HIV/AIDS Treatment Shock

The research shows that only 25 of SA's 64 largest employers know how many of their workers are on HIV/Aids disease-management programmes or are receiving ARVs. The findings come as a shock as many of SA's largest companies have over the past two years announced HIV/ Aids programmes for their workers that include treatment with ARVs.The study, Treatment of HIV/Aids at SA's largest employers: myth or reality, surveyed companies employing more than 6 000 workers.The 25 companies, with 656 000 workers, have only 26 255 employees (4%) on HIV/Aids disease management programmes and just 3 908 (0,6%) receive ARVs.

This compares with about 20 000 on government's slow-moving programme who receive ARVs through the public sector.More workers are probably covered by medical aid. But not all have medical cover. Aid for Aids, a company that manages HIV/Aids programmes for 44 medical schemes covering 1,5m people, says 23 637 (1,5%) members are on HIV/Aids management programmes.
Most of these are on antiretrovirals because they join the programme when they are already sick, says director Rodney Cowlin. Only a few companies make up most of the 3 908 workers receiving ARVs. Anglo American, for example, has more than 1 000 of its SA employees on treatment.

The contribution by the largest employers to national treatment goals needs to be viewed with caution, says Boston University research associate Patrick Connelly. And the scale and quality of these programmes still needs to be evaluated.Until now no quantitative studies on how many people are accessing ARVs in the workplace have been done.

The low uptake of treatment is puzzling: about 10% of workers in these companies should already be so sick that they need ARV treatment.Connelly says there are a number of reasons for this benefit being so underutilised. Stigma is largely to blame: many workers don't want their company to know they have the disease. Also, most workplace ARV programmes were started only in the past year or so.
Many companies waited to see what the government ARV programme would deliver, says Cowlin. This year, as they realise government is prioritising the unemployed and probably won't reach their sick workers, they are starting their own programmes.

Companies will now have to move to the next level, not just providing HIV/Aids services, but questioning the quality of the methods of delivering services and encouraging employees to access them, says Connelly.
Connelly found that at 52 of the 64 top private-sector companies surveyed , 48% make the benefit available to all workers and, of the 951 000 employees at these companies, 80% are eligible.

The mining and financial services sectors lead in providing HIV/Aids services. Connelly says all the financial services companies surveyed and 75% of mining companies offer ARV treatment to all employees. But only 31% of retail companies offer similar benefits to all workers. No construction companies offer ARV benefits to all employees.The report says companies with in-house HIV/Aids management programmes get more people onto treatment than those using medical aid.

In most companies only a minority of workers have medical cover and even then, despite the benefits offered to many medical scheme members, only a few take them up, he says

Financial Mail 14 January 2005
The department of health has urged the public to report pharmacists not abiding by the maximum R26 dispensing fee rule for medication. The government insists this is the legal maximum that pharmacists may charge. We urge South Africans to refuse to be subjected to this exploitation. The violation of the medicine pricing regulations, which put the dispensing fee at 26 percent to the maximum of R26 for prescribed medicines, should be reported to the Department of Health, a statement said on Monday.

There are retail pharmacies that are complying with medicine pricing regulations and we request the public to shop around to get good prices that are regulated by government. It used a model prepared by Managed HealthCare Systems for a group of pharmacists' submission to the Department of Health's pricing committee before new regulations were introduced last year, as an example of price differences.

The department claimed that under the MHS system a manufacturer could sell a packet of 20 Stopayne tablets at about R31,45. Pharmacists will add a fixed fee of R5,50, putting the price at R36,95 before charging another 50 percent (R18,48) of this amount. The medicine will end up selling at R55,43. This means that the pharmacist will end up making a return of 76 percent (R23.98) on a medicine bought from the manufacturer at R31,45.When applying government pricing regulations the same medicine would cost R39,63.

When approached for comment the PSSA's executive director Ivan Kotze said that the department had skewed it totally by using two extremes. The department's 26 percent calculation would reveal a 2,1 percent total income on a medicine costing R1000.He said that it was against the Competition Act for the PSSA to tell its members what to charge. We are advising our members to apply whatever (pricing model) they want, Kotze said.

The MHS model or parts of it was just one option available.

In December the Supreme Court of Appeals (SCA) declared the Health Department's latest pricing regulations invalid following an application by a group of pharmacists. The health Department had asked the Constitutional Court for leave to appeal this and said that their action resuscitated the regulations.

The matter will be heard on March 15. Legal experts, however, are divided on the matter. In terms of court rules an order of a High Court can be suspended pending an application to the SCA, and SCA judge explained. However, there was no guidance on whether an order may actually be suspended or remains in place when a matter is taken from the SCA to the Constitutional Court, as this had never happened before.

Both the health department and the pharmacists had their own interpretation of what the current legal position was. Meanwhile, pharmacists across the country were selecting their own pricing structures with some using the new regulations, other using the old and others devising their own fees.

(Source: Sapa, January 17, 2005)