Column: Tucker On Medications, Policies & More
[Opinion column written by MP Robin Tucker]
It is concerning that critical policies continue to be made without adequate consultation with key stakeholders.
The news that GEHI’s threshold for preapproval of prescription medicines was significantly lowered from $2,000 to $500 benefits the insurance provider as it helps ensure that GEHI pays the lowest prices for prescription medications available.
However, it has worrying impacts for patients and health outcomes, and for the sustainability of some of our smaller pharmacies.
Patients on more than one medication may have to consult with multiple pharmacies to get prescriptions filled, especially if one medication is approved by GEHI, but the others are not.
This may make access to certain medications more complicated and potentially delay treatment in circumstances where getting timely access to medications for patients is critical, especially for those who may be on special or lifesaving drugs.
Consideration must also be given to the pharmacies who will now have primary responsibility for securing pre-approval from GEHI before dispensing medication at or over the $500 limit. Pharmacies therefore assume additional administrative burdens as a result of this policy.
Although a 48 hour turnaround is promised by GEHI, if a request is denied, the approval process may have to be restarted at that pharmacy or at another pharmacy, compounding delays, adding stress for patients and wasted administrative efforts by the pharmacies.
As pharmacies can’t return special medications to their suppliers if they are not approved by GEHI, they may decide not to stock certain costly or hard to come by medications for some patients as they normally would, because there is a risk that GEHI may not approve it. These potential delays and denials add stress for patients and their healthcare providers.
It must be asked, how long does the pharmacy’s approval to supply certain medications last, is it per patient or per the length of time the medication is prescribed?
If medications have to be ordered after approval, there is also risk of delayed delivery as patients will have to wait for their medications to arrive on the island which has the potential of jeopardizing care.
The lowered threshold will also mean more prescriptions requiring pre approval. There is a likelihood that those administrative costs may get passed on to the patient, either from pharmacies or physicians who must intervene and advocate for patients where prescriptions are needed quickly or they will have to be absorbed by the pharmacies, further increasing operational costs. For some pharmacies it may threaten their ability to remain in business. The impact is unlikely to be felt in any significant way on the large insurer-owned pharmacies but it will have impact on small family-owned pharmacies.
A main driver of the GEHI policy change is to ensure that the lowest price for expensive medications is paid by the insurer, but wasn’t that the key purpose of establishing the drug formulary, first announced in 2021? The formulary was to provide a structured list of approved, cost-effective medications.
When giving an update on the progress of the drug formulary in the House of Assembly in March 2023, the Minister of Health said, “The Pharmacy and Therapeutics Committee is up and running, and advises the Health Council on the drug formulary where prices will be regulated. The purpose [of the formulary] is not to control the price of every medication sold in Bermuda. Rather, the Bermuda Drug Formulary will comprise the list of common essential medications along with associated products and devices used in medical treatments, which are intended to be medically appropriate, cost-effective and sold at a regulated price.”
Bermuda has established a drug formulary so why hasn’t it been updated to include the high-cost medications that led to this most recent policy change by GEHI, and use it to reduce or eliminate the need for pre-approval by standardizing insurance coverage decisions for medications in the formulary?
The Pharmacy and Therapeutics Committee has within its scope to evaluate drug utilisation and determine what will be added or removed from the drug formulary, so isn’t that committee an appropriate route to use rather than making access to prescription medications more complex for patients and more burdensome for physicians and pharmacies? If the process can be simplified through actual collaboration with stakeholders, and by using tools already in place, such as the drug formulary, then why aren’t we using them?
- Robin Tucker, Shadow Health Minister
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