The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

Private pharmacy owners are demanding that Government-owned clinics cease issuing prescription medicines under the proposed National Health Insurance (NHI) scheme, and that they receive work permit fee ‘waivers’.

The proposals, which appear heavily weighted in favour of private pharmacies, are contained in an August 26, 2015, paper ostensibly sent to the Government and its NHI consultants by the Bahamas Pharmaceutical Association (BPA).

The paper, obtained by Tribune Business, calls for a bar on government clinic competition because of the “cash flow constraints” imposed on private pharmacies by having to carry higher inventory levels as a result of the National Prescription Drug Plan (NPDP).

And it recommends that pharmacies be given up to $15,000 in work annual permit fee breaks, as there are not enough trained Bahamian pharmacists to meet the expected increase in demand that NHI will generate.

That, of course, will require the hiring of expatriates who, the report suggests should be capped at two per pharmacy. Whether Fred Mitchell and his hard-line Immigration policies will be accommodating enough to ‘waive’ fees as high as $7,500 per permit is another matter.

Meanwhile, several pharmaceutical industry sources have told Tribune Business that the ‘BPA paper’ does not represent all segments of the sector.

They are alleging that it was developed chiefly by the private pharmacy owners, with little to no input from others such as the industry’s wholesalers.

This has led to the emergence of divisions with the BPA, with the Pharmaceutical Wholesalers Group (PWG) understood to be unhappy that the document purports to represent the entire sector when it does not.

A source close to the PWG, speaking on condition of anonymity, said they believed the pharmacy owners’ paper had encouraged Sanigest Internacional, the NHI consultants, to propose a medicine procurement model that completely overturns the current system.

The proposal would allow pharmacies to buy direct from drug manufacturers, rather than go through wholesalers, as is the current norm.

“Are we advancing NHI in a coherent, responsible and sustainable fashion?” the PWG source questioned. “We met as a wholesalers group, and our report is separate and apart from the Association’s.”

They added that other BPA members had been unaware that the pharmacy owners met with Sanigest several times to develop the proposal, and expressed concern that the Government may have gained the mistaken impression that their views represented the entire industry.

“It could easily have caused confusion, and produced misconceptions where that group was seen as representing the entire industry.”

Meanwhile, the purported ‘BP’ paper complained that the NPDP had, for the past six years, forced all pharmacies to carry higher inventory levels to ensure prescription drugs/medicines were constantly available for plan beneficiaries.

Warning that inventory levels would have to further increase to cope with NHI, the paper said: “This has become a financial burden to the smaller pharmacies, especially for those where the number of their customers who qualify for the plan is minimal because of the proximity of the Government clinics to their establishments, which has resulted in direct ‘competition’.

“While it is envisioned that NHI will extend to the entire population of the Bahamas, thus resulting in increased numbers of beneficiaries who will become ‘customers’ of participating pharmacies, it is recommended that the NHI prescription drug service is discontinued at government-owned clinics, or that these pharmacy facilities be leased to private businesses in order to ‘level the playing field’.”

The ‘BPA paper’ also called for a “moratorium” to be imposed on private doctors’ practices opening in-house pharmacies. And it touted the “huge cost savings”, in terms of capital and operating expenditure, that the Government would enjoy by allowing NHI pharmaceutical services to be delivered through the private sector.

The document called for private pharmacies to be paid a ‘Retainer/Business Establishment Fee’, based on the number of NHI prescriptions filled per month and capped at $1,250 (more than 1,000 prescriptions).

Under the scheme outlined in the ‘BPA paper’, pharmacies filling under 250 NHI prescriptions per month would receive $500. Those dealing with between 251 and 500 prescriptions would be paid $750, and 501-1,000 prescriptions filled would result in a $1,000 payment.;

The paper also warned that the “substantial increase” in the number of prescriptions issued would require additional pharmacy staff.

“The pool of Bahamian pharmacists is currently inadequate to meet the existing pharmaceutical needs of the country, and this will be more evident as the volume of dispensed prescription drugs increases with the implementation of NHI,” the ‘BPA paper’ argued.

“Should the need arise for recruitment of expatriate pharmacists, it is recommended that the work permit fees, which are currently at $7,500 per annum, be waived for the contracted NHI term.

“It is further recommended that a cap of two additional expatriate hires per pharmacy be considered based on prescription turnover.”