Pharmacy body fights closed network
The Independent Community Pharmacy Association goes to court over Fedhealth’s move to limit chronic medication outlets
The Independent Community Pharmacy Association, which represents the interests of independent pharmacies, is taking Fedhealth to court for going ahead with plans to introduce a closed pharmacy network.
This will force the medical aid scheme’s members to obtain their chronic medication from selected pharmacies, failing which they will have to pay a 40% penalty copayment.
The appeal board of the Council for Medical Schemes (CMS) has already instructed the regulator to investigate the closed network principle.
The association has been trying for five years to break what it regards as the power of medical aid schemes to set up closed network systems.
Its first challenge to the CMS was dismissed but the appeal board mandated the council to probe the closed network and the penalty copayment mechanisms.
The CMS promised to publish a discussion policy document to resolve the issue.
However, Independent Community Pharmacy Association CEO Mark Payne said: "The CMS has not demonstrated that they are investigating the matter, or published the proposed legislative changes they promised."
The association intends to go to the high court to compel the CMS to make a ruling. The law allows designated service providers for medical schemes and copayments, but says nothing about closed networks and penalty copayments.
Payne said independent pharmacy groups were being marginalised because medical schemes implemented closed networks which restricted medical aid members to consulting with doctors and pharmacies selected by the scheme.
"A scheme like Fedhealth is saying that paying members cannot get medication from any pharmacy — they have to get it from corporate pharmacies or incur a 40% extra payment on chronic medication," he said.
The association argues that this practice removes customers’ choice and limits the standard of care.
An open system allows any pharmacy to join a medical scheme’s network and provide services at particular prices.
"We don’t object to designated service providers being appointed but we object to them being closed to specific service providers," said Payne.
"With National Health Insurance coming, we need to have as many healthcare professionals on board to drive this process — not marginalise about 2,000 pharmacists in favour of 266 corporate pharmacies."
Payne said there were inconsistencies in Fedhealth’s proposal. Patients can receive chronic medication in the post and acute medication from their local pharmacies. "These systems don’t speak to each other."
Medical aid schemes attempt to keep costs down by directing members to specific pharmacy chains. But the Independent Community Pharmacy Association argues that patient outcome is a more important issue than which professional helps them.
Bonitas Medical Fund and Polmed, the police service medical aid, use the designated service provider system.
Jeremy Yatt, principal officer of Fedhealth, said the scheme was acting "within legal bounds" and was not aware of any planned court action against it.