NHF’s QMS is ISO 9001:2015 Certified

Government of Jamaica

NATIONAL HEALTH FUND PAYS OUT ON TIME

NATIONAL HEALTH FUND PAYS OUT ON TIME

ANXIOUS to prove it will not starve participating pharmacies of cash, the state-run National Health Fund (NHF) on Thursday paid over its first reimbursement cheque, seven days after it received the invoice.

Health Minister John Junor himself handed over the cheque to Maureen Hemmings, pharmacist and proprietor of the Waltham Park Pharmacy in Kingston, sending a clear signal to pharmacies which have so far adopted a wait-and-see approach, because of fears that the fund would tie up already cash-hungry businesses by not paying on time.

The $2.2-billion National Health Fund holds out the prospect of making health insurance available to a wide group of over 70,000 adults and children, most not covered by private sector-run schemes. The fund covers some 14 chronic illnesses and access to over 70 drugs.

In all, some 71 pharmacies islandwide have signed onto the health insurance scheme, significantly funded by a 23 per cent so-called ‘sin’ tax on tobacco products, which is expected to generate $1 billion; with the balance coming from a $400-million injection from the Ministry of Finance and $800 million from a reconfiguration of the National Insurance Scheme (NIS).

As she accepted the history-making cheque from Junor, Hemmings, clearly relieved, welcomed the fund as offering “help to the poorest folks” and promised to promote the advantages of subscribing to the NHF.

Hemmings’ enthusiasm is not yet shared by some pharmacies which cite bad experiences in the past with getting money in a timely manner from health insurers.

Pharmaceutical Society of Jamaica president, Paul C Lindsay, on the eve of the start-up of the fund, said pharmacies were mostly in favour of it, but were cautious because they could not afford to tie up cash beyond a turnaround time of 10 days.

The NHF has a turnaround time of seven days for claims submitted electronically, while those done manually will take significantly longer.

“So far, only one pharmacy has indicated that it will be submitting manual claims, so we anticipate a smooth system,” NHF public information officer, Rosemarie Lee, told the Sunday Observer.

Another critical concern of pharmacists is the impact the NHF could have on the cost of retail drugs. Beneficiaries’ payments will be determined by the cost of the drug, a move that will likely lead to an increase in the use of cheaper generic drugs, as well as more discriminatory purchasing habits.

However, the portion of the drug cost that the NHF will cover will remain the same, regardless of the sale price.

At the cheque presentation, Junor sought to assure participating pharmacies that they had done the right thing. He said the fund was now well established and that pharmacies were the actual “point of control” at which the exchange of information critical to the care and monitoring of chronic illnesses would take place.

Junor’s message was also aimed at pharmacies such as the popular Liguanea Drug and Garden Centre in Kingston which has not signed onto the National Health Fund and is yet to be convinced about the efficacy of payment under the Government-funded scheme.

“The fund is a wonderful programme if it works,” admitted Shirley Murray, pharmacist at the centre. But she had fears about difficulties in collecting payments from the Government for drugs which pharmacies purchased often on 30-day credit terms and thereby exposed themselves to financial risk.

She cited the case of Barbados where she said a similar programme had failed because of difficulties pharmacists had in collecting from the Government.

“The problem, as I understand it, is that the Government sets the benchmark price for brand ‘X’ drug, which they use as a format for pricing other brands which the subscriber may choose, whether it is more expensive or not. If it costs more, the pharmacist is exposed to a loss as they cannot recover the difference from the Government,” she said.

But Rae Barrett, CEO of the fund, countered that “we don’t get into what the pharmacist charges, it’s a market system. We accept the market system and we have tried to direct the benefits straight through the market to the patient.”

National Health Fund © 2024. All Rights Reserved.