This means independent pharmacies will face new challenges when medical aid members must obtain their chronic medication from only one of two retail pharmacies or from a postal pharmacy, or face a 40% penalty co-payment.
In light of this announcement the Independent Community Pharmacy Association (ICPA), a body which represents the interests of independent community pharmacies, is taking its fight against closed DSPs and penalty co-payments to the next level.
Petersfield pharmacist Ernst de Wet says it is unfair and unreasonable not to give independent pharmacies the choice whether they want to be part of the network or not. He claims this places a burden on patients as they have no alternative choices from where they can obtain their medication without the 40% penalty.
“It is usually convenient for the community to obtain their medication at the pharmacy of their choice. Two of the larger medical aid schemes gave us an opportunity to decide whether we want to be part of their network to help their members,” he says.
In June the ICPA was awarded the ruling by the appeal board established in terms of the medical schemes act (Act 131 of 1998) against the Council for Medical Aid Schemes (CMS) mandating the CMS to investigate the closed DSP and penalty compartment mechanism with the view of declaring it an undesirable practice.
The ruling ordered the CMS to commence the process within 30 days, but despite confirmation that they have indeed commenced the process, no further action was forthcoming.
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Mogologolo Pasha, chairman of the ICPA, explains the proposed changes to the legislation have not yet materialised, despite the appeal board ordering CMS to commence the process.
She says the ICPA, supported by the Department of Health, is now appealing to the new registrar of CMS to act decisively and sort this matter out.
Failing to do so, they will compel the CMS through a High Court order to remedy the situation.
“We believe that DSPs should be open to all pharmacies and health care providers to join on a willing provider arrangement.
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“This will reduce out of pocket patient costs, improve adherence to medicines, patient care and outcomes,” says Pasha.
The ICPA finds it unacceptable that only big corporate pharmacies are being supported.
“Doing away with the practices of close DSPs and penalty co-payments would go a long way towards improving the service offering and the public perception related to medical aid schemes.
“This will be in the best interest of public and medical schemes themselves,” says Pasha.
