From CompliNEWS | Financial Service Intelligence Watch

Lobby group warns of NHI risk

The Health Justice Initiative lobby group warned yesterday that government’s National Health Insurance (NHI) plan has inadequate provisions for medicines, posing a risk to access to treatments for everyone in SA.

A Business Day report notes the NHI Bill entails centralising selection and procurement of medicines for patients under NHI, collapsing the two largely independent systems used in the public and private sector into an entirely new mechanism. In the private sector, most medicines are funded by medical schemes, while private sector medicine sales are governed by the single exit price (SEP) regulations.

These prices are publicly available, and the Health Minister controls annual increases. In the state sector, the government issues tenders for medicines that are procured at these prices by provincial health departments. Section 58 of the Bill says the system set out in the SEP regulations will be used under NHI, with manufacturers selling medicines to the NHI fund at prices published by the office of health products procurement.

But the Bill is not clear on how patients will access medicines that are not covered by the NHI fund, and how sales of these drugs will be priced and regulated, said the HJI lobby group in a discussion paper released yesterday. The Bill also does not deal with weaknesses in the SEP regulations, which do not control the launch price of medicines.

The entire shift of SA’s medicine selection, procurement and reimbursement system to ‘NHI reimbursement’ has not been adequately thought through, potentially posing a great risk for the future of medicine selection and access in the country for all people, it said.

Read the Full Business Day report here