Simon Henderson – Utilisation of EDL drugs in the

ESSENTIAL DRUG LIST TRANSLATED
TO MEDICAL SCHEMES
Milestones
• Positioning of work conducted
• What is EDL?
• Approach
• Results
• Comments
POSITIONING
Positioning
• Pilot review of the impact of applying the Essential drug list from NDoH on
medical scheme medication
• Requested as a initial investigation by BHF research
• curiosity
• Aim to generate thought and further research
• Question:
• Can we map the EDL to current utilisation of medial scheme benefits?
• What coverage is already in the system?
• Would there be a big switch between medications?
• Cost impact?
• Impact of
• MMAP movements
• Moving to State Tender prices
Positioning
• Some assumptions were made in the review in order to
render the results
• Creams and ointments were not included
• Difficult to exactly match the dosages etc.
• Some difference in the active ingredients were not a
adequate match
• Multiple drug allocations
• Isolated chronic conditions (CDL)
• Used claims data from January 2014 to April 2014
• So a small sub-set of all claims
• Hence the results may differ once all medication/conditions
are examined
Positioning
• Questions / comment raised in other discussions
• Primary health care offering
• Acute medication
• Chronic medication
• PMB’s not the long term solution
• Are there alternatives?
WHAT IS THE ESSENTIAL
DRUG LIST
What is the Essential Drug List (EDL)?
• Forms part of the NDoH Essential Drug Programme (EDP)
“The NDP aims to provide equal access to medicines for all South Africans
through the Essential Drugs Programme, which will include an Essential
Medicines List and Standard Treatment Guidelines.” NdoH website
• Introduces as policy in 1996
• Aims
•
•
•
•
•
Developing and maintaining a medicines list for all State providers
Provide equal access to medicines
Increase and maintain adequate supply of limited medication
Improved prices
Meet the needs of priority medicines for the population of South Arica
What is the Essential Drug List (EDL)?
• Approximately 520 listed medications
• 1,773 on SEP list
• Regularly updated - 2014 list
Medicine
INN
Combination
ATC
PHC 08
Adult 12
Acetylcholine Acetylcholine
chloride
chloride
H01AA
HA12
Acetylcysteine Acetylcysteine
V03AB23
HA12
Zuclopenthixol
Zuclopenthixol
acetate
N05AF05
PHC08
HA12
Zuclopenthixol
Zuclopenthixol
decanoate
N05AF05
PHC08
HA12
Paeds 13
HP13
4LL13
APPROACH
Approach
• Used ATC classes to provide an initial match to the
medicines in the medical schemes environment
• Match reviewed and adjusted as required
• Ensuring a correct match for active ingredients
• Strength of medication
• Pack size to ensure consistency of prices for impact
consideration
• Matched approximately 51.2% by cost
• Indicative of further refinement
• E.g. matching of creams and ointments
• Where price/quantity differentials did not make sense
Approach
• Multiple manufacturers
Adjustment for strength and
pack size to develop
equivalence
• Multiple prices
• Multiple strengths
Nappi
Nappi
Description
Strength
ATC5
ATC5
Description
703541
Prexum
4mg
C09AA04
Perindopril
705915
Coversyl
10mg
C09AA04
Perindopril
710297
Vectoryl
4mg
C09AA04
Perindopril
710302
Cipla-Perindopril
4mg
C09AA04
Perindopril
710510
Cipla-Perindopril
8mg
C09AA04
Perindopril
Pack SEP
103.20
219.00
81.00
125.70
125.70
NSN contract
EML Name
Contract Price
180004133
Perindopril 4 mg
28 tablets
10.27
180004133
Perindopril 4 mg
28 tablets
10.27
180004133
Perindopril 4 mg
28 tablets
10.27
180004133
Perindopril 4 mg
28 tablets
10.27
180004133
Perindopril 4 mg
28 tablets
10.27
RESULTS
Results
• Started at looking at options within the SEP and MMAP
structures
• Still some room to move
• Set base to R100.00
SEP
MMAP High
MMAP Average
MMAP Low
Switched SEP
100.00
116.26
97.71
85.42
88.49
Change
-16.26
2.29
14.58
11.51
Percentage change
-16.3%
2.3%
14.6%
11.5%
PLPM
0.02
0.28
0.50
0.77
0.99
1.26
1.52
1.77
2.06
2.34
2.62
2.93
3.26
3.58
3.93
4.33
4.69
5.04
5.39
5.85
6.24
6.68
7.15
7.66
8.24
8.97
9.78
10.69
11.55
13.38
16.19
19.66
24.66
44.28
84.68
339.49
Costs
Results
SEP
43.1% of members
switched
SEP
MMAP_High
MMAP_Average
MMAP_Low
Switched SEP
Results
• Now applying to State Tender Price
• More for curiosity
0.02
0.23
0.44
0.64
0.85
1.05
1.27
1.49
1.70
1.93
2.18
2.40
2.64
2.91
3.17
3.45
3.68
4.02
4.36
4.68
4.96
5.25
5.62
5.98
6.31
6.68
7.08
7.54
7.95
8.42
9.10
9.80
10.59
11.35
12.42
14.84
16.78
19.93
24.52
36.31
62.60
114.28
648.95
Costs
Results
SEP
SEP
MMAP_High
Switched SEP
EDL
Population Adjusted
Results
SEP
MMAP High
Switched SEP
EDL
Population
adjustment
100.00
116.26
88.49
17.43
31.17
Change
-16.26
11.51
82.57
68.83
Percentage change
-16.3%
11.5%
82.6%
68.8%
PLPM
COMMENTS
Comments
• Moving to MMAP Low similar to EDL
• Potential for further reduction in the cost of
medication in the industry
• But consider the impact (consequences) on
industry
• Beneficiaries
• Choice may be removed
• Ok for low (PMB) plans?
• “It does not work for me” / Noise
Comments
• Pharmacies
• via dispensing fee,
• range of medications/choice,
• and stock
• Manufacturers
• Reduced R&D
• Less incentive to innovate
• Etc.
Comments
• Appetite of industry to engage in debate and “move
the market”
• Point of departure for further research and
investigation
• Potential for consideration to use EDL as a benefit set
• Move away from CDL structure – variation of “PMB”?
• Increased access for primary care benefits?
THANK YOU

Download Report