Scriptpharm FAQ - Scriptpharm

FAQ

What is Drug Utilisation Review (DUR)?

Drug Utilisation Review (DUR) is a comprehensive review by our Scriptpharm DUR department of your medication, therapy options and alternatives that may be more cost-effective and beneficial to your health and well-being, taking into account your personal circumstances and needs. DUR has an immediate and direct effect on your care by detecting discrepancies before a prescription is dispensed. This is based on the professional judgement of pharmacists.

The DUR process involves the pharmacist reviewing your prescription for the following:

Cost effectiveness of the drugs prescribed
Making therapeutic & generic interventions
Excessive or significant under or over usage of medication
Problematic medicine interactions like:
- Drug-to-drug interactions
- Drug-to-age conflict
- Medicine duplication
- Insufficient/excessive drug doses
- Drug-to-disease contra-indications
Control of substance abuse

DUR is designed to contain costs without compromising on the quality of care for you, the patient. The DUR process includes implementing protocols to ensure the best clinical practice and are based on local and international treatment guidelines. Throughout the DUR process no changes are made to your prescription without the permission of your prescribing doctor. The end result should be a cost saving to both you and at the same time to your medical scheme, as well as ensuring that your well-being is not compromised in any way.

How many repeats may the doctor issue on my prescription?

The law only allows a prescription to be repeated for six months.

How do I change from a brand-name medicine to a generic medicine?

Speak to your Scriptpharm Pharmacist , who will assist you in this regard.

Are generic medicines as safe as the original product?

Yes. Generic medication works in exactly the same way and are just as safe and effective as branded medicines. The Medicines Control Council (MCC) of South Africa requires that all medicines, whether brand-name medicines or generic medicines, meet the standards of safety, strength, purity and effectiveness. For a medicine to be marketed under a generic label, the manufacturer must be registered with and comply with the MCC standards and regulations. The MCC sets up the guidelines and requires strict testing in order to ensure that generic medicines are the same as the original product. Generic medication are currently being manufactured and sold by many reputable SA and multinational companies and have been used safely worldwide for many years.

Why are brand-name medicines more expensive than generic medicines?

Once the brand-name medicine has undergone research and development, which is very costly and time consuming, the pharmaceutical manufacturer applies for a license and registers a patent in respect of the medicine developed. This patent gives the pharmaceutical manufacturer exclusive rights to market the product to the public for a certain length of time. When the patent expires, other pharmaceutical manufacturers may produce the same medicine under a different name, called a generic. The generic medicine is less costly because it does not have to undergo the same expensive research and development.

What are generic medicines?

Generic medicines are the equivalent to the brand-name medicines. They contain the exact same active ingredient, strength and dosage form as the original product.

What is the legislation on Generic Medicines and how will this effect me?

The legislation on generic medicine, which came into effect on 2 May 2003, makes it compulsory for a pharmacist to inform patients of the benefits of changing over to a generic medicine from a brand-name medicine prescribed by the doctor.

In accordance with the new generic medicine legislation the following applies:

A generic medicine may be offered to the patient, provided that its price is less than that of the prescribed brand-name medicine.
The patient has the right to refuse the substitution to the generic medicine.
A generic medicine substitution may not take place if the doctor has written, in his/her own handwriting, on the prescription the words “no substitution” next to the medicine prescribed.

It is no longer necessary for the pharmacist to consult with the doctor prior to making a generic substitution. The decision to substitute now rests with the patient, following the advice of the pharmacist.

What is the new medicine scheduling status and how will this affect you?

Medicine scheduling status, from schedule 0 to 6, is given to all registered medicines according to the active ingredient it contains thereby regulating the use of medicines.

The scheduling status of a medicine is determined by and legislated in terms of the Medicines and Related Substances Control Act and is as follows:

Schedule 0 substances may be purchased over the counter (OTC) without a prescription as well as in supermarkets.
Schedule 1 substances may only be purchased without a prescription but from a pharmacy allowing you access to the pharmacist's advice.
Schedule 2 substances may also be purchased without a prescription from a pharmacist but also allowing you access to the pharmacist's advice, however are subject to control in terms of dispensing and a schedule 2 register has to be maintained by the pharmacist.
Schedule 3 - 5 substances may only be purchased from a pharmacy with a valid prescription from a doctor or on verbal instruction from a doctor. A verbal prescription only allows a maximum of 7 days treatment to be dispensed by the pharmacy; thereafter the original prescription must be presented to the pharmacist. A prescription must be presented to the pharmacist for dispensing within 30 days from the date the prescription was prescribed by the doctor. Repeatable prescriptions may not exceed 6 months.
Schedule 6 substances may only be purchased from a pharmacy with an original written prescription. In the case of an emergency, the pharmacist may supply the patient with the medicine on a verbal instruction from the doctor, however only with a supply for a maximum of 48 hours and must be followed by an original written prescription within 72 hours. Prescriptions are valid for 30 days only and cannot be repeated.

What is a co-payment?

A co-payment is the amount you have to fund from your own pocket – the amount by which your medicines or treatment exceeds what the Medical Scheme would have paid if you had used a Designated Service Provider and, medicines stipulated on the medicine formulary.

What is a medicine formulary?

A formulary is a list of medicines that have been approved by a Medical Scheme for the treatment of a specific condition. The medicines on the list are considered safe, clinically appropriate and cost effective for the treatment of the specific condition.

What is a Designated Service Provider (DSP)?

By using proven and affordable interventions in accordance with Medical Scheme rules, a Medical Scheme may appoint a Designated Service Provider (DSP) or Provider Group, to provide members with the diagnosis, treatment and supply of medication of Prescribed Minimum Benefit (PMB) conditions. In this case, the member of the Medical Scheme may only use the Service Provider as designated by the Medical Scheme and all costs within the Medical Scheme rules will be paid in full by the Medical Scheme to the DSP.

Where a member decides to use the services of a provider that is not a DSP, a co-payment or levy may be imposed on the member by the Medical Scheme, except if the service was involuntarily obtained, i.e. in respect of an emergency condition. A medical condition that is of a sudden and unexpected onset and that requires immediate medical or surgical treatment is considered an emergency condition. Failure to provide this treatment would result in impairment of bodily functions, serious dysfunction of bodily organ or part, of would place the person’s life in serious jeopardy.

What are the chronic conditions listed on the PMB Chronic Disease List?

The Prescribed Minimum Benefits for the chronic disease list (CDL) differ from the general list of PMB’s in that their minimum treatment is specified in therapeutic algorithms for each condition.

The conditions on the PMB CDL are:

Addison's Disease
Asthma
Bronchiectasis
Cardiac Failure
Cardiomyopathy disease
Chronic Obstructive Pulmonary Disease
Chronic Renal Disease
Coronary Artery Disease
Crohn's disease
Diabetes Insipidus
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Dysrhythmias
Epilepsy
Glaucoma
Haemophilia
Hyperlipidemia
Hypertension
Hypothyroidism
Multiple Sclerosis
Parkinson's Disease
Rheumatoid Arthritis
Schizophrenia
Systemic Lupus Erythromatosis
Ulcerative Colitis

What are Prescribed Minimum Benefits (PMB’s)?

Prescribed Minimum Benefits (PMB) are the minimum benefits which by law must be provided to all Medical Scheme members and include the provision of diagnosis, treatment and medication costs for these medical conditions, as specified in the Regulations of the Medical Schemes Act.

What is a Single Exit Price (SEP)?

SEP is the price set by pharmaceutical manufacturers at which a medicine may be sold including VAT and a logistics fee. The first part of the pricing regulations has already been implemented with effect from 2 May 2004.

Medicine prices now have a totally new look in that:

What you see is what you get - the new reduced SEP does not allow for any discounts or rebates and includes all costs up to dispensing level (where the pharmacist gives you your medicine);
The price must now be reflected on the package or container of the product being sold;
Prices will be totally transparent to the public via information on product packs and on the internet so that patients will be empowered to make their own decisions;
Prices will not vary by pack size or where the medicines are purchased.

The second part of the pricing regulations is to benchmark the prices against international prices, which will be looked at and implemented later this year.