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

Subscribe to the M&G

These are unprecedented times, and the role of media to tell and record the story of South Africa as it develops is more important than ever.

The Mail & Guardian is a proud news publisher with roots stretching back 35 years, and we’ve survived right from day one thanks to the support of readers who value fiercely independent journalism that is beholden to no-one. To help us continue for another 35 future years with the same proud values, please consider taking out a subscription.

Related stories

Coming to a friendly chemist near you

The last scuffle over the Medicines and Related Substances Act saw the health department announce a ­complex four-tier dispensing fee for pharmacists. This was intended to satisfy the requirement of the Constitutional Court, which last year ordered that an "appropriate" fee be drawn up for the purpose.

Profit is the only prognosis

The health care industry is increasingly coming under the beady eye of the Competition Commission and Competition Tribunal. The Council for Medical Schemes recently referred a commercial venture involving doctors in the Netcare group to the commission, believing it might not be in medical scheme members' best interests.

Are doctors resisting change?

In the dying days of apartheid, FW de Klerk called his health minister, Rina Venter, and proposed the abolition of apartheid in state hospitals. During her subsequent investigations, Venter made a startling discovery: no laws specifically segregated hospitals. Doctors and hospital administrators had voluntarily enforced apartheid.

Don’t pop the champagne yet

A question put to me by a radio talk-show host last week suggested that the government's publication of regulations to keep down medicine prices was an election ploy intended to win over voters. It would be rather stupid of the government not to do this before the election. But the truth is it's been a long time coming.

The real road to hell

Afrox Healthcare CEO Michael Flemming minced no words in telling shareholders how the company derived its growing profits in the year to end-September. Medical inflation, he told Moneyweb, was responsible: the company charged about 10% more than the year before, while 5% was organic growth. Pat Sidley explains why a free-for-all in medical-aid rates is the 'primrose path of dalliance'.

press releases

Loading latest Press Releases…

The best local and international journalism

handpicked and in your inbox every weekday