Although there has been a slight increase medical scheme members’ expenditure on acute medicine in 2019, the overall long-term trend remains downward while expenditure and volume of medicines prescribed for PMB conditions, particularly oncology have increased, suggesting that more and more medical scheme members are buying down to options with less day-to day benefits.

This is according to the Mediscor’s latest Medicines Review that provides an overview of key trends in medicine expenditure and utilisation in South Africa based on claims submitted to schemes by doctors, pharmacies, and scheme members.

The latest review shows that while medicine expenditure increased marginally by 2.4% from 2018, mainly because of the 3.8% single exit price increase in 2019, utilisation has decreased by 0.2%. The cost of a basket of medicine, including all medicine schedules, increased by 2.2% with new chemical entities accounting for 1.1% of the overall increase.

The use of generic medicines continued to rise with generic utilisation rate now standing at almost 63%. In 2019, 77.5% of all products paid for were genericised items for which the patent had expired as well as their generic equivalents.

Top 5 CDL conditions

The five top conditions on the Chronic Disease List that were responsible for more than 61% of CDL expenditure and 71% of item volume were hypertension, type 2 diabetes, HIV/AIDS, hyperlipidaemia and asthma, remaining unchanged from 2018.  The review expressed concern about low medicine adherence rates showing that only 66.7% of patients claiming for CDL conditions reached an adherence rate of more than 80% over the 12-month period.

Specialty medicine costs increasing

Expenditure on specialty medicines, mainly high-cost biological medicines to treat autoimmune conditions and cancer increased by more than 8% due to an increase of 13% in the number of beneficiaries claiming for these drugs. These drugs now contribute to almost 11% of the total expenditure on medicines. Oncology speciality medicine made up 53.6% of the speciality medicine expenditure, while 36.1% was on the PMB benefit.

Top therapeutic groups

The top 5 therapeutic medicine groups according to expenditure changed slightly from 2018 with antihypertensive agents, cytostatic and antidiabetic agents remaining in the top three positions. Gastric-acid-reducing agents changed from positions five to four and antidepressants moved into position five, up from position six in 2018.

In terms of utilisation, cough and cold preparations, combination analgesics, beta-lactam antibiotics, nonsteroidal anti-inflammatory drugs and antihistamine agents remained in the top 5.

The top 5 products according to expenditure were NovoMix 30 FlexPen Insulin, the cytostatic agent, MabThera, the antiretroviral Tribuss, Herceptin 600mg for breast cancer and the antiretroviral, Atroiza.

According to the review, the five most costly conditions on a per patient per annum basis, were Haemophilia (R372 145),  Multiple sclerosis (R64 720),  Chronic renal disease (R22 648), Crohn disease (R19 679) and Diabetes insipidus (R16 475). These conditions were responsible for 1.1% of item volume and 8.3% of expenditure.

The bulk of paid medicine claims (93.3%) originated from pharmacies, of which 85.6% were from retail pharmacies, and 7.7% were from courier pharmacies. Approximately 6.4% of claims were submitted by dispensing GPs, while 0.2% of claims were submitted by other providers, mainly oncologists. The largest proportion of patients again made use of retail pharmacies (70.0% of beneficiaries), followed by dispensing GPs (15.0%) and courier pharmacies (4.8%).

The full review is available on: 

Mediscor Medicines Review 2019