A shambolic free medicine scheme
Monday 20th August 2020
A National Federation Party government will give true meaning to Free Medicine Scheme by: –
increasing the threshold of income to $30,000 from the current $20,000 to ensure more of our people benefit from the Scheme
giving true meaning to “free” by ensuring all those who qualify for the Scheme are able to receive any medication prescribed by a doctor – not just the 142 generic medicines selected by Government, which are often not available
enabling private pharmacies to send monthly bills to the Health Ministry on the total cost of free medicine dispensed to eligible patients
ensuring all private pharmacies are equipped with a separate information system specifically for the Scheme and connected to the database of recipients at the Health Ministry – unlike the current system of paperwork and paper shuffling
ensuring all prescribed medications are zero-rated or VAT-free. This will reduce the cost of medicine for everyone, especially those who are not eligible for the Scheme
The so-called Free Medicine Program was announced in the 2015 National Budget.
“Turning promises into deeds” was that Budget’s theme. One of the promises of Fiji First Government was to put price control on all medicines prescribed by doctors, even for Non-Communicable Diseases, for those earning less than $20,000 per year.
But when the scheme was implemented only 70 price control medicines were listed as free medicine. This was eventually increased to 142 prescribed price control medicines in 2016.
Because the scheme is poorly thought out, strange contradictions occur. Adults are entitled to free medicine if their yearly incomes are below $20,000. Children under 18 are entitled to free medicine if the income of their household is below $20,000 per year.
So if a husband and a wife each earn $15,000 per year they will be eligible for free medicine – but their children will not, because their parents’ combined income is over $20,000!
A week ago, the Health Minister revealed at the Fiji Pharmaceutical Society annual general meeting that 31,000 Fijians were benefiting from the Scheme. But for the above reasons, many of their children will not be.
Like the Fiji First promise to maintain zero-rated VAT on seven basic food items and medicines, the free medicine scheme has not turned “promises into deeds”. It has turned promises into broken promises.
Cosmetic changes and bureaucracy
In the 2018-19 Budget, cosmetic changes were made to the Scheme after the NFP demanded that it be reviewed. The only change is that pharmacies can buy their own stocks of the 142 free medicines in the Scheme and then claim the cost from Government.
But this is still restricted to 142 approved medicines, a vast majority of them being generic. Patients under this scheme will still not be able to get free medicine that is not on the list.
While one-third of our population live in poverty and thousands of others earn less than $20,000 annually, why isn’t the number of beneficiaries higher than 31,000?
The answer is bureaucracy. It is the same as running around to get one’s documents to qualify for a water subsidy or electricity subsidy. People are defeated by the paperwork they have to do.
The electricity subsidy, when it was initially announced, would have saved a recipient less than $20 per year. The water subsidy saving was less than $14. The savings are not much more now.
But by the time you ran from one place to another getting copies of the necessary certificates and evidence and filling out application forms, the cost of doing so would be more than the savings.
Free prescribed basic medicine can save you a maximum of $400 in one year – that is, if you are sick for most days in a year and need prescribed, price-controlled generic medicine for more than 150 days in one year. If you are that sick, you will still be spending a lot of money on medication.
So we need to make the system simpler and more accessible. That is what NFP will do.
The retail pharmacies have been forced to participate in the free medicine scheme because if they don’t, they can be fined up to $100,000. If the system does not work for the pharmacies they will find ways to avoid participating, which defeats the purpose of the Scheme.
Most pharmacists are compassionate people. They have chosen their profession so they can help others. They do not need to be threatened to do that.
But they are also in business. Putting in a scheme to benefit poor people should be at the Government’s cost, not the pharmacies’ cost.
Retail pharmacies have to provide space to store free medicine or whatever stock is supplied. Then their staff have to manually record recipient’s details and also that of the prescription. All this is done manually.
They don’t have direct access to the Ministry of Health computers to electronically ascertain the eligibility of the recipient. The electronic link to Ministry of Health database was promised by Government almost four years ago but has not been fulfilled.
Worse still, pharmaceutical staff have to tolerate abuse when they are told medication prescribed by the doctors is either not available or is not free. In many retail pharmacies the full list of 142 medicines is not available because the Government could not arrange supplies to them in the first place.
Recently we checked with a large retail pharmacy in Suva, one of the busiest and strategically located. That pharmacy had only 50 of the 142 listed medicines at one stage.
We have also found out that only one staff member at the Government Pharmacy looks after supplies of free medicine to 52 retail pharmacies. That is why stocks are either depleted or expire before they are used.
In 2018, $15,000 worth of insulin under the free medicine scheme expired in retail pharmacies when stocks had run out in public hospitals. There is no information and no co-ordination. These are simple problems to fix but the Government seems incapable of fixing them.
Simply put, the free medicine scheme is in a shambolic state. It needs to be reviewed urgently to bring about efficiency and to ensure it is fully maximised by all those eligible recipients.
We will also: –
change the eligibility criteria so that people under 18 years of age can have access to the scheme if both of their parents earn less than $30,000. In this way they have will have the same benefits as their parents
implement a truly genuine free medicine scheme where those eligible can access any medicine prescribed by the doctor. This means there is no need for pharmacists to wait for an inefficient Government system to supply them free medicines that may be overstocked, under-supplied or expiring.
Solving the problems of free medicine are not about additional cost. It is about working together with pharmacies, consulting them and learning from them, because they understand their patients.
It is about being smarter in the management of medicine stocks. Almost every retail shop in Fiji manages its inventories properly because its business depends on being efficient. If Government cannot be efficient, we will make sure that business teaches us how to be, in the interests of patients.
The Government seems to think that the Free Medicine Scheme exists so its Ministers can boast about it. An NFP Government will talk less and work more with the experts to make sure that the scheme works for the benefit of ordinary people. It is their taxes who pay for it.
After all the Free Medicine Scheme is for the people’s benefit. Not the Government’s.
By Hon. Professor Biman Prasad