Medical schemes to cover AIDS drugs?

 Government is likely to expand the prescribed minimum benefits that medical aid schemes are compelled to offer to members to include antiretroviral drugs, according to Dr Leighton McDonald, executive manager of the health risk management organisation, Qualsa.

‘€At present, medical schemes do not have to offer antiretroviral drugs, but we expect that there will be a move towards that,’€ McDonald told the Metropolitan HIV/AIDS conference in Maputo.

This is particularly important as government moves towards offering the drugs in the public sector. The Treatment Action Campaign has already expressed concern that medical schemes may ‘€œdump’€ AIDS patients on state hospitals to save themselves money once the drugs are available in the public sector.

However, at the same time medical inflation is double the normal inflation rate and most medical schemes have not attracted new members for the past five years because
medical cover has become so expensive.

Adding an ARV component to the prescribed benefits could well push prices higher, particularly as medical schemes are compelled to buy the drugs at market prices.

McDonald said the monthly cost of triple therapy this year was between R510 for Combivir and nevirapine and R525 for Combivir and efavirenz, the two most common regimens.

Government can procure the drugs far cheaper which means ARV treatment in the public sector will cost a fraction of the cost in the private sector.

Recently, pharmaceutical giants Boehringer Ingelheim (BI) and Glaxo Smith Kline (GSK) granted local manufacturer Aspen Pharmacare licenses to manufacture generic versions of their ARV drugs.  

However, BI has said that the generic version of its drug, nevirapine, can only be sold to government. GSK has said that generic versions of AZT and lamudine can only be sold to government, NGOs and employers who treat their workers who are not on medical schemes.

“This is wrong,’€ says the TAC. ‘€œMost poor people in rural areas buy their medicines from doctors and pharmacies in the private sector.

“If more people could afford to buy the medicines in the private sector, they are less likely to use the public sector to get their ARVs. This can reduce the burden on the
public sector.’€

TAC also notes that ‘€œmedical schemes are also under financial pressure due to the HIV epidemic. To ensure that they offer acceptable benefits to people with HIV and that more people are able to access medical scheme cover, it is important to keep ARV prices as low as possible in the private sector as well as the public sector’€.

At present, not many people are enrolled in the medical schemes’€™ HIV/AIDS programmes, but McDonald attributed this to both the fact that most people did not know their HIV status and to employee concerns that their HIV status may not be kept confidential in an employer-sponsored scheme.

“Once confidentiality is guaranteed, people come forward,’€ he noted.

McDonald also said that some employers who were treating their employees for HIV/AIDS regarded this as a taxable benefit and were deducting tax from these employees.

‘€œThere need to be tax breaks for HIV/AIDS treatment,’€ he said. Employers were grappling with decisions such as whether they should treat employees’€™ dependents and whether they could afford life-long treatment.

‘€œThere is a lot of corporate denial. But it is better to start treatment than to delay it because of these issues,’€ urged McDonald.

E-mail Kerry Cullinan

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