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Road accidents hurt medical scheme, state
2017-01-1214:01:19 PM

By: Moyagabo Maake                                 Published on: 12 January 2017

Source: Business Day

The Road Accident Fund faces huge claims as road death toll increased 5% over the 2016-17 festive season. Discovery Health Medical Scheme, SA’s largest medical aid provider, and the state’s Road Accident Fund (RAF) are paying dearly for SA’s high road death toll, which rose 5% over the 2016-17 festive season compared with a year ago.
Transport Minister Dipuo Peters said on Tuesday more than 1,700 people died on the roads during the period.
Many fatalities arose from cars overturning, or head-on collisions, which Peters blamed on unskilled drivers who had taken advantage of corruption at driving-licence testing centres.
Those injured in these accidents are costing the state and medical schemes millions.
“The RAF’s claims expenditure still remains unacceptably high at more than R32bn per annum, where each rand paid is a painful reminder of the extent to which lives are lost and people seriously injured on our roads,” said Eugene Watson, the agency’s CE.

Source: Business Day

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HIV home-testing kits at your corner chemist
2017-01-1014:01:10 PM

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”.

Online retailers such as Takealot sell World Health Organisation-approved HIV home-test kits that use a pinprick of blood to give results within 15 minutes.
The kits are considered to be at least 99% accurate.
“Having HIV tests available over the counter makes it easy for people to test for HIV in the privacy of their own home and might increase [willingness to be tested],” said Venter.
The government plans to have 90% of people aware of their HIV status, and 90% of HIV-positive people on treatment, by 2020, in line with UN goals.
“I’m aware that many pharmacies sold the HIV tests used in healthcare settings under the counter,” said Venter.
“You could buy them openly on the shelf in the international section of OR Tambo Airport, next to other self-tests, such as those for malaria.”
The SA HIV Clinicians’ Society has long called for HIV self-test kits to be freely available over the counter at pharmacies and has said the belief that people would harm themselves if they tested positive at home was attributable to “paternalism”.
“Large studies on self-testing found no increase in suicide or self-harm associated with a positive test result,” Venter said.
“Pregnancy tests, which [can have] huge consequences and are a theoretical suicide risk, have been sold over the counter with no problem for decades.”
Last month the SA Pharmacy Council gazetted draft legislation, open for public comment, to the effect that pharmacists must tell their customers that if they test positive at home they should test again for confirmation.
The draft proposes that test kits sold by pharmacies be approved by the World Health Organisation or other regulatory authority.


Source: Times Live

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15 facts you should know about open medical schemes
2017-01-1013:01:27 PM

By: Susan Erasmus                                        Published on: 10 January 2017

Source: Fin24

Cape Town – How much do you really know about the inner workings of your medical scheme? Here are some quick facts on open medical schemes in SA.
Whereas each scheme will readily provide you with the facts on themselves, not everyone has the time or the patience to go and do a comparative study. Fortunately, Alexander Forbes Health has done it for you in their Diagnosis 2016/2017. Some additional information comes from the Council of Medical Schemes.
Find out here what the facts are on open medical schemes in South Africa:
  • Since the year 2000 to the present, the number of open schemes in South Africa has decreased by 24 from 47. There are now 23 open medical schemes in SA, to which anyone can belong. Many smaller schemes have amalgamated, making them less prone to market volatility. The bigger the scheme, generally, the more financially stable. A small open scheme can be derailed by a couple of large claims, but that doesn’t happen so easily to a bigger scheme.
  • During 2016, Bonitas Medical Fund merged with Liberty Medical Scheme – the only amalgamation recorded during that year.
  • Almost 59% of principal members covered on medical schemes, belong to open schemes. The other 41% are on restricted schemes. The numbers of dependants on medical schemes in general have decreased, pointing to financial pressure being experienced by principal members. This also indicates that members are most likely to add only family members who need medical attention – this could increase the financial pressure on all schemes.
  • Discovery Health is the biggest open scheme in the country and had just over 1.2 million principal members and just over 1.4 million dependants.
  • The top ten medical schemes, according to membership figures, are (in order): Discovery Health, Bonitas, Bestmed, Medihelp, Medshield, Fedhealth, Liberty (now merged with Bonitas), Sizwe and Keyhealth. Hosmed and Topmed come in at numbers 11 and 12 respectively.
  • Six open schemes had a positive growth in membership numbers during 2015.
  • The average annual increase in medical scheme contributions over the last 16 years has been 7.6%. Average CPI inflation has been 5.7%. Medical care and health expenses have gone up by average 7.7% per year during the last 16 years. Medical scheme contribution exceeds CPI by at least 1.9% on an annual basis.
  • During 2015, open schemes had an overall risk claims ratio of 88.7%. This is proportion of contributions used to fund claims. The generally accepted benchmark for a claims ration is 85%. Excess funds are used to build reserves and pay for non-healthcare expenses, such as administration.
  • The open scheme that had the highest claims ration in 2015, was Keyhealth (90%), followed by Fedhealth (86%). Discovery Health had a claims ratio of 77%.
  • Open schemes spent an average of 10.4% of their contribution income on non-healthcare expenditure. Cost increases of non-healthcare expenditure increases with CPI. Non-healthcare expenditure includes administration expenses, broker commission and marketing fees, and bad debts.
  • The open scheme with the highest non-healthcare expenditure was Sizwe (just over 16%), followed by Medihelp (just over 15%). The open scheme with the lowest non-healthcare expenditure was Medshield with just over 11%. Discovery Health spent just over 13% of its contribution income on non-healthcare expenses. On average (both open and restricted schemes) the industry spent 11% on average on these expenses – about R275 per member per month.
  • Open schemes recorded an operating deficit of R565.63m in 2015. This was down from an operating surplus achieved in 2013 of  R626.54m. In 2015 only 8 of the 23 open schemes achieved an operating  surplus. When there is an operating deficit, schemes have to rely on investment income to break even.
  • Open schemes have 45.8% of their assets held in cash. Schemes may not hold more than 40% in equities (stocks and shares) and the limit on property-related investments is 10%. There is a preference for cash investment, often driven by a need to have access to liquid assets.
  • Schemes are required by law to have 25% of their assets in a reserve fund. By the end of 2015, open schemes had just under 30% of their contributions in reserve, as opposed to just under 40% held by restricted schemes.
  • Of the open schemes, Medshield has a solvency level of just over 50%, Sizwe of just under 50%, Fedhealth about 35%, Keyhealth just over 30%, and Discovery and Bonitas very close to the legal requirement of 25%.
(Sources: Alexander Forbes Health Diagnosis 2016/2017; The Council for Medical Schemes)

Source: Fin24


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Are drug companies taking advantage of cancer angst?
2017-01-0914:01:47 PM

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.

No death sentence

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?”

Pricing principles

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.

Pay for results?

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.


Source: Business Day

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Could six injections a year protect you from HIV infection?
2017-01-0914:01:51 PM

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.

As part of the trial, about 150 South African men who have sex with men and transgender women will be given either the HIV prevention pill or the experimental jab. They will be among about 4 500 participants in eight countries, including the United States, Brazil and India, who will test whether bimonthly injections of a new ARV, cabotegravir, works as well as the current HIV prevention pill to curb infection.
In 2015, South Africa became one of the first countries in the world to introduce the HIV prevention pill as a form of pre-exposure prophylaxis (PrEP). Sold under the brand name Truvada, the pill combines two ARVs. Several studies have shown that, when the HIV prevention pill is taken once a day, at around the same time, it can reduce a person’s risk of contracting HIV by more than 90%.
The Desmond Tutu HIV Centre will be conducting the research in Cape Town. According to the centre’s deputy director, Linda-Gail Bekker , and a fellow researcher of the study, Karen Dominguez, Cape Town will be the only trial site in Africa to test whether cabotegravir works as well as Truvada to prevent HIV. Results are expected to be released in 2021.
The injectable ARV is being tested among men who have sex with men and transgender women because these two groups are at a high risk of contracting HIV, in part because they engage in anal sex.
“The annual number of new HIV infections among young people, especially men who have sex with men and transgender women who have sex with men, has been on the rise despite nearly flat HIV incidence worldwide,” says the trial’s communication officer, Kevin Bokoch.
The risk of contracting HIV through unprotected receptive anal sex is almost 20 times greater than the HIV risk associated with vaginal intercourse, according to a  2010 study published in the International Journal of Epidemiology.
Bokoch says researchers are awaiting more data to show that the injectable ARV is safe to use in women before embarking on a similar trial pitting the shot against Truvada later this year.
Currently, the HIV prevention pill is available in the private sector. The government has also begun to provide the pill to sex workers at 10 sites in an effort to reduce HIV infections among the high-risk group. But the pill only works if taken every day.
University student Dineo Twala* began taking Truvada in June. Like many who take medication daily, she says it’s hard to take PrEP consistently.
“To take a pill at the same time every day, it’s like I am already living with HIV. It’s hard to swallow, even though you do it because you know it helps protect you against HIV,” she told Bhekisisa in July.
Bokoch says, if the new experimental HIV prevention jab is proved to be effective, it could help provide people like Twala with an additional and easier-to-use method to prevent HIV infection.


Source: Mail & Guardian

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New laws on gap cover and hospital cash plans
2017-01-0914:01:28 PM

By: Susan Erasmus                                         Published on: 09 January 2017

Source: Biznews

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


Source: Biznews

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Three restricted medical schemes top sustainability index
2017-01-0912:01:33 PM

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.

Source: Personal Finance

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South Africa’s HIV/AIDS Crisis: why drug resistance matters
2016-12-0914:12:17 PM

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.

The average patient in the US today, for instance, typically initiate antiretroviral therapy on 3rd or 4th line drugs priced at an annual average of approximately R 299,000. This rising cost is because of the early introduction of AIDS treatment in that part of the world: the virus simply had ample time to develop resistance. In north-eastern Brazil, it was reported in 2011 that 19.1% of all new HIV infections were resistant to 1st line drugs. 10–15% of these strains were resistant to all available ARVs, so-called super HIV.
Meanwhile, in South Africa, the population has remained largely treatment naïve because AIDS treatment was not comprehensively introduced in the country until 2004. This means that South Africans initiating ART today are still mostly put on 1st line drugs at an annual cost of about R 7,700. South Africa is about eight years ‘behind’ other nations such as the US or Brazil, which is a good thing, resistance-wise.
But will similar levels of drug resistance as those in the US or Brazil not eventually emerge in southern Africa? Say, perhaps in eight years’ time? If so, the consequence could be nothing short of a looming catastrophe of unprecedented proportions — the notion of South African health services sustaining public AIDS care worth more than an annual quarter of a million rand per patient is frankly absurd.
So what is the likelihood of this ever happening? Let us consider four essential variables: the future, viral mutation, adherence, and, perhaps most importantly, community viral loads.
Looking ahead
With respect to the future, well who can tell? Pharmaceutical pricing and patents may change; new and better drugs may or may not be developed. However, global funding for HIV/AIDS research has been decreasing steadily in recent years and we should not anticipate any game-changing breakthroughs, at least not in our most immediate future. Talk of a cure is still premature.
Whereas natural viral mutation is inevitable, certain things, however, can be done to slow its progression. For instance, non-adherence to ARVs is a major cause of drug resistance. ‘Retention in care’ is a measure for the quantity of patients who remain in their AIDS programmes over time and take their pills regularly (i.e. adherence). Troublingly, retention in care remains poor in southern Africa. According to systematic reviews, as many as 35% abandon their treatment. Improving retention in care would therefore be one good place to start.
Another good place would be the ‘community viral load’. An individual suppressing HIV with ARVs has a low viral load and there is evidence that well-treated patients are much less likely to transmit the virus. As such, treatment is prevention. The higher the viral load in the community as a whole, the greater the likelihood of mutation and drug resistance, so it would seem logical to simply treat everyone as soon as they are diagnosed in order to keep the community viral load supressed.
Community viral loads remain high
Accordingly, in many developed countries, this is also the official recommendation. In the US, for instance, patients initiate ART regardless of their CD4 cell count, a measure used to gauge the detrimental effect of HIV on an individual’s immune system. So when the UNAIDS reports that we have now reached any level of treatment coverage in any given African country, the truth is that this number is based on how many people are ‘in-need’ of treatment, which again is determined by when they are deemed eligible for drug initiation. Throughout sub-Saharan Africa, such criteria, say CD4 <250, has traditionally been set low because of scarce resources. Patients are initiated earlier now, especially in South Africa, but not soon enough, meaning that community viral loads remain high.
‘Coverage’ is not the only concept sometimes used to obscure important epidemiological facts. Yes, it is true that South Africa’s ‘national prevalence rate’ is 19.2% in the reproductive age group (15–49), but this number disguises the fact that if we look separately at ethnic groups, we will find HIV prevalence to be highly disproportionate: 22.7% blacks, 0.6% whites, 4.6% coloureds (mixed race), and 1.0% Indians/Asians (reproductive age groups). Additional afflictions brought on by multi-resistant strains of HIV would therefore affect these groups differently and (very) unequally.
While we cannot predict with any level of certainty how drug resistance will develop in South Africa, we can say that there is nothing much to suggest that its progression should occur any slower than in America. On the contrary, poor rates of adherence and relatively high community viral loads seem to hint that it might actually happen faster. If US or Brazilian levels of drug resistance are reached, there are grounds for serious concern about the continued affordability and sustainability of public AIDS care in South Africa.
Providing millions of ordinary people with ARVs, only to withhold them later when it becomes financially unmanageable to do so seems unimaginable, but following the line of thought presented here, it is one possible future. As such, many HIV-positive people might again one day find themselves back in the dark days before the dawn of the treatment era.
Dr Bent Steenberg Olsen, PhD, is based at the African Centre for Migration and Society (ACMS), Africa’s leading scholarly institution for research and teaching on human mobility at the University of the Witwatersrand.


Source: Health E-News

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Pharmacy body fights closed network
2016-12-0913:12:55 PM

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.

The Independent Community Pharmacy Association, which represents the interests of independent pharmacies, is taking Fedhealth to court for going ahead with plans to introduce a closed pharmacy network.
This will force the medical aid scheme’s members to obtain their chronic medication from selected pharmacies, failing which they will have to pay a 40% penalty copayment.
The appeal board of the Council for Medical Schemes (CMS) has already instructed the regulator to investigate the closed network principle.
The association has been trying for five years to break what it regards as the power of medical aid schemes to set up closed network systems.
Its first challenge to the CMS was dismissed but the appeal board mandated the council to probe the closed network and the penalty copayment mechanisms.
The CMS promised to publish a discussion policy document to resolve the issue.
However, Independent Community Pharmacy Association CEO Mark Payne said: “The CMS has not demonstrated that they are investigating the matter, or published the proposed legislative changes they promised.”
The association intends to go to the high court to compel the CMS to make a ruling. The law allows designated service providers for medical schemes and copayments, but says nothing about closed networks and penalty copayments.
Payne said independent pharmacy groups were being marginalised because medical schemes implemented closed networks which restricted medical aid members to consulting with doctors and pharmacies selected by the scheme.
“A scheme like Fedhealth is saying that paying members cannot get medication from any pharmacy — they have to get it from corporate pharmacies or incur a 40% extra payment on chronic medication,” he said.
The association argues that this practice removes customers’ choice and limits the standard of care.
An open system allows any pharmacy to join a medical scheme’s network and provide services at particular prices.
“We don’t object to designated service providers being appointed but we object to them being closed to specific service providers,” said Payne.
“With National Health Insurance coming, we need to have as many healthcare professionals on board to drive this process — not marginalise about 2,000 pharmacists in favour of 266 corporate pharmacies.”
Payne said there were inconsistencies in Fedhealth’s proposal. Patients can receive chronic medication in the post and acute medication from their local pharmacies. “These systems don’t speak to each other.”
Medical aid schemes attempt to keep costs down by directing members to specific pharmacy chains. But the Independent Community Pharmacy Association argues that patient outcome is a more important issue than which professional helps them.
Bonitas Medical Fund and Polmed, the police service medical aid, use the designated service provider system.
Jeremy Yatt, principal officer of Fedhealth, said the scheme was acting “within legal bounds” and was not aware of any planned court action against it.
Source: Business Day

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How changing drug patent rules will affect developing nations
2016-11-2417:11:15 PM

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.

Source: The Conversation

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