Tamar Khan, Business Day
CAPE TOWN — The pharmacy dispensing fees and medicine price hikes announced last week were in line with expectations, and should not affect medical scheme members’ contributions for next year, key industry players said at the weekend.
The news should come as some relief to consumers anxious about their medicine bills. Although schemes spent 8,8% less on medicines last year than they did in 2004 (a drop from R7,9bn to R7,2bn) according to the Council for Medical Schemes, medicines remain a worrying driver of health-care inflation.
The new laws, which are to be implemented in full by January 1, limit the fees pharmacists may charge for medicine sales. They replace a variety of approaches used during the past three years, as government and pharmacists used the courts to contest what constituted an appropriate dispensing fee.
Some pharmacies applied government’s original proposal, which capped dispensing fees at R26; many added “administration fees” to cover their costs; some applied a sliding scale proposed by the industry; and others took an independent approach. To complicate matters, medical schemes applied various rules, with many refusing to pay above the R26 threshold and forcing members to pay the difference.
SA’s biggest processor of medical claims, Medi-Kredit, has analysed the impact of the new laws on medical schemes, and concluded that they will have minimal impact on schemes such as Discovery Health, Profmed and Camaf, which have reimbursed claims above the R26 rate. Discovery, for example, has reimbursed dispensary fees of up to 36%, capped at R59.
“The average markup per medicine (under the old system) was R24,41 for Discovery Health. Under the new system it will be R26,83, representing an average increase in cost per item of about 1,7%,” said the scheme’s MD, Neville Koopowitz. The analysis considered Discovery’s medicine claims since January, during which time the average item cost R120.
Solutio CEO Pieter Dorfling agreed, saying schemes such as Medshield, Fedhealth, and Sasolmed, which had paid above the R26 rate, would be little affected by the changes. Solutio is the health risk-management arm of medical scheme administrator Medscheme.
By contrast, schemes that had paid only R26 would in future pay on average R9 to R10 more a line item, said Medi-Kredit MD Wimpie du Plessis. This translated into an average increase in the cost per medicine claimed of around 3,8% but figures for individual schemes would vary depending on their product mix.
For the schemes within Solutio’s stable that applied the R26 cap, the change would translate into a 7,7% increase in their combined medicine bills, said Dorfling.
Qualsa’s Pharmacy Management head, Dylan Moodley, said all the schemes managed by the company had applied the R26 cap, and expected to see increased costs next year. Since the model announced last week was only a slight variation on the draft published for comment in March, these increases had been built into schemes’ tariffs for next year, he said.
Schemes had similarly anticipated the 5,2% increase in medicine prices, said Dorfling. However, news that further price increases would be allowed next July could have an inflationary effect, he said.
