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Essential drug list translated to medical schemes. Milestones. Positioning of work conducted What is EDL? Approach Results Comments. Positioning. Positioning. Pilot review of the impact of applying the Essential drug list from NDoH on medical scheme medication
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Milestones • Positioning of work conducted • What is EDL? • Approach • Results • Comments
Positioning • Pilot review of the impact of applying the Essential drug list from NDoH on medical scheme medication • Requested as a initial investigation by BHF research • curiosity • Aim to generate thought and further research • Question: • Can we map the EDL to current utilisation of medial scheme benefits? • What coverage is already in the system? • Would there be a big switch between medications? • Cost impact? • Impact of • MMAP movements • Moving to State Tender prices
Positioning • Some assumptions were made in the review in order to render the results • Creams and ointments were not included • Difficult to exactly match the dosages etc. • Some difference in the active ingredients were not a adequate match • Multiple drug allocations • Isolated chronic conditions (CDL) • Used claims data from January 2014 to April 2014 • So a small sub-set of all claims • Hence the results may differ once all medication/conditions are examined
Positioning • Questions / comment raised in other discussions • Primary health care offering • Acute medication • Chronic medication • PMB’s not the long term solution • Are there alternatives?
What is the Essential Drug List (EDL)? • Forms part of the NDoH Essential Drug Programme (EDP) “The NDP aims to provide equal access to medicines for all South Africans through the Essential Drugs Programme, which will include an Essential Medicines List and Standard Treatment Guidelines.” NdoH website • Introduces as policy in 1996 • Aims • Developing and maintaining a medicines list for all State providers • Provide equal access to medicines • Increase and maintain adequate supply of limited medication • Improved prices • Meet the needs of priority medicines for the population of South Arica
What is the Essential Drug List (EDL)? • Approximately 520 listed medications • 1,773 on SEP list • Regularly updated - 2014 list
Approach • Used ATC classes to provide an initial match to the medicines in the medical schemes environment • Match reviewed and adjusted as required • Ensuring a correct match for active ingredients • Strength of medication • Pack size to ensure consistency of prices for impact consideration • Matched approximately 51.2% by cost • Indicative of further refinement • E.g. matching of creams and ointments • Where price/quantity differentials did not make sense
Approach • Multiple manufacturers • Multiple prices • Multiple strengths Adjustment for strength and pack size to develop equivalence
Results • Started at looking at options within the SEP and MMAP structures • Still some room to move • Set base to R100.00
Results 43.1% of members switched
Results • Now applying to State Tender Price • More for curiosity
Comments • Moving to MMAP Low similar to EDL • Potential for further reduction in the cost of medication in the industry • But consider the impact (consequences) on industry • Beneficiaries • Choice may be removed • Ok for low (PMB) plans? • “It does not work for me” / Noise
Comments • Pharmacies • via dispensing fee, • range of medications/choice, • and stock • Manufacturers • Reduced R&D • Less incentive to innovate • Etc.
Comments • Appetite of industry to engage in debate and “move the market” • Point of departure for further research and investigation • Potential for consideration to use EDL as a benefit set • Move away from CDL structure – variation of “PMB”? • Increased access for primary care benefits?
