DURBAN - THE Council for Medical Schemes (CMS) said yesterday it was co-ordinating public-private sector collaborations to ensure there is universal access to the Covid-19 vaccine.
The council said the Covid-19 vaccine has been included in the amended Prescribed Minimum Benefit regulations, approved by the Minister of Health Dr Zweli Mkhize recently.
This amendment included the insertion of the Diagnosis and Treatment Pair in the list of Prescribed Minimum Benefits under the heading "Respiratory System" Treatment: screening, clinically appropriate diagnostic tests, vaccination, medication, medical management including hospitalisation and treatment of complications, and rehabilitation of Covid-19.
The council’s comments come after the Bonitas Medical Fund and Momentum Health Solutions confirmed on Monday the cost of Covid-19 vaccines would be covered for members and beneficiaries.
Dr Ryan Noach, chief executive of Discovery Health, said yesterday that following the declaration of funding for the Covid-19 vaccine as a Prescribed Minimum Benefit, medical schemes were effectively obliged by law to fund the Covid-19 vaccine.
He added that medical schemes had agreed to support a pricing arrangement for the vaccines, “which ensures that a surplus is generated by the schemes’ purchases of the vaccines, that can be used to cross-subsidise higher risk non-medical-scheme members, on a one-for-one basis i.e. for each vaccine procured for a medical scheme member, sufficient surplus is generated through procurement arrangements for the vaccine to subsidise the vaccination of one non-medical scheme member”.
“The medical scheme industry is collaborating closely with the National Department of Health to ensure access for all South Africans to the vaccine, and especially for the priority groups. In relation to this, the Board of Trustees of Discovery Health Medical Scheme has already approved funding the Covid-19 vaccination of all adult members,” said Noach.
The CMS said it has been in continuous engagements with the national health department and industry associations including the Health Funders’ Association (HFA) and the Board of Health Funders (BHF), which have supported an approach that seeks to ensure universal access, provisioning and availability of the Covid-19 vaccine for those who were prioritised.
It said the public-private collaborative approach was aimed at supporting the national effort of achieving a herd immunity of 67% and more through the equitable access to the vaccine.
“The CMS acknowledges there may be an additional cost burden to medical schemes for the provision of the vaccine, but this is not expected to be prohibitively high. In addition, industry associations have assured the CMS that vaccine costs can be absorbed by most medical schemes.”
The minister of health has directed the CMS continue engagements with the medical schemes and associations in the quest to develop a detailed framework that will guide the industry and the members of the public on this concession.
The council said there were several issues which needed further exploration and discussion before there was an agreement on them. These included the development of:
• A clear criteria on prioritised populations
• Clinical guidelines and protocols
• Guidelines on medical scheme liquidity management and scheme reserve requirements
• The vaccine funding model and mechanism
• The appropriate funding vehicle
• Governance processes for the prevention of fraud, waste and abuse
• Possible exemption of the Covid-19 from single exit price requirements
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