Imsa represents the local offices of six multinational pharmaceutical
companies, which have been dealt a double legal whammy since 2004. No price
increases have since been allowed, and it is now mandatory for pharmacists to
offer patients cheaper generic alternatives to Imsa's medicines.
Referring to the latest Council for Medical Schemes annual report, published
last month, Imsa executive director Val Beaumont said: "Medical schemes are
paying a lot less for medicines, yet despite these savings they are shifting
benefits from the risk pool to members' medical savings accounts."
This meant members were effectively forced to fund more of their medicine
costs out of their own pockets, she said.
"Schemes are doing this as a cost-saving mechanism because it's
easy," she said.
The greatest portion of scheme members' contributions are paid into a risk
pool, used to cross-subsidise members' bills for specified conditions. Some
members elect to pay into a medical savings account, which they use for medical
expenses incurred out of hospital.
The council's 2005-06 report shows total medicine expenditure was 8,8% down
on the previous year's, from R7,9bn to R7,7bn. Medicine claims paid out from the
risk pool in 2005-06 totalled R5,64bn, a drop of 11,4% on the previous year's
R6,37bn.
Claims from members' medical savings accounts remained constant at R1,56bn.
The proportion of medicines paid for from members' savings accounts increased
slightly from 19,7% to 20,2% in the review period. Medical scheme membership
rose slightly (2,6%) during this time, to 6,8-million.
"We are seeing a huge squeeze on medicine expenditure, but not on
administrative costs," she said.
Council spokeswoman Pat Sidley said schemes' attempts to shift claims from
risk pool to savings accounts were not unique to medicine.
Medical schemes tried to place as much risk as possible with members, she
said.
The council's report shows administrative costs rose to R5,4bn last year, up
10,4% on the 2004 figure.
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