Now is the time to have your say about a common and restrictive medical scheme practice known as closed Designated Service Providers (DSPs).

The Independent Community Pharmacy Association (ICPA) has been challenging the practice of closed DSPs for several years as they believe it does not have the interests of the consumer, or pharmacies, at heart.

Now the Council for Medical Schemes (CMS) has published, for comment, their intention to do away with closed DSPs and to re-look at the way co-payments are calculated.

What are closed DSPs?

A DSP (Designated Service Provider) is a healthcare provider network (doctor, pharmacist, hospital etc.) appointed by your medical scheme to diagnose, treat or care for their members.

“However, many medical schemes in South Africa have imposed very restrictive closed DSPs that effectively deprive medical scheme members of choice when it comes to where they can get their medicines from,” explains Jackie Maimin, CEO of the ICPA.

WIN a R 2,000 Woolworths Voucher

Subscribe to our Free Daily All4Women Newsletter to enter

How does it affect us?

“Coupled with the issue of closed DSPs is the fact that if people choose to get their PMB chronic medicines from a non-DSP pharmacy they will be charged a hefty penalty co-payment,” says Maimin.

“While we accept that some co-payments may be necessary, we are challenging how these co-payments are calculated, as we believe the penalties are too high and often patients end up paying as much as 40% – 100% of the total cost of their medicines out of their own pocket. It is also critical that a patient’s history of medicine taking, acute or chronic, is managed in a single environment to avoid the possibility of dangerous drug interactions.”

The negative impacts of closed DSPs

  • Impinges on your right to choose your own healthcare provider could be violated.
  • You may have to pay an exorbitant penalty co-payment if you voluntarily decide to use a non-DSP provider even if that provider supplies goods and services at the DSP rate.
  • If your medical scheme chooses a courier pharmacy as the DSP then you lose the global gold standard in pharmaceutical healthcare which is face-to-face consultation with a pharmacist.
  • You will also have to adjust your schedule to fit in with the courier company’s delivery times and not vice-versa.
  • DSPs can result in discordance of healthcare when chronic, acute and OTC medicines are supplied from different pharmacies. A pharmacist cannot effectively monitor your medicine regimen for potential adverse effects and drug-drug interactions if they do not have your complete medication history. This fragmentation of pharmacy providers can lead to unintended clashes in medicines as the different pharmacists are unaware of the other medicines.
  • You may have to travel further to get to your Schemes DSP which will incur additional travelling costs and time.

“Basically, it boils down to consumers being able to buy their medicines from a pharmacist they trust at a pharmacy of their choice without being penalised.”

How to make your voice heard

The CMS, via Board Notice 435 of 2017, invites interested persons to make written representations concerning their intention to declare certain practices by medical schemes in selecting DSP providers and imposing excessive co-payments on members as irregular or undesirable practices.

“The ICPA believes that this practice violates the constitutional right of medical scheme members to choose where they wish to have their medicines dispensed, to choose which doctors they wish to consult and to choose where they would like to be hospitalised,” says Maimin.

“This is the opportunity to stop this undesirable practice and everyone has until the end of June to make comment to the Council for Medical Schemes and the Minister of Health. If a closed DSP has negatively affected you, a loved one or someone you know, please visit your local pharmacy to fill in a commentary form. You may leave it with the pharmacist who will forward your comments to the CMS for you.”

Alternatively, interested parties may provide comment directly to the CMS by writing to the Registrar of Medical Schemes (attention: Alicia Schoeman), Block A, Eco Glades, 2 Office Park, 420 Witch-Hazel Ave, Eco Park, Centurion or email: legal @medicalschemes.com.

You have the right to choose

Several years ago the ICPA challenged the CMS to do away with closed DSPs and to re-look at the way penalty co-payments were calculated.

The CMS, in concurrence with the Minister of Health, has now agreed to declare these as undesirable business practises and have thus published the proposed amendments for commentary.

“You have the right to health and you have the right to choose your healthcare provider including a pharmacy of your choice without being unfairly penalised. Exercise your rights,” concludes Maimin.

While All4Women endeavours to ensure health articles are based on scientific research, health articles should not be considered as a replacement for professional medical advice. Should you have concerns related to this content, it is advised that you discuss them with your personal healthcare provider.