MEDICAL aid schemes have threatened to delete drugs from the lists of medicines they will cover for members unless pharmaceutical companies pay them substantial kickbacks, according to a report in The Star newspaper.
Doctors will also be encouraged to get in on the act, with financial rewards for those who prescribe the drugs on the list, said The Star. Health industry sources have warned that this could have serious repercussions for patients, with doctors prescribing drugs with financial targets rather than a patient’s best interests in mind.
Medscheme, which administers medical schemes for at least two million people, has told drug manufacturers that they will soon be asked to “tender a percentage rebate”. Drugs that are not categorised as “cost-effective” in terms of this initiative will be “disincentivised” by medical schemes and they will refuse to cover part of, or the full cost, of the drug for a member, The Star said.
Earlier this week, the Cape Times reported that hundreds of doctors were receiving money directly and indirectly for prescribing drugs. Millions of rands are involved.
Even doctors who send their patients to a pharmacy for medicines benefit through organised buying groups of doctors who compile records of the amounts of specific drugs they sell. Doctors can earn more than 50% of the amount that patients pay for the drugs they have been prescribed, according to The Star?s report.
Moves are also afoot by medical schemes to grade doctors according to their cost-effectiveness for medical schemes. This has sparked fears that patients could be “under-serviced” by doctors who would be paid higher consultation fees, depending on how they rate in terms of the drugs they prescribe.
Following the Cape Times report, the SA Medical and Dental Professional Board said that it would investigate the “cost-cutting” practices that were in place and the proposals, as there were fears that these “could influence a doctor’s judgment in the wrong way”.
Mike Noeth, of Medscheme, told The Star that his organisation’s main aim was to keep costs to a minimum. Ethical issues were a matter for the SA Medical and Dental Professional Board.
Noeth said the “mechanisms” in the market place meant doctors were being rewarded for prescribing certain drugs, “although they don’t dispense”. The proposed “performance-based re-imbursement” incentive was intended to change the emphasis.
Medical schemes and doctors were “enthusiastic” about the proposals, Noeth told The Star.