Pharmaceutical benefit management company Mediscor PBM today announced that medicine expenditure has continued the downward trend first exhibited in 2011, when spend decreased by 5.1%. Commenting on the findings of the 2012 Mediscor Medicines Review (MMR), Christo Rademan, Managing Director of Mediscor PBM, said medicine expenditure has again reflected a decrease, albeit by a slight 0.6%.
“This is good news for healthcare consumers and the medical schemes industry, as it indicates that efforts to control medicine costs are continuing to pay dividends,” he commented.
According to Rademan, there were a number of complex, often inter-related, factors that contributed to the continued reduction in medicine expenditure, noting a 0.8% decrease in the utilisation of medicines among the approximately one million medical scheme members whose medicine usage comes under scrutiny in the MMR. There was little change observed in the item cost of the medicines used, which increased by 0.2%.
“A positive trend in recent years is the fact that healthcare consumers are increasingly using less expensivegeneric medicines,” says MadeleinBester, Manager: Benefit Management of Mediscor. “The number of generic items claimed, or the generic utilisation rate as it is referred to in the MMR, increased to 53.4% in 2012, compared with 52.4% in 2011 and 50% in 2010.”
“An increase in the use of generics results in significant savings for the healthcare consumer, as well as medical schemes,” observes Bester. “The use of generics is encouraged through the implementation of formularies, reference pricing and other benefit design strategies. The MMR indicates that the cost effectiveness of generics is increasingly embraced by funders and ordinary South Africans alike.”
Of general concern is the fact that medicines for the treatment of what are often lifestyle-related medical conditions, such as high blood pressure, high cholesterol levels, and diabetes continue to feature prominently in the top therapeutic groups.
Diseases of lifestyle are becoming a more and more worrying phenomena in South Africa. They are increasing the disease burden and are costing the economy dearly in terms of lost productivity. These diseases are a massive burden on the funding industry. Greater efforts must be made to educate South Africans in this regard, and medical schemes need to meet this challenge urgently.
Top 10 therapeutic groups according to total expenditure 2012
Rank 2012
|
Rank 2011
|
Therapeutic group
|
% Expenditure
|
% Item volume
|
1
|
1
|
Antihypertensive agents
|
11.3
|
12.2
|
2
|
2
|
Cytostatic agents
|
6.4
|
0.3
|
3
|
3
|
Anti-diabetic agents
|
5.6
|
3.8
|
4
|
5
|
Hypolipidaemic agents
|
4.6
|
5.1
|
5
|
4
|
Antidepressant agents
|
4.5
|
3.6
|
6
|
6
|
Gastric acid reducing agents
|
4.1
|
3.1
|
7
|
7
|
Antiviral agents
|
3.1
|
1.4
|
8
|
8
|
Bronchodilators
|
2.8
|
2.0
|
9
|
9
|
Beta-lactam antibiotics
|
2.7
|
3.6
|
10
|
12
|
Antiepileptic agents
|
2.7
|
1.4
|
The top 50 products that were used by medical scheme members were responsible for 21.4% of total expenditure and 13.1% of the total volume of items in 2012. The top five medicines, in order of prevalence are: an insulin, a cytostatic agent, a proton-pump inhibitor, another cytostatic agent and a selective COX2 inhibitor.
Bester says that it is interesting to note that two of the top five products are cytostatic agents, which are innovative and expensive therapies largely used in the treatment of certain cancers. The introduction of such therapies to the market is contributing to more effective management of diseases, but their costs are disproportionately high. For Bester, this adds to the ongoing dilemma faced by medical schemes, of where and how to deploy funds to meet the needs of members in the most clinically and financially appropriate way.
“This is where tight management on the part of healthcare funders can bear fruit whilst affording much-needed protection for hard-pressed healthcare consumers,”says Rademan. “Mediscor remains committed to tackling the challenges of keeping healthcare costs to a minimum, while never losing sight of the fact that medical schemes exist because of their members and that their sole reason for being is to ensure that members receive the most appropriate and cost efficient medical care.
“We will continue playing a pivotal role in the industry by identifying and actively managing cost drivers, and by working in close partnership with our clients to stem the tide of runaway medicine costs to ensure the long- term sustainability of the healthcare funding industry,” concludes Rademan.
