While optimistic about working with the Minnis administration on National Health Insurance (NHI), Bahamas Pharmaceutical Association (BPA) President Michelle Finlayson revealed that 53 pharmacies have yet to sign on board with the proposed NHI reimbursement model due to a number of concerns that they claim, if left unaddressed, could impair the survival of the local pharmacy industry.
Speaking with Guardian Business yesterday, Finlayson said the BPA is looking forward to working with the new government and having open and effective discussions to determine the industry's next steps.
"It is quite a breath of fresh air that our prime minister and Minister of Health (Dr. Duane Sands) are both in the medical field," she said.
"Not only will they understand the business, but also, they will understand the foundation where we come from."
Finlayson said pharmacies would like to have a sustainable program for NHI moving forward.
"None of the current 53 pharmacies signed onto NHI. We felt that the plan was a bit rushed and that there needed to be a bit more dialogue so that other stakeholders in our pharmacy industry are not disenfranchised," she said.
Prior to the general election, the NHI Authority (NHIA) released a revised draft document dated April 25 on pharmacy reimbursement fees and an approach to procurement.
NHI primary care was also launched on April 25.
The document stated that the proposed reimbursement fee per medication would be $4 instead of $3.
"Recognizing The Bahamas' unique geography, pharmacies in the Family Islands will now receive a dispensing fee of $4.50 per line item to account for higher costs of business and to incentivize private sector participation," the report states.
In addition, the report notes that initial provider agreements with pharmacies would last for a one-year term.
In terms of approaching procurement, the document notes that the NHI Secretariat reviewed a number of options for procurement of NHI pharmaceutical drugs, such as a centralized procurement in-house or through a request for proposals.
"After careful consideration of stakeholders' feedback and detailed analysis of options available, the NHI Secretariat decided to allow flexibility in procurement and give choice to pharmacies as long as drugs meet the standards of quality that are required by the regulatory authority and in line with leading practices," the document states.
However, Finlayson said there are still concerns surrounding procurement, particularly from a wholesaler's perspective.
The NHIA document also mentioned some concerns raised by wholesalers.
"Wholesalers stated the necessity for the proposed reimbursement prices to reflect the current business climate," the document states.
"They also expressed concerns about the risk of increased quality-related issues, such as the government's capacity to enforce existing regulations."
Finlayson asserted the need for the government to be open to discussions in this regard.
"We are all just cogs in the big wheel of health care," she said.
"Pharmacies cannot exist without private insurance, customer service and cost effectiveness.
"We need to make certain our tax compliance certificate (TCC) is given on a timely basis so we are reimbursed on a timely basis.
"We want to make certain by the end of this exercise, that each pharmacy's door remains open, from our largest chain to our small community pharmacy."

Reimbursement analysis
Meanwhile, a separate analysis of NHI reimbursement for pharmacies was prepared for the BPA by Derek Osborne, partner at Morneau Shepell, dated April 10, 2017.
The analysis provided uncertainties for pharmacies with NHI, with one of them being the cost associated with the new requirements.
Osborne also inquired about how technology would be used for NHI authorization and how much pharmacy volumes would actually increase.
The analysis looked into the likely changes with NHI as well.
One consideration was the possibility of additional costs for pharmacies, including recruitment of pharmacists from overseas.

Necessary steps
Finlayson said pharmacies need to see a plan.
"We need to see a transition plan from where we are now to the implementation of NHI," she said.
"We need to make certain that pharmacies are not carrying one or two separate inventories and the IT infrastructures are in place.
"We need to make sure that proper funding, if not made available, is accessible for some of the smaller businesses who may have to look at financial expenses due to added inventory.
"We need to have answers on how insurance companies will now play into this model. Those would be our critical points, along with reimbursements."
Pharmacy owners representative for the BPA Shantia Hield told Guardian Business the pharmacy owners' main objective is to go into a sustainable partnership with the government.
Hield said the reimbursement mechanisms for pharmaceutical services up to April 25 were not "feasible or functional".
"It wasn't providing for us to ensure that we keep medication on hand, we keep customer service at an optimal level that our companies are providing and what the government wants us to provide going forward," she said.
"We are just ready for discussions and dialogue now."

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