The Tribune

By ANNELIA NIXON

Tribune Business Reporter

anixon@tribunemedia.net

Pharmacists yesterday voiced concerns that they may face late and delayed payment once Government completes the National Prescription Drug Plan’s (NPDP) transfer from the National Insurance Board (NIB) to the National Health Insurance (NHI) scheme.

The concerns come as the NPDP is already grappling with temporary shortages of some medications used to treat chronic illnesses, forcing programme administrators to activate emergency procurement measures and seek alternative supply sources while awaiting replenishment shipments.

The Tribune reported in May 2025 that the NHI Authority was set to take control of the prescription drug programme on February 1, 2026. However, one pharmacy operator, speaking on condition of anonymity, said the plan will shift to NHI on July 1. They pointed to growing financial uncertainty tied to government reimbursement systems, particularly as the NPDP prepares for integration into the NHI Authority.

“With government, their margins are very, very small… so really and truly, it’s just a cash in and cash out system,” the pharmacist said.

“There are times that we have to wait for our payments from the government,” they added, noting that while larger pharmacies may be able to absorb delays, smaller operators are more vulnerable to cash flow pressure. “Luckily for us, we make sure that we don’t have that cash flow issue,” the pharmacist said. “But for some pharmacies, very small pharmacies, that is an issue.

“I’m going to be quite honest with you, the next biggest thing we are going to have to deal with is NHI,” the pharmacist said, adding that the sector is “very concerned about how we are going to get paid”.

They added that, under the current NIB system, payments, while occasionally delayed, are usually predictable. “Prior to July 1 coming up, payments have always been made by NIB… you might have had to wait a month or two, but you knew you were going to get your money,” the pharmacist said. “Now… the Government is now switching that over to NHI, which is now going to be government paid.

“How is it I have to wait six months to get paid, which is common for some people,” they said, adding that some contractors already face significant delays in government arrears.

The transition also comes as the Government expands the NHI programme, and funding arrangements remain unclear to some providers. “They’re expanding the system. But they have yet to explain how they’re paying for the system,” the pharmacist said.

The concerns are amplified by recent issues within the wider NHI system where doctors and other healthcare providers have reported delayed payments, raising fears among pharmacies that similar challenges could emerge under the expanded drug plan.

“It’s a legitimate concern,” the pharmacist said. “You’ve been having issues paying these people, now all of a sudden you take on more burden.” They also highlighted differences between medical services and pharmaceutical supply chains, noting that pharmacies face less predictable demand.

“When you come to pharmaceuticals, you don’t know how many people are coming in there for an antibiotic… that fluctuates from month to month,” the pharmacist said.

Another pharmacist acknowledged that supply chain issues are not unique to The Bahamas. Philip Gray, chief executive of Quality Care Pharmacy, said while occasional shortages exist, they are not currently at alarming levels.

“There are a couple but not in a major way,” Mr Gray said. “In any market, at any given point, there is the possibility that the availability of a medication may be difficult [to obtain] at any given point in time.”

He added that global events continue to influence pharmaceutical supply chains, underscoring the importance of maintaining strong local distribution systems.

“Particularly during periods when you have actions like the war going on, you just want to sort of be on what we need for the country,” Mr Gray said, adding that local distributors “do a good job” managing coverage.

Still, for the anonymous pharmacist, the convergence of supply instability, procurement delays and an impending shift in payment administration raises broader concerns about system readiness.

Speaking on the medication shortage, they alleged that the tendering process for NPDP has long been slow and increasingly strained. They claimed the process worsened following the COVID-19 pandemic, but was significantly exacerbated by global disruptions that intensified competition for limited pharmaceutical supply.

The pharmacist warned that Bahamas-based procurement delays can push the country further down the queue in global distribution chains.

“If we slow on uptake, and if we don’t have our ducks in a row as a country or as a government, then you can see where shortages will occur,” the pharmacist said. “If Cayman ready, and Jamaica ready and Trinidad ready, and we ain’t ready, we go to the back of the line.”