The National Health Insurance Authority (NHIA) has reviewed upwards the prices of medicines and services paid to providers and suppliers on the health insurance scheme, with effect from yesterday.
Dr Bernard Okoe Boye, Chief Executive of the NHIA, told the Daily Graphic that the prices of framework medicines had been increased by 80%, while non-framework medicines had been increased by 20%.
He defined framework medicines as those used by the scheme and assigned fixed prices negotiated and agreed upon by stakeholders, including manufacturers and the Ministry of Health, in collaboration with the NHIA.
the list of medicines reviewed on the scheme include, Artemether Injection 50mg/ml, which is widely used for the treatment of uncomplicated malaria (Plasmodium falciparum), and Levofloxacin Infusion, a drug used to treat bacterial infections in different parts of the body.
Dr. Okoe Boye stated that the revision negotiations facilitated a 50% increase in framework medicine prices, which reflected production costs.
However, to bring the prices on the National Health Insurance Scheme (NHIS) closer to market prices, the NHIA added 30% to cover other expenses in the delivery of the medicines.
He also stated that all medicines outside the framework box, also known as non-framework medicines, that could be supplied by any dealer or manufacturer in accordance with the law had been increased by 20%.
He also stated that fees paid to service providers for all services rendered under the scheme, such as surgical procedures, had been increased by 10% across the board.
“The approved list will be disseminated through the respective provider associations. I hope that these reviewed documents will be implemented by your respective groupings according to the contractual arrangements in place,” Dr Okoe Boye told service providers.
He added that the reviews were in accordance with the National Health Insurance Act, 2012 (Act 852), explaining that they were necessary to enhance service delivery for subscribers and give providers value for money to avoid certain gaps in access to medications and services under the scheme.
He indicated that if market prices of medicines were higher than what the NHIS was paying, service providers would prescribe the medicines but would not dispense them to patients to avoid making losses.
“Some facilities will not stock the medications, meaning that patients or patrons of NHIS facilities would have to go through the inconvenience of moving from the facilities where they accessed care to other outlets to get medications.
“Others also illegally charge small fees to make up for the gap in tariffs for medicines on the market and those under the scheme,” Dr Okoe Boye said.
To avoid such inconveniences and illegalities, the NHIA conducted periodic reviews through consultations and market reviews to offer providers “something very close to market prices, if not the same,” he said.
According to the Daily Graphic, a similar review was conducted last year, effective July 4, last year, after the scheme and stakeholders conducted a market survey of prices and agreed on the figure largely based on inflation and some other variables.
Dr. Okoe Boye explained at the time that the last review before the 2022 review was about five years ago, and that it was done because the scheme realized that the charges were unrealistic after stakeholders conducted a scientific review of the prices.
The NHIA explained that the 30% increase in July of last year was imposed on the agreed-upon 2020 increase in medicines and service provider tariffs.
Dr. Okoe Boye explained at the time that the last review before the 2022 review was about five years ago, and that it was done because the scheme realized that the charges were unrealistic after stakeholders conducted a scientific review of the prices.
The NHIA explained that the 30% increase in July of last year was imposed on the agreed-upon 2020 increase in medicines and service provider
