Perumal-Pillay Velisha Ann, Suleman Fatima
Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
J Pharm Policy Pract. 2020 May 21;13:17. doi: 10.1186/s40545-020-00223-5. eCollection 2020.
The affordability of essential medicines is a challenge in achieving Universal Health Coverage (UHC). One of The Lancet Commission's recommendations on financing of essential medicines is to ensure governments and national health systems include essential medicines in the benefit packages provided by public and private healthcare sectors. Currently in South Africa (SA), there is a dearth of information on the processes for medicines selection for private sector medical scheme formularies. This study aimed to improve the understanding of how formulary managers of selected medical schemes made decisions for the selection of medicines for their formularies. This paper described their opinions obtained from in-depth interviews.
Qualitative in-depth interviews were conducted with 10 individuals from 7 private sector medical schemes and administrators in SA. All participants interviewed were involved in formulary development and management. Interviews were conducted from June 2013 - January 2015. Interviews were guided by a discussion guide and audio recorded. Recorded interviews were transcribed verbatim. Transcripts were coded by the first author, corroborated by the second author, reconciled, and imported into NVIVO for data analysis.
Schemes and administrators had similar formulary decision making and management committees in place (viz. Clinical and Therapeutics committees). The process of and criteria for medicines selection and evidence based review of formularies were also similar. Selection of medicines was inherent in the formulary review process. Medicine price was important in the decision taken to list medicines. Most schemes expressed a difficulty with lack of information to support pharmacoeconomic evaluations of medicines for inclusion on the formulary. This together with the basic monitoring of use of medicines by patients for most schemes left room for improvement in the decision making process for those schemes.
This is one of the first studies in SA describing interviews with private sector medical scheme Formulary managers. It contributes to an increased understanding of how decisions are taken to include/exclude medicines on private sector medical scheme formularies. It provides insight into the medicine selection and review processes, including processes on monitoring and evaluation of medicines use by the private sector which serve as lessons for Low-Middle income countries moving towards UHC.
基本药物的可负担性是实现全民健康覆盖（UHC）面临的一项挑战。《柳叶刀》委员会关于基本药物筹资的建议之一是确保政府和国家卫生系统将基本药物纳入公共和私营医疗部门提供的福利套餐中。目前在南非，关于私营部门医疗计划处方集药物选择流程的信息匮乏。本研究旨在增进对选定医疗计划的处方集管理人员如何为其处方集选择药物做出决策的理解。本文描述了通过深入访谈获得的他们的观点。
对来自南非7个私营部门医疗计划和管理人员的10个人进行了定性深入访谈。所有接受访谈的参与者都参与了处方集的制定和管理。访谈于2013年6月至2015年1月进行。访谈以讨论指南为指导并进行了录音。录音访谈逐字转录。转录本由第一作者编码，第二作者核实、核对并导入NVIVO进行数据分析。
各医疗计划和管理人员设有类似的处方集决策和管理委员会（即临床和治疗委员会）。药物选择过程、标准以及基于证据的处方集审查也相似。药物选择是处方集审查过程中固有的环节。药品价格在决定将药物列入清单时很重要。大多数医疗计划表示难以获取支持对列入处方集的药物进行药物经济学评估的信息。这与大多数医疗计划对患者用药的基本监测一起，使得这些医疗计划的决策过程仍有改进空间。
这是南非首批描述对私营部门医疗计划处方集管理人员进行访谈的研究之一。它有助于增进对如何决定在私营部门医疗计划处方集中纳入/排除药物的理解。它提供了药物选择和审查过程的见解，包括私营部门对药物使用的监测和评估过程，为迈向全民健康覆盖的中低收入国家提供了经验教训。
