Jamaica Gleaner / Guest columnist Milton Wray made a number of inaccurate assertions in the article titled ‘Save the pharmacy sector’, published in The Sunday Gleaner of October 1, 2017.
Arising from this article, the National Health Fund (NHF) has received feedback from beneficiaries, pharmacists, and other stakeholders confirming their confidence in the work of the NHF.
The board and management of the Fund believe Mr Wray missed the mark on accuracy and fairness and wish to clarify a number of points that are not representative of the facts.
Mr Wray begins his column by warning that a “frightening crisis is looming in the pharmacy trade, which could result in severe shortage of medications, as well as financial fallout akin to that of the 1990s”. These pronouncements are not grounded in fact.
The truth is that hundreds of pharmacies have partnered with the NHF to serve our beneficiaries and have, in turn, benefited from this collaboration. Since its inception in 2003, the NHF has paid out more than $31 billion to the trade as the number of beneficiaries has increased.
For the 2016-2017 financial year, some $4.2 billion was paid to participating pharmacies, and for the first six months of the current financial year, these pharmacies earned approximately $2.1 billion from the NHF.
The number of private pharmacies signing on as NHF Pharmacy Providers has grown from 376 in 2015 to 401 in 2017. Based on enrolment trends, we expect that number to increase in the future. Ongoing feedback from pharmacy providers and beneficiaries shows strong support for the NHF programmes.
Mr Wray appears to be ascribing blame to the NHF for the failure of a few pharmacies in the private sector. We readily acknowledge that pharmacies are our vital partners in the health-care system. However, we recognise that like any other business, pharmacies have to follow a proper business model to remain viable in a competitive economy.
NHF MANDATE – HEALTH FOR ALL
Mr Wray makes the point repeatedly about NHF benefits going to the ‘rich’. The revenues received by the NHF are derived from the National Insurance Scheme, taxes on tobacco, and special consumption tax, which are garnered from all sectors of the population.
Two of the principal objects of the NHF Act 2003 are to provide prescribed health benefits to all residents, regardless of age, gender, health, or economic status, and to offer greater access to medical treatment and preventative care.
We should be careful, therefore, not to label NHF beneficiaries as rich since sudden catastrophic illnesses can drive many Jamaicans into medical poverty. Our primary objective, therefore, is to support Jamaica’s health-care system to ensure that improvements that will guarantee a more healthy and productive nation.
In keeping with its mandate, the NHF provides assistance to patients in meeting the cost of prescription drugs to treat specific chronic illnesses. Currently, there are more than 370,000 active beneficiaries who use NHF and JADEP cards. Approximately 42 per cent of these patients are elderly persons considered part of our vulnerable population.
In addressing the matter of wider access to drugs for public patients, the NHF introduced a pilot Public-private Pharmacy Partner Programme, whereby 17 private pharmacies also dispense drugs to public patients. The pharmacies are provided with government drugs and receive a fee of $600 for dispensing each prescription, not $200, as Mr Wray falsely reported. The patient pays $200, while NHF pays $400 for each prescription filled.
We are proud to acknowledge that this pilot programme, launched in December 2016, was, for the most part, successful and has provided us with insight into areas of weakness that will be addressed in the full rollout of the programme. The partnership resulted in more than 33,000 prescriptions being filled as at August 31, 2017.
We commend the pharmacies that participated in this pilot project and note, in particular, the success of the programme in St James, where private pharmacies continue to dispense prescriptions for public patients as a result of the outpatient pharmacy at the Cornwall Regional Hospital being scaled down.
Mr Wray’s assertion is misleading when he says that “… Drug Serv outlets no longer provide medications only to patients of public hospital and clinics. They have begun to accept prescriptions from private doctors, too”.
Here are the facts. More than 1.4 million prescriptions were filled at Drug Serv pharmacies for the 2016-2017 fiscal year, with a mere five per cent representing private prescriptions.
There are some private patients, particularly those battling cancer, kidney disease, and HIV, who have difficulty sourcing certain medications. In addition, from time to time, the NHF provides support to the private health sector when it is in need of critical and hard-to-source pharmaceutical and medical supplies. Some of these medications are not stocked in the private sector and are only available from the NHF.
Is Mr Wray suggesting that the NHF should not dispense critical drugs to Jamaicans who are in dire need?
NHF’s MANAGEMENT OF PUBLIC PHARMACIES
Further to the assessment of the service offered by public-sector pharmacies in the auditor general’s report of 2011, Cabinet mandated the NHF to assume management of these pharmacies. Public-sector pharmacies, including Drug Serv, provide free medication on the Vital, Essential and Necessary (VEN) list to patients with prescriptions from public hospitals or health centres.
The NHF recognises that it has an awesome task when it assumes full responsibility for managing public-sector pharmacies. We anticipate that some 2.2 million outpatient prescriptions will be filled annually and that more than 200,000 patients admitted to hospital will require pharmacy services.
Our commitment is to improve service to the public by reducing waiting time, maintaining a strong focus on technology, strengthening the partnership with private pharmacies, and creating a culture of compassionate service for all Jamaicans.
On the matter of the VEN list, Mr Wray asserts that while Drug Serv outlets were originally intended to distribute only a handful of items, they are now dispensing even highly expensive brand-name drugs.
Here are the facts: The Ministry of Health’s VEN list was never created as a “handful of drugs”. The VEN list currently comprises 847 items. The ministry, together with the Pan American Health Organization, the NHF, and clinical experts, is currently reviewing the VEN list as part of a continuous process, as is done in other countries.
In the 2015-2017 pharmaceutical tender for the public sector, a total of 728 awards were made, for which approximately 100 branded items were awarded, representing 13.7%.
The NHF acknowledges that all countries face drug shortages from time to time. The reasons for these shortages include inconsistent supplies from the manufacturers, discontinuation of products, global shortages, and financing arrangements. Within the context of available resources, the NHF was able to achieve an average service level to patients of 85 per cent of prescription items during the 2016-2017 fiscal year.
Strategies to continually improve service level include increased sharing of awards among distributors, improved financing, and increased efficiencies supported by a robust information technology system.
Constructive feedback is helpful as it forces us to look more closely at our policies and helps us identify areas where we can improve our service delivery. All we ask for is fairness and accuracy from contributors and opinion leaders.