MMA president Dr Ravindran R. Naidu said approval for giving patients drugs outside the ministry’s formulary – at public clinics or hospitals – should not rest solely with the Health director-general.
“It’s important to have a transparent process, so everyone knows exactly what is needed for approval,” asserted Dr Ravindran.
“If a safe and effective generic is available in MOH formulary, every public-sector patient should receive the same drug, except where the patient cannot tolerate the generic (e.g. due to allergy). In case of intolerance of generic, the government should supply original drugs ― it’s not the patient’s fault,” he added.
Dr Ravindran said that MOH should instead bring in original drugs with good cost-to-benefit ratio should generics be unavailable, pointing out that “many” drugs do not have generic versions as well.
“Generic first” policy applies to all now
This comes after Health deputy director-general Datuk Dr S. Jeyaindran confirmed, that as part of the “generic first” policy, approximately 700,000 retired government servants will now no longer be reimbursed if they buy brand-name medications that are unavailable at public hospitals – unless they fulfil certain conditions.
Instead, they will receive generic medicines, like other patients, he added.
The policy is part of MOH’s management of medical treatment of federal government retirees and pensioned military veterans, together with the Ministry of Higher Education (MOHE) and the Defence Ministry (MOD), which took effect on 1 June this year.
The change occurred after the contract for the supply of medicines with Oratis Rx Sdn Bhd ended early this year. Pensioners are now told to pay for their purchases first and submit claims subsequently – a process which takes an average of three to six months.
“The process has been made difficult, so people opt for the cheaper generics,” said a doctor who requested anonymity.
Dr Jeyaindran assured that the standard operating procedure (SOP) has been fine-tuned and put into place in the last six weeks, with the Public Service Department (PSD) transferring funds to MOH for pensioners’ healthcare and the Retirement Fund (Inc) (KWAP), handling all dialysis and dialysis-related claims.
Change in SOP causes confusionHowever, pensioners lamented that with the change, hospitals needed to approve of the prescriptions first. If approval is declined, pensioners would have to directly pay out-of-pocket for medicines that were previously dispensed for free through Oratis Rx Sdn Bhd.
According to a circular published on 30 June, approval was also needed from the Health director-general to get drugs outside the MOH formulary. This was based on three conditions: drugs in the formulary were ineffective in treating the patient; the patient suffered adverse effects from drugs in the formulary; and the application was not intended to continue medical treatment that had been started at a private hospital or a hospital from another ministry.
This has generated confusion and unnecessary backlog as the rule took effect on 1 June, but only notified relevant parties on 30 June.
The MOH however, remained firm and Dr Jeyaindran cautioned, “If doctors want to use a drug outside the Blue Book, they must justify why the patients need it.”
Efficiency compromised with change
MMA past president Dr Milton Lum said generics are sometimes ineffective in cases of dialysis, high blood pressure and arthritis. There is also an increased resistance to generic antibiotics and common drugs, and there are also no generics for many cancer drugs.
“The Blue Book is based on essential medicines,” explained Dr Lum, referring to the MOH formulary. “They cover the majority of common illnesses, but not everything.”
However, local generics pharmaceutical manufacturers have asked Dr Lum to back up his statement that generics are ineffective in certain cases on 21 August.
In addition, Dr Lum also questioned how long patients and doctors must wait for approval of applications to use branded medicines.
“Is there a process to fast-track it, particularly when it’s needed urgently? What happens if the DG is not in the country? Who approves it then?” he asked.
“It has to be an efficient process with certain timelines for decision to be made, for approval to be given. If you give approval, there is a time lag before you obtain the medicine. So, there has to be efficiency in the process and timelines to be complied with,” he added. MIMS
Are biosimilars really cheaper?
Drugmakers under global pressure to lower prices
Doctors do not take cost into consideration when ordering tests or prescribing drugs, study reveals