The National Health Insurance Authority (NHIA) has reviewed upwards the prices of medicines and services paid to providers and suppliers on the health insurance scheme, with effect from yesterday.
It has also reviewed the list of medicines on the scheme to include, Artemether Injection 50mg/ml, which is widely used for the treatment of uncomplicated malaria (Plasmodium falciparum), and Levofloxacin Infusion, a drug used to treat bacterial infections in different parts of the body.
Providing details of the review to the Daily Graphic, the Chief Executive of the NHIA, Dr Bernard Okoe Boye, said the prices of framework medicines had been increased by 80 per cent, while non-framework medicines had been reviewed upwards by 20 per cent.
He described framework medicines as those used by the scheme and ascribed fixed prices that had been negotiated and agreed upon by stakeholders, such as manufacturers and the Ministry of Health, together with the NHIA.
Non-framework medicines, on the other hand, are medicines outside the framework box.
Dr Okoe Boye said the negotiations for the revision facilitated a 50 per cent increment in framework medicine prices, which reflected production cost.
However, the NHIA added 30 per cent to cover other expenses in the delivery of the medicines to bring their prices on the National Health Insurance Scheme (NHIS) closer to market prices.
He said all medicines outside the framework box, also known as non-framework medicines, which could be supplied by any dealer or manufacturer, in line with provisions of the law, had also been increased by 20 per cent.
Also, fees paid to service providers for all services rendered under the scheme, such as surgical processes, had also been increased by 10 per cent across the board, he said.
“The approved list will be disseminated through the respective provider associations. I hope that these reviewed documents will be implemented by your respective groupings according to the contractual arrangements in place,” Dr Okoe Boye told service providers.
He added that the reviews were in accordance with the National Health Insurance Act, 2012 (Act 852), explaining that they were necessary to enhance service delivery for subscribers and give providers value for money to avoid certain gaps in access to medications and services under the scheme.
He indicated that if market prices of medicines were higher than what the NHIS was paying, service providers would prescribe the medicines but would not dispense them to patients to avoid making losses.
“Some facilities will not stock the medications, meaning that patients or patrons of NHIS facilities would have to go through the inconvenience of moving from the facilities where they accessed care to other outlets to get medications.
“Others also illegally charge small fees to make up for the gap in tariffs for medicines on the market and those under the scheme,” Dr Okoe Boye said.
To avoid such inconveniences and illegalities, the NHIA, through consultations and market reviews, carried out periodic reviews to offer providers “something very close to market prices, if not the same”, he said.
The Daily Graphic gathered that a similar review was done last year, effective July 4, last year, after the scheme and stakeholders had undertaken a market survey of prices and agreed on the figure largely on the basis of inflation and some other variables.
Dr Okoe Boye, at the time, had explained that the last review before that of 2022 was about five years ago and was done because the scheme realised that the charges were unrealistic, after stakeholders had undertaken a scientific review of the prices.
The NHIA explained that the 30 per cent increment in July last year was imposed on the agreed 2020 increment of medicines and services tariffs for service providers.