Villains through clumsiness

In the soap opera of the new transparent medicine pricing system, the latest unforeseen twist is the Pharmacy Council’s list of extra items for which pharmacists can charge over and above a drug’s single exit price, plus dispensing fee.

Pharmacists have made it clear they intend to maintain their earnings by any means possible. With astonishing clumsiness, they have projected themselves to consumers as the money-grubbing villains of the piece, when they were really at the wrong end of a chain of events.

In another unintended consequence, the pharmaceutical companies emerge smelling of roses. Whatever the truth, they look like they took the pain and got on with it.

A key, unintended outcome is that consumers will not benefit from reduced medicine prices. In fact, many will pay more. Medical schemes are unlikely to pay for many extra charges and are likely to pass on charges they absorb to members.

And those most likely to pay are those who can least afford to. Take the poor woman with little English and a baby with diarrhoea. She will ask the pharmacist, who does not speak her language, what to do. He will sell her a drug, and if she is lucky, explain how to mix the rehydration fluid. He will charge the single exit price, the dispensing fee and, depending on the length of his explanation, a rate per five minutes spent.

Most of the problems fall into the medical scheme arena and could have been avoided with some planning. No one, however, spoke to schemes or the Medical Schemes Council — resulting in uncertainty and anxiety among schemes, members and even pharmacists.

By now, most schemes have budgeted for next year and redesigned their benefits; many have already sent proposals to members.

With a single exit price for drugs and set dispensing fee, this should have been easier. Schemes could estimate the cost of treating members with high blood pressure or diabetes. Now, however, they face a range of extra charges.

In their indecent haste to introduce the charge, pharmacists apparently overlooked the fact that schemes will not automatically reimburse for all billed items.

Schemes are legally obliged to pay in full for certain chronic medication — in particular, for 25 diseases gazetted with treatment guidelines. Provided the medication meets the guidelines and comes from an outlet it approves, the scheme must pay in full.

But with other medicines, there is neither a moral nor legal obligation to pay, if they are not covered by the scheme’s rules.

In addition, the Medical Schemes Act requires health service to be “relevant”, while each service is coded so that claims can be processed. Only then is the scheme likely to decide what it will pay for.

Why should a scheme cover extra charges for services not all pharmacies offer? For example, outlets that courier or post medicines probably do not give advice in the same way as pharmacists across the counter.

Pharmacists clearly should have adequate payment for services, and all stakeholders should agree on the amount. It would probably be facilitated, however, if they withdrew their case against the Department of Health .

They should then vote new representatives on to their industry body who will digest relevant policy documents — like African National Congress health policy, which they should have read 10 years ago — and relevant laws like the Medical Schemes Act, so they grasp the obstacles.

And shareholders of larger pharmacies now trying to recover lost profits, like Clicks, should fire executives who decided that despite 10 years of notice in policy documents and legal proposals, the government would not implement its medicines policies.

Pat Sidley is head of communication and education at the Council for Medical Schemes

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