THANDI SKADE
GOVERNMENT Employees Medical Scheme (Gems) members on chronic medication are paying dispensing fees higher than the legislated maximum – in some cases more than double the fee.
Based on the four-tier Transparent Pricing System for Medicines and Scheduled Substances, which sets the maximum dispensing fee that pharmacists can charge per tier, members receiving any medication priced lower than R40 are invariably paying more than what Health Minister| Aaron Motsoaledi has gazetted.
This anomaly has come about by Gems awarding Medipost – a courier pharmacy – a multimillion-rand tender to be the scheme’s sole chronic medication and antiretroviral designated service provider. It negotiated a flat “professional fee” of R23.78.
If patients want to go to their local pharmacist, they will be penalised with a 30 percent co-payment.
But, according to the Medicines and Related Substances Act, no pharmacist, person licensed to dispense, wholesaler or distributor is allowed to sell medicines at a price higher than the legislated fee.
Outraged members say they were not aware of the negotiated fee until it was reflected on their invoices from late last year. They claim Medipost and Gems are contravening the act by over- charging for medicines on the lower end of the cost spectrum, and several members have laid complaints with the Council for Medical Schemes.
“I can buy the same medicines cheaper at the pharmacy, yet because Medipost holds the contract, my father is penalised with a co-payment if he wishes to use them,” a relative of a member said.
The Star is in possession of a member’s invoice which shows patient X paid R40.36 (including the “professional fee” of R23.78) for a drug worth R16.58.
At a pharmacy, the same medicine would cost R30.20, which includes the maximum dispensing fee of R13.62 for that particular drug. (See graphic for calculation.)
But both Gems and Medipost say they are not breaking the law because they are acting within a lawful service-level agreement.
Medipost marketing director Rentia Myburgh said the agreed fee covered a range of services, including establishing and operating an administrative call centre, extensive data analysis, comprehensive reporting on prescription usage and compliance trends, and IT capability, among others.
“The fixed service fee agreed to as part of our service agreement with Gems was the most inexpensive offering, resulting in substantial savings for the scheme and members,” Myburgh added.
Gems principal officer Dr Eugene Watson saw nothing wrong with the scheme’s negotiated flat fee, saying it was a cost-effective intervention.
“Gems is of the view that it is not in contravention of the pricing regulations.
“The arrangement benefits the members of Gems and it is a cost-effective measure for providing Gems with chronic medication.”
Based on claim data for January, Watson said that while 48 percent of the 689 298 chronic medication items dispensed were for tier-one drugs, it made up only 12 percent of Gems’s overall spend on chronic medication, which totalled R92m.
The scheme had in fact saved more than R20m for the month as a result of the flat fee negotiated with Medipost.
“Based on the quantum of R92m worth of chronic medicine dispensed, the regulated dispensing fee across all tiers would have been R38m as compared to the R17m that Gems paid to Medipost.”
Sham Moodley, chairman of the Independent Community Pharmacist Association, said they “found it strange” Gems and Medipost were applying a fixed fee option now when the option was previously rejected by the pricing committee because it would make medicines at the lower end of the cost spectrum too expensive.
Consumer Commissioner Mamodupi Mohlala agreed, saying the practice violated at least two sections of the Consumer Act.
The Health Department could not be reached for comment.