!

Media Statement from the Independent Community Pharmacy Association of South Africa (ICPA): Pharmacy goes the distance for patients’ right to choose!


On the 23rd April 2021, the Council for Medical Schemes (“CMS”) published a landmark notice which declares certain practices by medical schemes in selecting designated health care providers and imposing excessive co-payments on members as irregular and/or undesirable practices by the medical schemes.

The Independent Community Pharmacy Association (“ICPA”) has been fighting these practices for nearly a decade. The dispute with CMS, but more specifically the medical schemes practices, dates back to before 2013. ICPA’s unwavering fight for patient rights led to successfully launching and winning two appeal processes against the statutory council, which ultimately resulted in the publication of this declaration.

ICPA contended that certain medical schemes select Designated Service Providers (DSPs) in a non-transparent and discriminatory manner without considering applications to join the network from all interested service providers. Further these schemes then effectively coerce their members to utilise these DSPs or face punitive co-payments. In some instances, vulnerable patients with complex treatment regimens are forced to utilise a single pharmacy courier service for all their chronic medicines. This can be disastrous for a diabetic patient who may require an emergency change in their insulin prescription only to be told that a Service Level Agreement (SLA) between the scheme and the DSP gives the courier pharmacy 7 days to deliver the new medication. If these patients try to obtain the medicine from their usual pharmacy, they are faced with a 20 to 40% penalty co-payment! “It is a very sad day when service level agreements override patient care!” says Jackie Maimin, CEO of ICPA.

“We received many complaints from patients who are forced to utilise courier services when they would actually prefer to use their local pharmacy to collect their chronic medicines,” says Maimin. “It has been these cries for help that kept us going during this marathon dispute with CMS and the schemes.”

According to legal services at CMS, the declaration is for immediate implementation. This means that a patient may select a pharmacy, medical practitioner or hospital of their choice and will no longer attract a percentage penalty co-pay. The only co-payment the scheme may charge is the difference in the amount between what the DSP would charge and that which the non-DSP charges. Effectively, if a non-DSP matches the DSP charges, there will be NO co-payment.

“This is a victory for the independent community pharmacy and the medical industry as a whole, which for so long have been marginalised by these closed DSP arrangements, but more importantly it is a victory for patient rights. The right of the patient to select his or her pharmacy or doctor of choice,” says Maimin.

The publication of the declaration empowers the pharmacist who can now provide comprehensive pharmaceutical care – previously pharmaceutical care was disjointed with chronic medicines often being delivered by a DSP courier service while acute and over-the-counter medicines were obtained at the local pharmacy. “This represents a nightmare for a dispensing pharmacist who does not have a view of all prescribed medication and yet must advise the patient of any potential interactions or adverse drug reactions” Maimin added.

ICPA advises all medical scheme members to take back control of their health and select healthcare providers that give individualised quality healthcare services.

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