The public is being called on to have their say about restrictive and punitive closed DSP’s imposed on them by their medical aid scheme in a bid to do away with this unfair practice.
The Independent Community Pharmacy Association (ICPA), has been fighting the practise of closed DSP’s for several years now and has thus far been successful in their challenge to the Council of Medical Schemes (CMS) to do away with closed DSP’s and to also re-look at the way co-payments are calculated, as the current structure does not have the interests of the consumer, or pharmacies, at heart.
How closed DSP’s and penalty co-payment harm you, the consumer
A DSP (Designated Service Provider) is a healthcare provider network (doctor, pharmacist, hospital etc.) appointed by your medical scheme to diagnose, treat or care for their members.
“However many medical aid schemes in South Africa have imposed very restrictive closed DSP’s that effectively deprive medical aid members of choice when it comes to where they can get their medicines from,” explains Jackie Maimin, CEO of the ICPA. “It also means that independent pharmacies are deprived of a source of revenue from medical aid members who are forced to use a DSP. We believe that it should be the case of an open DSP, in other words a willing buyer, willing provider arrangement”.
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 aid’s DSP pharmacy network they will be charge a penalty co-payment.
“Currently it is accepted that if a person chooses not to use the DSP selected by their scheme, they will have to pay a portion of the bill as a co-payment. While we accept that co-payments may be necessary, we are challenging how these co-payments are calculated, as we believe the penalties are too high and some patients can end up paying as much as 40% – 60% of the cost of their chronic medicines out of their own pocket.
“It is in the consumer’s best interest to be able to buy their medicines from the provider of their choice without being charged a penalty.”
Public urged to voice their opinion and share their experiences
The Department of Health and the Council of Medical Schemes (CMS) has now published their intention to declare closed DSP’s and penalty co-payments unfair and irregular and has asked for interested and effected parties to have their say. The ICPA is urging the public to make their opinions known in a bid to do away with closed DSP’s entirely.
“Many South Africans have been inconvenienced – some with dire consequences – by closed DSP’s which force them to get their medicines from only certain pharmacy channels of face penalties. We want to hear all of these stories!” says Jackie Maimin, CEO of the ICPA.
A hard won victory
Several years ago the ICPA challenged the CMS to do away with closed DSP’s and to relook at the way penalty co-payments are calculated. “However, the CMS did not move towards correcting these issues with the medical aid schemes and dismissed our challenge,” explains Maimin. “We therefore lodged an appeal 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.”
The CMS, in concurrence with the Minister of Health, has agreed to declare these as undesirable business practises and have thus published the proposed amendments for commentary.