SA’s independent pharmacies still battle for Covid vaccine payments

SA’s biggest association for independent pharmacies says some of its members are still out of pocket in the wake of the Covid-19 vaccination programme, fuelling anxiety about the financial implications of providing services to the state under National Health Insurance (NHI).

Under NHI, the government plans to contract with public and private sector providers, including pharmacies, and reimburse them from a state-controlled NHI fund.

“We are feeling very disillusioned. It is difficult to say to the members ‘let’s engage with the department on NHI’ when we are facing this [issue], which involved just two medicines. Can you imagine [the situation] when we bring in the whole essential medicines list?” Independent Community Pharmacy Association (ICPA) CEO Jackie Maimin said.

Private sector pharmacies played a crucial role in the government’s Covid-19 vaccination programme, providing shots manufactured by Pfizer and Johnson & Johnson (J&J) to state patients and medical scheme members. Corporate and independent pharmacies were involved, including about 200 of the ICPA’s 1,200 members. They initially administered some J&J shots, but the majority were Pfizer jabs.

The ICPA went public in September 2022 with a complaint that its members were not being fully reimbursed by the health department for the extra doses they had squeezed out Pfizer vaccine vials when shots were in desperately short supply in 2021. Their action was in line with guidance issued by the US Food and Drug Administration and later by the SA Health Products Regulatory Authority, which both said it was acceptable to use every full dose obtainable from a Pfizer vial, said Maimin.

At the time the health department said the vaccination programme had been designed around extracting only six doses from Pfizer’s vaccine vials, and there was no mechanism to pay for the administration of a seventh.

Almost two years later, the issue is still unresolved, said Maimin. There are also outstanding disagreements over reimbursements for vaccinating state patients, with many ICPA members yet to receive the money they believe they are owed, said Maimin.

They have been denied access to the records held by the health department in its electronic vaccination data system, making it difficult to reconcile the issue, she said.

The ICPA questioned the health department’s decision to make them bear the risk of purchasing large trays of expensive vaccines, which it had received as donations or obtained at a lower cost, without any provision for those that were not used or had expired. Private sector pharmacies bought trays containing either 195 Pfizer vials (providing 1,170 Pfizer doses at six doses per vial) or 480 J&J vials (providing 2,400 doses at five doses per vial), at R308.48 and R286.96 per dose respectively, said Maimin.

But contracts made public in the wake of legal action by the Health Justice Initiative show the state paid only $10 per dose, approximately R134.23 at the prevailing exchange rate of R13.42/$, said Maimin.

J&J previously told Business Day it had, in fact, charged the SA government $7.50 a dose.

The ICPA had not received a response to the letters it sent to health director-general Sandile Buthelezi, and was considering legal action, said Maimin.

The health department denied that it had not taken action to resolve the payment issues, saying it was actively working to ensure the proper use of public funds. “While some requests for deviations from standard procedures have been submitted, not all can be approved, particularly when there is a risk of fraud,” it said.

“While it is important to acknowledge and appreciate the substantial contributions of pharmacies to the Covid-19 vaccination programme, it is equally important to adhere to the Public Finance Management Act and regulations,” it said.

Reconciliation issues had arisen not only because of the seventh dose administered from Pfizer vials, but also because some vaccinators worked at multiple sites and were not properly verified by pharmacies, so shots were recorded under the wrong locations, it said.

Unauthorised stock transfers between pharmacies created discrepancies between the number of vaccinations recorded and the stock allocated to sites, and caused mismatches between submitted invoices and the records held by the department. These inaccuracies had complicated the reconciliation of claims, said the department.

kahnt@businesslive.co.za