Date: June 9, 2017

Board Notice 435 (click here) the Declaratory Order on closed DSPs and penalty co-pays has been published in the Government Gazette for comment at last! This notice invites interested persons to make written representations concerning the intended declaration of certain practices by medical schemes in selecting DSPs and imposing excessive co-payments on members as irregular or undesirable practices by the Medical Schemes, in terms of section 7 of the Financial Institutions (Protection of Funds) Act, 2001 read with section 61 of the Medical Schemes Act, 1998.

Certain Medical Schemes are sure to oppose this declaratory order. We do, however, have strong arguments in support of it. ICPA will submit a comprehensive commentary on why we support this declaratory order and we invite ICPA members to do the same in their individual capacity. If we get this declaratory order implemented it will mean that we will all be able to participate as a DSP as willing providers. More importantly, though, it will mean that if we match the DSP rate our patients will not have to leave us even if we are not a DSP, or they will only pay the nominal difference between the DSP dispensing fee rate and our dispensing fee rate. No longer a penalty on the fee and SEP. Most of our patients would be more than satisfied to have a superior service for a small fee.

A few tips when submitting comment – your submission should be patient focused.

  • How have closed DSPs and penalty co-pays negatively impacted your patients and your ability to provide a comprehensive pharmaceutical service? You may have patients who have not received their medication in time from their courier DSP and have gone without tablets for days, endangering their health, before coming to you and paying cash for a few tablets to tide them over until the DSP can supply them?
  • You may have patients who you cannot effectively counsel because they receive their chronic medicines from one pharmacy, their ARVs from a courier and their acute medicines from you and all they can remember is that they take 5 white pills.
  • You may have DSP patients who choose to get medicine from you but cannot afford the 40% penalty co-pay.
  • How many long-term and loyal patients have you lost over the last few years from Polmed, Bonitas and now Fedhealth? Patients who trust you and are now forced to go courier or corporate against their will, often out of their way to get chronic meds from the DSP but you are good enough to supply their acute meds!

“Call to action”

Your comment should be submitted to The Registrar Council for Medical Schemes legal@medicalschemes.com by no later than 30 June 2017.

The most powerful comment will be those from medical aid members.

Click here for an overview document for customers.

Click here for a template for comment by your affected customers.

Let as many as possible complete the forms, email them to CMS and copy the ICPA office.

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