SA’s biggest association for independently owned pharmacists says it warned the Government Employees Medical Scheme (GEMS) that its controversial plan to deliver multivitamins to its members flew in the face of good clinical practice and that its chosen product was overpriced.
GEMS is SA’s biggest medical scheme for public servants and their dependants.
The Council for Medical Schemes (CMS) is investigating it over a contract it awarded to Afrocentric subsidiary Activo Health to provide about 1.2-million adult beneficiaries with a five-month supply of vitamins and minerals. Afrocentric is an investment holding company, which, according to its website, is “substantially invested” in health care.
Earlier this week, GEMS principal officer Stan Moloabi said the board agreed to set aside R400m from its ex gratia fund to provide adult beneficiaries with a five-month supply of multivitamins during the coronavirus pandemic.
It outsourced the job of choosing a supplier to medical scheme administrator Medscheme, which is also an Afrocentric subsidiary. The vitamins are couriered to members by Medipost or members can collect them from designated pharmacies, including those belonging to the Independent Community Pharmacy Association (ICPA) and pharmacy chain Dis-Chem.
ICPA CEO Jackie Maimin said it has written to the GEMS board of trustees, expressing its concerns. There is insufficient high-quality evidence demonstrating that multivitamins and minerals are beneficial for the public, and global health authorities do not recommend routine prescribing of these products, she said.
It is also important for a healthcare provider to check if it is safe for people to take supplements as some vitamins and minerals interfere with prescribed medication, she said.
For example, vitamin B6 impairs the uptake of the Parkinson’s disease treatment levodopa, and iron inhibits absorption of the thyroid treatment levothyroxine if taken at the same time.
“It is very unusual for a scheme to procure a medicine directly for members,” she said.
Medical schemes typically set a benchmark price for a medicine and allow members to choose other brands, provided they are below this price. If members opt for a more expensive brand, a scheme typically pays up to the threshold price, and members pay the balance out of their own pocket.
The ICPA told GEMS that the bundle it plans to supply to members, consisting of a 60-pill and a 90-pill pack of ActivoVite vitamins and minerals, is overpriced, as it could source five 30-pill packs of the product for less, said Maimin.
The bundled pack costs R310.50 a month, while five monthly packs of 30 pills would have cost R256.30, she said. This means GEMS is paying R54.20 more per beneficiary than it needs to.
It could also have saved money by sourcing a cheaper brand, of which there are plenty, said Maimin.
Waste
She said it is unwise for GEMS to provide a large volume of any product to an individual in one go, as they could be wasted or accidentally swallowed by children. Patients are usually limited to a 30-day supply of medicines, she said.
Moloabi told Business Day on Tuesday that three criteria were set for selecting a vitamin provider: it must be cheap; a well-known brand; and the provider should be able to guarantee a sustained supply.
Members had asked for the benefit, hoping the vitamins would protect them against Covid-19, he said.
He defended GEMS’s decision to provide eligible beneficiaries with vitamins, saying it did so in response to a need expressed by members. GEMS beneficiaries had asked for vitamins as immune boosters to protect them against Covid-19, he said. So far, 187,000 beneficiaries have signed up for the vitamins.
Moloabi said GEMS will co-operate fully with the CMS, which has initiated an inquiry into the scheme in terms of section 43 of the Medical Schemes Act. This is a softer option than a full-blown inspection in terms of section 44 of the act, which would require the scheme to open its books.
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