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Medical aids prepare for Covid vaccine rollout

Schemes are currently battling with a possible Plan B should the government procurement process not come off correctly, notes Profmed CEO Craig Comrie.

DUDU RAMELA: According to Health Minister Dr Zweli Mkhize, South Africa will receive Covid-19 vaccines from India this month, but only frontline workers will be the first in line for the one million vaccines. For the rest of us, when vaccines eventually become accessible you will have your Covid-19 vaccinations subsidised by medical schemes that pool health-insurance premiums through an agreement with government. Of course, this is if you are on medical aid.

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Let’s find out what this means for everybody else who is not. Craig Comrie is the CEO of Profmed and he joins us now. Craig, a very good evening to you and thank you for joining us. Essentially, should we be cautiously optimistic here or excited as the rest of South Africans who are not frontline workers?

CRAIG COMRIE: We have to watch it quite carefully. I think the availability of the vaccines is the major issue. We’ve got some insights into the pricing and some plans in terms of distribution, but we really need to get the vaccines into the country and ready to deliver to everybody in the country. There’s no doubt that that priority schedule and that phased approach rolled out by the minister is going to cause some ructions, and obviously we need to see if we can get enough vaccine eventually during 2021 to vaccinate everybody.

DUDU RAMELA: Let’s talk about the pricing. I think that’s an issue that most South Africans are worried about. So, when we do eventually get it and I ask my medical aid to pay for the vaccine, is it covering the entire amount? Will there be a co-payment from medical-aid holders?

CRAIG COMRIE: There should not be a co-payment. The vaccine has been included in the prescribed minimum benefit legislation, which basically means that every scheme has to cover and include the vaccine for every beneficiary of a medical scheme. That should be the actual cost of the vaccine and delivering to the beneficiary as well. The only place where you can have some levels of co-payment is if your medical scheme has perhaps its GP network, or a specific pharmacy network that they are going to arrange with for the delivery of the vaccine. So you would have to go to their designated provider. And if you go outside of that provider you may have to pay some co-payments

DUDU RAMELA: There is a figure that’s been bandied about of R7 billion in terms of what it could cost medical schemes to buy these vaccines. Is this something that you can confirm for us?

CRAIG COMRIE: Yes. Government is going to be the only person that currently is enabled to procure vaccines. Everything is going to come through that channel, and that’s what is currently is on the table. The number is actually a lot more, but for the medical scheme portion it’s probably closer to the R3 billion, but there is a request from the minister to fund an additional R3.8 billion to cover some of those [costs] not covered by medical schemes. So that’s the current request from the minister. I think there’s still a lot of water to cross the bridge to actually get to what medical schemes are prepared to do. There are lots of current consultations in terms of determining that.

DUDU RAMELA: And that leads to my next question. You’ve got people who will be able to get access to this because they have medical aid, but the reality in South Africa is that the majority of people would not be able to access it because they do not have medical aid. So how are those negotiations progressing? Could you maybe give us a little bit more information on that?

CRAIG COMRIE: Yes, we are right in the middle of those negotiations. And so there’s no doubt that the medical schemes want to contribute in a meaningful way in terms of the rest of South Africa, and in many ways that could be through some upfront guaranteed payments to secure vaccines earlier rather than later. But much of the medical-scheme reserves that have been built up over all the years are exclusively for the use of the medical-scheme members themselves. So to try and overcome that hurdle is going to be a difficult one to do. And boards of trustees of those medical schemes need to carefully consider their fiduciary responsibilities – firstly towards the members, and then further how they can contribute to the rest of the South African population. We are hoping that much of that will lie in the fact we, as part of the government procurement policy or procurement process, can get vaccine at a more reasonable price for both medical-scheme members and for the rest of South Africans.

DUDU RAMELA: You speak of price. There’s also another figure that’s being bandied about of R500 per person in terms of the cost of getting the vaccine. Do you have any knowledge on this?

CRAIG COMRIE: Yes, I’ve looked at some of the numbers across all the different vaccines. So just the manufacturing costs of the vaccines have a broad range – anywhere from R80 to close to R800 for just the vaccine. And then you have to consider transportation, administration, perhaps the nurse that administers the vaccine as well, and that’s going to be additional. On average it’s going to be around R400 to R500. That would be correct.

DUDU RAMELA: In terms of numbers do we have an idea of just how many beneficiaries across the country are on medical aid?

CRAIG COMRIE: Yes, we have very close to nine million lives on medical schemes at the moment. So the request would be to cover the nine million, which would be covered in terms of the prescribed minimum benefits. And then to actually try and cover another nine million is where the additional cost would lie. The pricing, if you do the calculation right, will in total get you to about that R6.8 billion.

DUDU RAMELA: You did mention a little bit earlier on that government will be in charge of sourcing their vaccines. In your consultations have medical-aid schemes perhaps been asked to maybe look into that as well, and help chip in, in terms of finding vaccines?

CRAIG COMRIE: It’s been very difficult. In fact, the private industry has not been able to engage with manufacturers. I think they are tied into agreements with the government in terms of the procurement strategy. So at the moment there’s very little that the private industry has been able to procure. There’s always a question, as many ask, as to what Plan B is if the government procurement process doesn’t come off correctly. And that’s something that all the schemes are currently battling with.

DUDU RAMELA: How would you describe the tone of the negotiations with government?

CRAIG COMRIE: I think the government has been quite clear on what is needed, and the direction is quite clear. The real crux of the matter comes to the funding questions – so trying to fund what is about R12 or R12.1 billion worth of vaccines, where the bulk of it is going to be coming from, or is suggested to come from medical schemes and business, is a real big ask from the government’s perspective to the private industry and the private sector.

DUDU RAMELA: Let’s leave it there. Thank you very much for your time this evening, Craig Comrie, CEO of Profmed.

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In view of the above, the government must cancel the R16bn earmarked for the SAA vanity project and reallocate it to the covid-19 pandemic with immediate effect.

WTF — I pay my butt off in taxes for the government to have medical care that does not function so I pay my butt off again for medical aid so I at least have something that works and now that medical aid I contribute to have to help the Government ???

This is BEYOND RIDICILOUS !!!!!!!!!!!!!!!

End of comments.

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