Copayment change

Annabel Young, Pharmacy Guild chief executive, recently touted the idea of a two-tiered pharmaceutical copayment system, where people would either be charged $3 or $15 for their prescriptions, depending on their ability to pay.

It has prompted discussions within pharmacy circles.

Pharmacybrands chief executive Alan Wham says the copayment system should be up for debate, and many agree the system needs to change.

Ms Young’s idea was floated to a panel responsible for finding a way to improve New Zealanders’ access to high-cost, highly specialised medicines.

Auckland pharmacist and Waitemata DHB member Warren Flaunty says he can understand the guild’s point.

Mr Flaunty says, when the fees were reduced to the $3 level, there was an increase in dispensing, and the DHBs picked up the extra costs instead of the patient.

“Customers were surprised at the cheaper costs and we had a difficult job convincing them that it was not a mistake.”

Mr Flaunty says, rather than a two-tier system, there should be nothing to pay for those who don’t have the ability to pay, or $15 for those who do.

“This would create huge savings for DHBs. It would improve access for those in the lower socioeconomic group and assist in eliminating in-equalities.”

Denise Wood, chief executive of the Researched Medicines Industry, would also like to see a review of the current copayment system.

She says other country’s systems consider exemptions for certain groups of patients, such as pregnant women, or those suffering from illnesses like diabetes, as well as subsidies for low income households.

Some systems offer patients the option of paying the actual cost of the medicine if lower than the prescription charge.

Ms Wood says New Zealanders who can afford it may be comfortable with paying a higher copayment, but would want to be assured any freed-up funds are spent on the highest priority medicines on the waiting list and not absorbed elsewhere.

“The RMI also suggests, as well as reviewing the method and level of copayments in New Zealand, funding of certain low cost, over-the-counter medicines, for example, some antihistamines and analgesics, be reviewed to further release funds.”

Veteran pharmacist Des Adams does not think all freed-up funds should be earmarked for new, innovative medicines. Mr Adams believes pharmacy services such as MURs and chronic disease management could be funded through a copayment system.

He suggests a deprivation model be put in place, where people are categorised according to their deprivation status and are charged a percentage of the copayment fee. For example, if there is a $3 copayment fee, those on the highest deprivation level would pay 0.7% of the fee ($2.10) while those on a lower deprivation level would pay 1.4% ($4.20).

Mr Wham says those who can afford it should pay a higher copayment fee.

He believes the argument that a regular $15 copayment fee could be a barrier for many to access healthcare is not entirely valid because of the intervention fee.

“Patients paying a $50 or $100 intervention fee, depending on how long a pharmacist has spent on the prescription, is a lot more of a barrier than a regular $15 copayment.”

Intervention fee
Mr Adams believes charging an intervention fee can be confrontational to many patients. He would like them dropped in favour of a smaller, incremental levy across the board.

“It would be much better to do what the banks do, levy it across everyone.”

Mr Wham says intervention fees do not foster relationships within primary care.

“Often the intervention occurs when the doctor has made a mistake on a prescription. We want to improve links within primary care, and charging an intervention fee will not foster these.” RN

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