INN Live investigates how millions of dirhams worth of medicines go to waste due to insurance abuse. Gross abuse of insurance in the UAE is resulting in a shocking wastage of medicines worth millions of dirhams.
A landmark study of 2.7 million claims conducted by Accumed PM, a Dubai-based healthcare consultancy this month, has found that the average value of medicines in an insurance claim is as high as 23.31 per cent.
So the question is, can the high costs of medicines and their wastage be ignored?
Industry experts said the wastage occurs most commonly with painkillers, paracetamol, anti-histamines, cough syrups, nasal sprays etc, where the consumption is invariably less than what is sold by pharmacies. Even antibiotics end up in surplus, despite being prescribed in specific quantities for a specific duration.
But pharmacies contend that barring over-the-counter drugs, they are required by law to sell medicines as entire units. Any attempt to do otherwise would amount to tampering, a legal violation.
“The health authorities require that we dispense medicines as one unit. It is standard practice that we sell them in sealed packs and not as individual strips. Let’s say a medicine is prescribed once a day for 20 days, we would still have to sell the sealed pack of 30 tablets, regardless,” said Dr B.N. Rajkumar director of Unicare Medical Center in Bur Dubai which also runs a pharmacy. “Even with OTC drugs, pharmacists can sell single strips, but not cut strips.” Stefan Sickel, General Manager Group Pharmacy and Procurement, Mediclinic Middle East which runs two hospitals and nine clinics in Dubai, said: “One of the reasons pharmacies dispense full boxes of medicines is to comply with batch and expiry control. For example, if a strip of pills is cut in half, the expiry date and batch number print might be lost.”
He said Mediclinic pharmacies usually dispense medicines in full packs. “In most cases, there is no excess medication waste since they are either in the form of a full antibiotic course or monthly chronic medication pills (e.g blood pressure, diabetes, etc). There are some cases where excess tablets are dispensed (i.e pain killers, cough syrups, etc).”
He said: “Controlled medications are strictly regulated and pharmacists only dispense the exact amount as per the prescription. Most of the medicine wastage is in the form of syrups, inhalers or sprays since the patient might not require a full bottle/container. This cannot be avoided.”
Dr Ayham Refaat, managing director of healthcare solutions provider Accumed PM, who did a landmark study of insurance claims in the UAE this month, told INN Live that based on an analysis of a sample of 2.7 million claims with a total value of Dh1.14 billion, he found the value of medicines within a claim to be an average of 23.31 per cent with the cost at Dh266 million.
“When we looked at the drug claims only, we found that out of the Dh266 million, 6.76 per cent were disputed drugs by payers (insurance companies). It amounted to Dh18.03 million. Out of the disputed claims, 17.41 per cent were disputed due to being clinically not justified. This presented the biggest reason for disputed drug claims, according to the payer, of course. However, that doesn’t mean it was not clinically justified or indicated based on the patient’s diagnosis. An accurate judgement of the same cannot be made unless clinical care pathways are implemented.”
According to him there are inconsistencies in prescribing/dispensing medicines for the same diseases. “I would like to stress the regulators’ role in mandating the prescription of the generic name of drugs and help implement clinical care pathways that will define the best treatment steps for a condition, including best recommended medicines, all based on evidence-based studies and thorough analysis of available local market data.”
He said the main issue with medicines in the UAE is the practice to prescribe medicines based on the trade name versus the generic name. “Hence, pharmaceutical companies are accustomed to incentivise doctors and pharmacies to go with their brand. The incentives could be financial or otherwise which means the patient might not be getting the best medicine always, or at least not the most cost-effective one. The regulator should enforce the prescription and dispense medicines based on generic names.”
Sanjay Tolani, managing director of Goodwill Insurance, which has a client base of over 5,000 individuals, said it is a vicious circle which begins with insured residents running to a doctor for the flimsiest reasons and those not taking medicines for the entire course. “People run to the doctor for even a small problem just because they have insurance. When the doctor prescribes medicines based on symptoms, they go pharmacies and collect medicines. But when they start feeling better in a day or two, they stop the medication which results in wastage.”
He said the abuse is prompting many insurance companies to rethink their policies and increase their premiums. “The premiums have been going up by 10-15 per cent every year. Many local [insurance] companies are also setting cut-off limits for pharmacies to dispense medicines on direct billing, beyond which they must seek pre-approval. Some are even mulling co-payments where patients could be asked to pay 10-15 per cent of the medicine costs.”
A concerned consumer in Dubai said there must be a way to put surplus medicines to good use. “My wife suffers from an auto-immune disorder and she is prescribed a painkiller as an SOS. But the quantity we get from the pharmacy is so huge, I invariably take a bagful of the drugs to India and give it away to a charity doctor. It would be great if there is a mechanism like this within the UAE,” he said.
Another resident with a chronic muscular problem said she had collected a huge quantity of painkillers over the years but does not know what to do with them: “I do not have an option of buying less even if I want to.”
But as Dr Refaat’s findings show, the quantity of medicines disbursed is seldom questioned in the event of a claims dispute. Of the disputed claims in his study, only 1.33 per cent were disputed by the payer due to the quantity dispensed being more than prescribed or required.
Dr Rajkumar of Unicare said: “The best solution lies in doctors prescribing the right medicines in correct dosages for the appropriate period of time. It is the responsibility of insurance companies to closely monitor prescribing habits of different doctors, compare and assess data.”
Dr Refaat said the new system of medical coding and other measures taken by the health authorities are helping move towards a more efficient healthcare system.
No comments:
Post a Comment