Road accidents hurt medical scheme, state
By: Moyagabo Maake Published on: 12 January 2017
Source: Business Day
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By: Moyagabo Maake Published on: 12 January 2017
Source: Business Day
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By: Katharine Child Publishhed on: 09 January 2017
Source: Times Live
Pharmacies are no longer prohibited from selling HIV self-test kits. The SA Pharmacy Council abolished the restriction on December 23.Francois Venter, deputy director of the Wits Reproductive Health and HIV Institute, said the law that had prevented pharmacies from selling HIV self-test kits but not other retailers was an “odd prohibition”.
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By: Susan Erasmus Published on: 10 January 2017
Source: Business Day Published on: 06 January 2017
Cancer treatments are poised to become the biggest earner in the pharmaceutical industry.
Years before becoming a top cancer specialist, Eric Winer used to save money on his own medical care by talking US pharmacists into giving him expired treatments free of charge.
Winer, who has a bleeding disorder known as haemophilia, knew the drugs would still work for a brief time after the official use-by date. The young physician was trying to stay within his insurer’s spending limit and avoid having to pay out of pocket one day. Decades later, he recollects that anxious time as he tries to make sense of the soaring prices of drugs for his own cancer patients.
“Cancer is just viewed differently in our society,” said Winer, 60, who is chief strategy officer and director of the Breast Oncology Centre at the Dana-Farber Cancer Institute. “It evokes more fear. And somehow, I think the manufacturers of these drugs are able to take advantage of that in terms of the prices they set.”
That cancer angst, combined with prices that have surpassed $200,000 a year for revolutionary new treatments, is poised to give oncology medicines the biggest share of the $519bn global pharmaceuticals market this year, eclipsing drugs for cardiovascular and metabolic diseases for the first time. And while drug makers claim the revenue will propel innovation, the costs are stoking patients’ distress and creating a rift between manufacturers, health authorities and payers in many markets.
Take the new lung-cancer drugs from Merck & Co, Bristol-Myers Squibb and Roche, for instance. They are part of a new class of treatments known as immune therapies, which harness the body’s own cells to fight tumours and tantalise doctors with the possibility of defeating one of the most common causes of death in the developed world.
The drugs are a game-changer for some patients, helping them live more than twice as long. They are also expensive: from $12,500 to $13,100 per month of therapy. And now they are being combined with other medicines. Bristol-Myers estimates a cocktail of its Opdivo drug with another immune product Yervoy, for melanoma patients, costs between $145,000 and $256,000 a year. It has received “very little push-back on the pricing,” says chief commercial officer Murdo Gordon, because patients are living long enough to come back for annual checkups for the first time.
“What about the people who can’t get coverage?” Winer asked in December. “Nobody can afford this.” The prices also mean doctors must wrestle with how much benefit is worth the cost, even as they try to focus on which treatment is best for individual patients, he said.
Merck’s Keytruda, which harnesses the immune system and can help patients with a form of skin cancer that was once a death sentence, costs about $12,900 per month. Merck is studying biomarkers in the body to target the patients who will benefit most from the drug, and believes its value is being reflected appropriately, the company said in an e-mailed statement.
Global revenue from branded oncology treatments may rise 12% to surpass $100bn this year, according to a Bloomberg Industries survey of analysts’ estimates, before climbing to about $150bn by 2020.
Costly new medicines should not take all of the blame, because at least two other factors are at play.
Drug makers are taking advantage of the rising tide to lift prices on older treatments as well, and cancer patients live longer, meaning they are left paying for drugs for a longer time.
“That’s a mixed blessing,” said Steven Miller, chief medical officer of Express Scripts Holding, one of the biggest managers of prescription-drug benefits in the US, the world’s largest market for pharmaceuticals. “We’re going to be able to help people who previously weren’t able to be helped, and so we’re very excited about that. On the other hand, it’s going to beg the question: Are we going to be able to afford it?”
Last year just two drugs, Celgene’s Revlimid and Novartis’s Gleevec, accounted for more than one-fifth of oncology spending through Express Scripts, one of the key intermediaries that negotiate with drug makers for rebates on the list prices on behalf of their customers.
Novartis raised the price of Gleevec 19% in 2015, before it faced generic competition last February, according to Express Scripts. Neither drug is brand-new: Gleevec was first approved in 2003 and Revlimid in 2005.
Celgene said it has “pricing principles” designed to keep developing cutting-edge medicines, but account for varying levels of affluence in countries around the world. Novartis points out that Gleevec’s US price has not budged since 2015 and drug makers need to recoup their research investment and fund further innovation.
Express Scripts and its rivals have started pushing back. CVS Health in August said it will no longer cover some treatments for cancer in 2017, including Novartis’s leukaemia treatment Tasigna, and Medivation’s prostate cancer drug Xtandi. This is the first time brand-name oncology drugs have been taken off its standard formulary list.
Express Scripts, which handles price negotiations on behalf of clients for pills and drugs that patients inject themselves, expects the cancer-drug spending it oversees to spike about 20% annually for the next three years.
In response, the benefits manager says it is expanding a programme that allows for different prices depending on how effective drugs are, and grants refunds when treatment ends early.
Express Scripts will not disclose details of the drugs involved, but the goal is to cover nearly one-quarter of the oncology pharmacy spending that it will oversee this year, up from 5% in 2016.
Government authorities are taking note — and pushing back as well in some cases. US president-elect Donald Trump has declared himself an opponent of high drug prices, and said he would favour allowing the import of treatments from abroad.
In Germany and the UK, the health systems rely on expert panels to assess whether new medicines help patients more than old ones, and pricing power follows.
The UK’s National Institute for Health and Care Excellence has turned down funding for a handful of new cancer medicines lately, saying their benefits do not justify their cost. It is currently debating a new Roche treatment for breast tumours called Kadcyla.
Pay-for-performance would in theory be a way to maintain prices for cancer medicines that work and winnow out those that do not.
But such a system is hard to introduce in the US, the world’s biggest pharmaceuticals market, where federal and private insurers are often on different reimbursement structures, said Nicolas Dunant, a spokesman for Roche. The company has been in talks with 20 European countries since 2012 on outcomes-based pricing and has already introduced package prices for some cancers in Italy and Switzerland.
“We would welcome a system where we could price a medicine based on how it performs,” Dunant said. “In order to pursue such an approach, we need data.”
In the meantime, patients — and especially those with inadequate insurance — are the ones left juggling financial worries alongside medical ones.
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By: Pontsho Pilane Published on:09 January 2016
Source: Mail & Guardian
A new injectable drug could change the face of HIV prevention and the revolution might start right here in South Africa. A clinical trial expected to start in Cape Town this year will pit a new long-acting antiretroviral (ARV) drug against the HIV prevention pill. If successful, the study could be the first step towards an era in which easy-to-use bimonthly injections could help prevent HIV infection.
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By: Susan Erasmus Published on: 09 January 2017
Cape Town – After four years of consultation, Treasury gazetted final demarcation regulations in late December, ending years of uncertainty on the future of gap cover, hospital cash plans and primary healthcare policies.
Finance Minister Pravin Gordhan and Health Minister Aaron Motsoaledi published the final demarcation regulations under the Long-term and Short-term Insurance Acts in December.
The issue at stake has been about where the line should be drawn between medical scheme products and health insurance. Medical scheme products are regulated by the Medical Schemes Act of 1998, and health insurance products are regulated by the Long-term and Short-term Insurance Acts of 1998.
Gap cover, which covers clients for co-payments/shortfalls incurred for in-hospital private doctors’ bills, and hospital cash plans, which pay clients a lump sum per day they spend in hospital, will continue to exist, but strict regulations will be enforced from 1 April 2017 with regards to maximum payouts allowed to be made by both these products to their clients.
Existing policies will have to comply with the new regulations from January 2018, and new policies from 1 April 2017.
The new payout limits
The new regulations stipulate that hospital cash-back plans are limited to paying their clients a maximum of R3 000 per day, or a total lump sum of R20 000 per year. Currently there are no limits in place for these payments.
In the past, Motsoaledi criticised gap cover policies, as their existence “gives doctors a free reign to charge much higher tariffs, … as they have no need to compete on either price or quality in order to attract patients”.
Gap cover policies will now be limited to a payout of R150 000 per annum per client.
Primary healthcare policies to go
Primary healthcare policies are not full medical schemes, and they provide limited medical service benefits, such as GP visits, basic dentistry and optometry, and some acute and chronic medication.
These policies are not governed by the Medical Schemes Act, and because they do not cover private hospitalisation costs, their contributions are much lower than those of full medical schemes, or even hospital plans.
These have been criticised for discouraging people from becoming medical scheme members, thereby contributing to the essential cross-subsidisation within schemes. Medical scheme membership in South Africa has been almost static for the last 20 years, with only 1.4 million new principal members (with 2.2 million beneficiaries) joining since the year 2000.
The medical schemes industry and the Council for Medical Schemes are currently looking at low-cost benefit options (LCBO), which would fall under the Medical Schemes Act, but that would possibly entail having to make changes to the current medical schemes legislation. One of the issues at stake is the stipulation that all schemes have to provide 270 Prescribed Minimum Benefits to all members at cost. This increases the cost of medical-scheme membership, and can make it more difficult for schemes to remain financially viable.
The new regulations outlaw primary healthcare policies from 1 April. These policies are seen as straying into the territory of medical schemes, and will no longer be seen as insurance products, but will have to be amended to comply to the stipulations of the Medical Schemes Act.
The relatively high cost of medical scheme membership is, however, seen as a deterrent to many prospective new members, and it is hoped that the proposed new low-cost benefit options will cover this gap. – News24
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By: Laura du Preez Published on: 07 January 2016
Source: Personal Finance
THREE restricted medical schemes have again achieved the highest scores on an index that measures their sustainability. The scheme for members of the South African Police Service, Polmed, was the top scorer for the third year in a row in the Alexander Forbes Health Medical Schemes Sustainability Index. Polmed was followed by the restricted scheme for municipal workers, Samwumed, and the scheme for local government employees and their dependants, LA Health.
The index measures a number of key factors that Alexander Forbes has identified as contributing to the sustainability of a scheme. The measures are calculated for the 10 largest (based on membership) open and the 10 largest restricted schemes for the period since 2006. If a scheme scores well on the index, some comfort can be taken in that it is regarded as well-positioned to pay claims, and that it will not be liquidated or merged with another scheme.
According to Alexander Forbes’s “Diagnosis 2016/17” report, although Polmed had the best score over the nine years since 2006, Samwumed and LA Health showed the greatest improvement to their scores in 2015 – 20 and 15 percent respectively. The publication states that the improvement in Samwumed’s score was driven by a reduction in the average age of the scheme’s beneficiaries, a substantial operating profit in what was a tough year for the industry, a substantial increase in accumulated funds
and an improvement in its statutory solvency ratio. The index measures a scheme’s operating profit, but schemes are not-for-profit entities.
Any surpluses after claims and non-healthcare expenses, such as administration, have been paid form part of the scheme’s reserves. When the average age of a scheme’s beneficiaries decreases, its
claims typically decrease, resulting in a higher operating profit and, eventually, lower contributions for members. The index uses the latest available data, in this case for the 2015 calendar year, which was released in the Council for Medical Schemes’s annual report in September last year. Alexander Forbes says LA Health scored well on all components of the index, with a good operating surplus, an increase in its solvency ratio, an increase in the size of the scheme and an improvement in the age profile of beneficiaries.
Polmed achieved a small operating deficit for 2015, but still increased its reserves and maintained a solvency level of 51.1 percent, which is significantly above the required minimum of 25 percent. Discovery Health Medical Scheme was fourth overall and the highest-rated open scheme. The next-best open scheme was Fedhealth, which was in seventh position overall.
Medihelp was in eighth position, Sizwe was in ninth position, Medshield 10th, Momentum 11th, Profmed 12th, Bonitas 13th, and the Government Employees’ Medical Scheme was in 14th position. Liberty and Transmed both experienced a decline in their index values during 2015, Alexander Forbes noted that Liberty was ranked 18th out of the 20 schemes considered. Transmed once again ranked lowest on the sustainability Index out of the 20 schemes considered. Although the index can help to identify a strong scheme to join, one should take care how one interprets the index, because it takes into account only quantitative factors, not qualitative factors, such as service levels or benefits offered. In addition, only the top 10 open schemes (out of a total of 23) and the top 10 restricted schemes (out of 60) are rated.
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By: Dr Bent Steenberg Olsen Published on: 09 December 2016
Source: Health E-News
Great strides have been taken to deal with HIV/AIDS in South Africa, but now drug resistance may become a serious problem. International institutions and governments create the impression that things are going well and we are in control of the pandemic. But we’re not, says Dr Bent Steenberg Olsen.
Following the introduction of three-drug antiretroviral (ARVs) regimens in 1996, HIV/AIDS morbidity and mortality were rapidly reduced in countries where these medications were made available for the public, particularly in North America and Brazil. HIV, however, naturally mutates and eventually develops resistance to ARVs, which are then rendered ineffective. Patients infected with drug resistant strains of HIV are therefore commonly moved to alternative (and significantly more expensive) regimens known as 2nd line drugs.
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By: Michelle Gumede Published on: 09 December 2016
Source: Business Day
The Independent Community Pharmacy Association goes to court over Fedhealth’s move to limit chronic medication outlets.
By: Natalie Schellack Published on: 23 November 2016
Source: The Conversation
After years of legal battles, a global agreement has been reached for developing countries to buy – and for drug manufacturers to produce or import – generic medicines without breaching patent rules. The Conversation Africa’s Health and Medicine Editor Candice Bailey asked Natalie Schellack to explain what this means for the developing world.
Are drugs about to become cheaper for poor people in developing countries? Why?
Through the World Trade Organisation an agreement was reached in November 2015 for the world’s poorest countries to buy – and for drug manufacturers to produce or import – generic medicines without breaching patent rules until January 1, 2033. The decision was taken by the organisation’s Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS). Put simply, the need of a nation trumped the right to derive protected benefit from a patent. This initiative will help developing countries come up with better policies.
It will provide legal certainty, which should lead to better access and more affordable drug prices. The agreement is good news for all countries in the Southern African Development Community as members of the World Trade Organisation (except for the Seychelles). They will be able to incorporate the TRIPS agreement into their national laws. The community’s Protocol on Trade confirms this position. South Africa, as a signatory to the TRIPS agreement, can pass intellectual property legislation, inclusive of patent laws, so that intellectual property rights do not become barriers to legitimate trade while ensuring the technology is transferred and disseminated in line with social and economic welfare.
If South Africa actively participates in this opportunity for more generic trade, medicines should be more affordable. South Africa has been fighting for access to generic drugs for some time. In the late 1990s around 40 big pharmaceutical companies such as GlaxoSmithKline and Boehringer Ingelheim filed a lawsuit to the Pretoria High Court against the South African government due to the importation of generic antiretroviral medicine to treat the HIV/AIDS pandemic. Millions of people were suffering from HIV/AIDS and could not afford the original brand-name medicines. The South African state was trying to find a way to guarantee their health. After three years, the court overruled the patent law in this case and recognised the right to health as a basic human right of South African patients.
How do patents affect prices?
A patent in this context is when a pharmaceutical company develops a new drug for a disease. The company sells it under a “brand name”. The patent protects the pharmaceutical company’s right to manufacture and market the drug to profit from it. This helps recover the costs that have gone into developing the drug. In most cases the drug patent is awarded for around 20 years. Once the patent has expired other companies can “copy” and manufacture the drug. Generic drugs must be near-identical “copies” of the branded drug. For example, they must be identical – or “bioequivalent”- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. In South Africa, this is regulated by the Medicine Control Council of South Africa. For a developing country like South Africa, the most effective and sustainable way to bring down the price of a drug is by driving competition between different generic manufacturers. This cannot be done if a medicine is still under patent and the patent owner is not willing to allow competition. Preventing competition can drive up the price to an artificially high level. Developing countries cannot afford this. Life-saving treatments for diseases such as HIV/AIDS, tuberculosis and malaria are needed. The price of medicine for people with these diseases is a matter of life or death.
What changes and challenges has South Africa made to patent laws and how could they affect people?
South Africa’s draft Intellectual Property Protection Policy of 2013 is designed to reform the country’s patent law and to address various shortcomings that hamper access to medicine. The draft policy provides public health safeguards and promotes cooperation between ministries. And more recently, South Africa’s cabinet approved a new Intellectual Property framework. The three-year delay in finalising the policy first set out in 2013 has affected the health of certain patients adversely. Two examples stand out.
Patients with multidrug-resistant tuberculosis (MDR-TB) struggle to pay for one of the medications they need called linezolid. The hepatitis B medication, entecavir, is another example. It remains inaccessible to most people because it is so expensive – while generic products are available outside South Africa at prices that are around 84 percent lower. Once the policy becomes law, South Africa could be a role model for the rest of the world in prioritising people’s health over profit.
What more needs to be done?
The process of finalising the Intellectual Property Protection Policy needs to be treated with urgency. The Department of Trade and Industry and all ministries involved must continue to prioritise turning it into law. This will mean more affordable medicines can become available. But there are other steps that can be taken too. The most effective and sustainable way to bring down the price of a drug is through competition between manufacturers. Investment is also needed. This can be promoted by having large pharmaceutical companies invest directly in South Africa to boost local production of medicines. And the approval process for new medicines should be streamlined by the Medicine Control Council. Another market in South Africa that should get more attention is clinical trial research. This would not only allow research into conditions inherent to South Africa, it would also be an investment in local specialists. The distribution of medicines throughout South Africa by the National Department of Health should be streamlined to avoid medicines being unavailable. One solution could be to transfer logistical and distribution costs of medicines to the suppliers to avoid delays, additional transport costs and stock-outs.
Natalie Schellack is Associate Professor and Course Leader: Post Graduate Programmes in Clinical Pharmacy in the Department of Pharmacy, Sefako Makgatho Health Sciences University.
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