Shortage of key medicine blamed on fight over prices

Sunday May 13 2018

Drugs

The pharmacists say the shortage affects drugs for rare and special case ailments as well as prescribed medicine from Europe, mainly due to the euro’s continuous appreciation against the Rwandan franc. PHOTO | CYRIL NDEGEYA 

By JOHNSON KANAMUGIRE
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Patients and caregivers are struggling to get some drugs at several pharmacies and this is attributed to pharmacies being reluctant to buy expensive medicine for fear of insurance companies not reimbursing them.

Patients are struggling to get vital medicine as most pharmacies are understocked, Rwanda Today has learnt. This is linked to an ongoing rift between pharmacies and insurance companies over drug pricing.

Patients and caregivers are struggling to get some drugs at several pharmacies and this is attributed to pharmacies being reluctant to buy expensive medicine for fear of insurance companies not reimbursing them.

Rwanda Today learnt that the shortage only affects medicine deemed expensive and with little to no return for pharmacies based on the tariffs set by insurance companies in the country.

Pharmacies said that most insurance firms took two to three years to update their tariffs and so many drugs from Europe — without alternative generics that would be cheaper — had increased in price and therefore selling them only translated into losses for their business.

Limited stock

As a result pharmacies stock a limited number of medicine.

“Unlike medicine from India and African countries, drugs bought from Europe have increased in price beyond the tariffs set by insurance companies due to the euro’s continuous appreciation against the Rwandan franc. So pharmacies find it difficult to sell at a price equal or below that of the market rate,” said Patrice Bakundufite, a pharmacist.

“The issue may not go away if insurance firms don’t agree to review tariffs at least every three to five months to reflect the changes in the exchange rates,” he added.

The pharmacists say the shortage affects drugs for rare and special case ailments as well as prescribed medicine from Europe without cheaper generics available in the market.

Patients who spoke to Rwanda Today said it was becoming a common trend to find most pharmacies not stocking certain medicine.

Claudia Umugwaneza, is an expectant woman who was unable to find Utrogestan — which is prescribed to minimise risk of a miscarriage — in seven pharmacies subscribed by her insurance firm.

Extra costs

She later learnt that she could get the medicine only if she was willing to pay the extra costs not paid for by her insurance cover.

A number of market players voiced concern that without intervention, vitaldrugs that pharmacies find not lucrative to sell would increasingly get harder to find on the shelves.

Individual medical insurance firms that this paper contacted reported not being aware of such cases and indicated that in situations where specific drugs are not available, pharmacists had a list of agreed substitutes to dispense, which were equally effective.

However, pharmacists argued that some doctors and patients rejected such alternatives.

The mismatch in drug tariffs with fluctuating market rates had made it difficult for pharmacies to comply with the terms of their contracts, which include making sure that they have enough stock of the drugs covered by medical insurance firms.

This has seen several private pharmacies working with the RwandaSocial Security Board (RSSB) — the biggest medical insurance firm — see their contracts suspended.

RSSB also accused the pharmacies of failing to meet other requirements such as obligatory presence of a pharmacist at all times that the pharmacy is operating, while others were found with expired drugs on the shelves, among other malpractices.

Malpractice

Viviane Akili, RSSB acting public relations and communication specialist did not discuss the concerns around tariffs but said that pharmacies whose contracts had been suspended had them reinstated after proving that they had addressed the raised issues.

Officials of the National Pharmacy Council said they could only act when there was proof of professional malpractice.

“The council wasn’t instituted to defend the interests of the pharmacies rather those of the general public to ensure that their lives are not endangered,” said Raymond Muganga, chairperson of the council.

Dr Muganga said the only cases that had come to their attention and which were investigated, involved pharmacies colluding with individual doctors to dispense unnecessary volumes of medicine and in most times expensive drugs for commercial gains, which resulted in losses for insurance firms.

This trend led to insurance companies compelling pharmacies to exercise caution and seek approval prior to dispensing expensive drugs or they risked not being reimbursed for the costs.

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