Friday, August 8, 2014

The National Prescription Drug Plan and its Healthy People Programme

Concern Over Sustainability Of Prescription Drug Plan

The National Insurance Fund pumped nearly $7.5 million into the National Prescription Drug Plan back in 2012, throwing into question the continued success of the programme to provide quality drugs and supplies as well as future expansions.

Based on the fund’s most recent audited report tabled in the House of Assembly on Wednesday, there was a significant growth of 41 per cent in the cost of drug and medical supplies from $4.06 million in 2011 to $5.71 million the following year.

According to National Insurance Minister Shane Gibson, much of this 41 per cent growth is attributed to reimbursement costs to private sector pharmacies as the purchase price for drugs for public pharmacies was significantly less in 2012 at $464,300 from $738,500 in 2011.

“…If we continue in this direction and with the funding of mini hospitals by the medical benefits branch, the branch will be challenged to provide continued funding for the plan,” he said.

“Indications are that the central government will soon have to consider providing funding for the plan, at least until the drug plan is incorporated in the pending National Health Insurance (NHI) programme.”

Since its inception, more than 1.1 million claims have been paid and over $20 million spent on drugs and medical supplies.

According to the minister, whilst this is the case, a great percentage of the beneficiaries – 84 per cent – have opted to use private pharmacies as opposed to the public pharmacies.

“To paint a clearer picture, the average number of weekly claims paid to private pharmacies total 5,984 and for the public pharmacies this average is far lower at 898 claims weekly. These numbers are not satisfactory and evidence that the plan is not being utilised to capacity in the public sector,” he said.

Other challenges in the public and private sectors include turning away drug plan members from accessing medications resulting in low drug utilisation, not requesting members use their ACE prescription card and dispensing from public stock instead, filling prescriptions under the clinic name instead of the doctor’s name, inhibiting claim submission on refills because the prescriber is unknown and not using the claims processing system when dispensing to members resulting in a higher number of manual claims.

Officials have also found that less than consistent internet connections have prevented the adjudication of claims and that there has been tardiness in sending in requisitions for supplies in checking and verifying receipt of supplies.

“I appeal to those persons on the front line to keep in mind that one of the reasons the drug plan was implemented was to relieve the stress on the public system and increase availability of medications for chronic diseases. If we all work together, we can improve the plan throughout The Bahamas,” Minister Gibson said.

The drug plan was implemented nearly four years ago to essentially increase access to cost effective drugs for specific chronic illnesses and to reduce the financial burden of purchasing the drugs and specified medical supplies.

There were 6,500 beneficiaries in its first place.

To date, the number has more than tripled to just over 25,000 active beneficiaries.

“We have heard the cries of many and I am pleased to say that recommendations have been made to add medication for Alzheimer’s disease to the presently covered condition psychiatric illness,” Minister Gibson said.

“I am certain to the delight of many individuals, recommendations have also been made to increase the number of covered conditions with the addition of Lupus to the drug plan.

But despite its growing plans, the minister noted that one of the plan’s greatest successes lie in its Healthy People Programme.

In each phase, 40 individuals were afforded the opportunity to 12 weeks of professional wellness coaching and personal fitness training.

Many of the participants experienced significant weight loss with some as high as 78 lbs. There were also significant reductions in blood pressure, blood sugar and cholesterol readings with more than 12 people being taken off prescription medication.

However the minister accepted that there are many people who suffer from more than just chronic diseases that require a lot more than just prescriptions.

“There are many who cannot afford private health insurance, hence our goal is to provide affordable coverage for persons to have access to the health services they need,” Mr. Gibson explained.

“This comprehensive care will definitely improved the lives of many Bahamians and given them peace of mind in knowing that they are covered no matter what.”

August 07, 2014

Jones Bahamas