Understanding the decision making process of selection of medicines in the private sector in South Africa – lessons for low-middle income countries

Abstract

Background: The affordability of essential medicines is a challenge in achieving Universal Health Coverage (UHC). One of The Lancet Commission's recommendations on financing of essential medicines is to ensure governments and national health systems include essential medicines in the benefit packages provided by public and private healthcare sectors. Currently in South Africa (SA), there is a dearth of information on the processes for medicines selection for private sector medical scheme formularies. This study aimed to improve the understanding of how formulary managers of selected medical schemes made decisions for the selection of medicines for their formularies. This paper described their opinions obtained from in-depth interviews. Methods: Qualitative in-depth interviews were conducted with 10 individuals from 7 private sector medical schemes and administrators in SA. All participants interviewed were involved in formulary development and management. Interviews were conducted from June 2013-January 2015. Interviews were guided by a discussion guide and audio recorded. Recorded interviews were transcribed verbatim. Transcripts were coded by the first author, corroborated by the second author, reconciled, and imported into NVIVO for data analysis. Results: Schemes and administrators had similar formulary decision making and management committees in place (viz. Clinical and Therapeutics committees). The process of and criteria for medicines selection and evidence based review of formularies were also similar. Selection of medicines was inherent in the formulary review process. Medicine price was important in the decision taken to list medicines. Most schemes expressed a difficulty with lack of information to support pharmacoeconomic evaluations of medicines for inclusion on the formulary. This together with the basic monitoring of use of medicines by patients for most schemes left room for improvement in the decision making process for those schemes.

Implementing essential diagnostics-learning from essential medicines: A scoping review

“…The barriers for the implementation of the EML are similar to the EDL barriers reported above, and the main barriers were poor financial access 39,48,78,79,83,[86][87][88][89]104,110,136,[140][141][142][143][144][145][146][147][148][149] , poor geographical access 36,65,74,82,104,143,146,150 and health facility access 73,74,106,[150][151][152] .…”

“…Similar barriers were identified in the implementation of EML 43, 49, 65, 173 . Other barriers unique to the EML included poor information management practices 50, 110, 111, 122, 125, 137, 142 consisting of poor record- keeping, lack of standardized treatment protocols in health facilities, lack of reporting procedures and structured ordering systems 107, 131, 146, 176 , and inadequate capacity to support information systems 70, 105, 138 .…”

“…Lack of accountability was highlighted as a barrier to EML implementation. These included a lack of accountability of authorities on medicines orders, procurement, distribution, stock management, and delay in disbursement of health funds 94, 109, 110, 142, 156 . Poor accountability of personnel in the ministry of health and community-based health insurance financing 87, 110, 156, 164 and inconsistent inventory records 111 in the facility were also highlighted as barriers to EML implementation.…”

“…Barriers to the EML implementation included market ideologies where generic medicines enter the market without a review process 142 , and political ideologies where facilities are built for political and economic purposes and without the involvement of the communities 73 and a disconnect between insurance drug list and drug prescription guidelines 41 . Community beliefs and attitudes negatively influenced the use of internationally controlled essential medicines (ICEMs) by patients with end-stage diseases 146 .…”

An Evaluation of the Reflective Constructs Influencing Community Pharmacists’ Decision-to-Procure from Pharmaceutical Suppliers: A Structural Equation Modeling Study

“…Community pharmacists are expected to maintain a practical balance between their commercial interests and the welfare of the patient [Hepler & Strand, 1990;. Therefore, procurement decisions should be guided by considerations such as cost, affordability, and business profitability [Mathews et al, 2020: Lee et al, 2021: Suh, 2011, service quality from suppliers [Njoki & Kimiti, 2018], and product quality [Njoki & Kimiti, 2018: Giralt et al, 2020, the type of product selected whether generic or substitutes or branded medicines [Seeley & Singh, 2021: Dedrick and Eckel, 1984: You et al, 2019: Perumal-Pillay and Suleman, 2020: Desai et al, 2019 and quantity of products requested. [Dubois et al, 2019].…”