Today's Labour News

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councilmedicalschemesBL Premium reports that the medical schemes regulator has banned the imposition of excessive co-payments on patients who choose health-care providers outside the networks chosen by their medical schemes.

While the move potentially has implications across the private health-care sector, it will bring particular relief to independent pharmacies shut out of these networks and give patients greater choice in where they purchase their medicines. Medical schemes have for many years used designated service providers (DSPs) to help manage costs, but they have drawn criticism for steering patients to courier and retail pharmacy chains at the expense of independent pharmacies that do not belong to their approved networks. Some schemes have also drawn fire for levying stiff penalties of up to 40% of the total cost of a prescription on members who opt to use pharmacies that do not belong to a DSP. These practices have limited patient choice and hurt the businesses of independent pharmacies that draw a significant portion of their income from the fees they charge for dispensing medicines. In a notice published in the government gazette on 23 April, the Council for Medical Schemes (CMS) banned schemes from levying penalties greater than the difference between the rate charged by a health-care provider belonging to their approved network and one that did not. It also prohibited the appointment of a DSP without engaging in a procurement process that was “fair, equitable, transparent, competitive and cost-effective”.

Read the full original of the report in the above regard by Tamar Kahn at BusinessLive (paywall access only)


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