National Drug Prescription Plan in Dispute

Drug plan in dispute
By CANDIA DAMES ~ Guardian News Editor ~ candia@nasguard.com


The National Insurance Board and the Bahamas Pharmaceutical Association have failed to reach agreement on the government's National Drug Prescription Plan, with a major disagreement erupting over markups for the drugs that will be a part of the scheme.

"You can't ask business owners to sign their own death certificates," said Dr. Marvin Smith, who heads the association.

The government plans to implement the national plan through NIB in August to increase access to cost-effective drugs for certain conditions. During the initial phase of the plan, patients who qualify will be able to fill prescriptions at no cost to them from participating private and government pharmacies.

Thousands of Bahamians who qualify for the plan are waiting for it to start. The plan is a key campaign promise of the Ingraham administration, which has touted it as a crucial initial element of a national health insurance program. The drug scheme's beneficial schedule will include prescription drugs and specific medical supplies deemed necessary by an attending physician for treating a chronic condition of a plan participant.

But NIB has so far failed in its efforts to get the Pharmaceutical Association onboard.

Smith said the nearly 50 pharmacies that are members of the grouping still have concerns about the markups that would be allowed under the plan, and will not participate under the current proposal.

He told The Nassau Guardian that NIB is proposing a 45 percent markup for drugs that cost at under $5; a 35 percent markup on drugs that cost between $5 and $25 and a markup of 25 percent on drugs that cost over $25. Added to the costs of the products would be a $3 dispensing fee per drug.

"There is no way that pharmacies can support, in this first phase, any markup that they're proposing," Smith said.

He said the pharmacies would not be able to survive under that proposal because they have numerous overhead costs that must be taken into consideration.

The association is proposing a 45 percent markup on pharmaceuticals that cost under $20; 40 percent on drugs that cost between $20 and $40 and a markup of 35 percent on drugs over $40. Under the association's plan, the dispensing fee would range from $3 to $5.

"We're not asking for excessive markups," Smith said. "We're saying let's get it to where people can survive, get it to where businesses could be steady and stable. That's all we want."

NIB Director Algernon Cargill said the plan will go forward even if an arrangement cannot be worked out with the Bahamas Pharmaceutical Association.

"We've negotiated markups based on a scientific review of similar plans throughout the region," Cargill said. "While our markup is at the highest level of all the similar plans that already exist in the region, we believe that markup allows for a fair and reasonable return based on the anticipated 35,000 new clients in the first phase and 100,000 in the final phase of the National Drug Prescription Plan.

"In our view, the markups that approximate 50 percent allow for a reasonable return and also allow for the pharmacies to provide for a high level of service to clients that ordinarily would not have visited their pharmacies because they primarily now go mostly to public pharmacies to receive their prescription drugs."

He noted that several pharmacies have already embraced the plan. Cargill said these include Walk-In Medical Clinic pharmacies; Betande Pharmacy; Lowe's Pharmacy; People's Pharmacy and Centerville Pharmacy. He said Wilmac's Pharmacy is also signing on.

According to Cargill, the contracts are flexible and pharmacies that sign them can opt out at any time without penalties.

"We are happy that we have a representative group of pharmacies in order to move the plan forward," Cargill said.

While Cargill admitted that no Family Island pharmacy has signed on as yet, he said the prescription drugs for Family Island locations will be available at public clinics.

He also said the biggest challenge with launching the plan right now is identifying the wholesalers who will provide the drugs to the participating pharmacies.

Cargill stressed, "The National Insurance Board is not insisting that all of the pharmacies sign on to the plan. We want the pharmacies that want to work in partnership in providing better health care services to Bahamians in The Bahamas and can do so with a reasonable profit."

But Smith told The Guardian, "Do you really want a plan that says only the giants who can afford to operate at a loss maybe a bit longer than other people are going to be involved? All that would do is deplete the sector of small businesses and if you only leave the giants then the government puts itself at risk because they would be the only ones who can actually pull a power play on the government. You need the small business persons."

He said, "We want to partner with the government in this initiative. We want this plan to work."

The initial phase of the plan will include NIB pensioners; people receiving invalidity benefits; minors 17 and younger and all full-time students up to 25.

During the later stages of the plan, a new addition to NIB contributions will be initiated to cover the plan.

April 29, 2010

thenassauguardian

Bahamas Blog International