Health department to oppose doctors 
9 January 2009

The health department would oppose the bid by dispensing doctors to have the courts scrap the laws controlling the fees they may charge for medicines they provide to their patients, according to health department spokesman, Fidel Hadebe. The National Convention on Dispensing (NCD), which represents dispensing doctors, is hoping to get the provisions in the Medicines Act that control their fees declared unlawful. These say doctors may levy fees of up to 16% for medicines that cost less than R100, and may not charge more than R16 on medicines above this threshold.

NCD chairman Norman Mabasa said the fees, which were set in April 2004, were so low that it was uneconomical for doctors to dispense expensive medicines and many had stopped doing so altogether, compromising the quality of care for poor patients. Dispensing doctors are largely clustered in townships and rural communities that do not have ready access to retail pharmacies.  “The dispensing fee does not provide medical practitioners with sufficient revenue to cover the operating costs associated with maintaining an adequate stock of medicines and dispensing them to patients,” he said in court papers.

Mabasa told Business Day that 8000 doctors had been issued with dispensing licences before the pricing regulations came into effect, but only about 6000 were actually dispensing. Research commissioned by the NCD found doctors needed to be able to levy a dispensing fee of 30%-40%, he said.  “We suspect that having failed to stop doctors from dispensing medicines, (the health department) intends the low dispensing fees to do the same, by making us do it at a loss,” he said, referring to a ruling by the Constitutional Court in 2005 that rejected the department’s attempt to prevent doctors from dispensing medicines within 5km of a pharmacy.

The NCD served papers on Health Minister Barbara Hogan and the chairperson of the pricing committee charged with overseeing the medicine pricing regulations on December 18, giving them 15 days to indicate whether they planned to oppose the legal challenge. Hadebe said the minister had sought legal advice, and would oppose the matter. He declined to be drawn on whether the department was open to settling out of court. Mabasa said the NCD had taken legal action because its numerous attempts to get the health department to consider revising the dispensing fee had failed. But the group remained hopeful that the matter could be settled out of court, he said.

The NCD had hoped that the department would review doctors’ fees when it was forced by the Constitutional Court to revise fees for pharmacists, he said. The Constitutional Court ruled in September 2005 that while the health department had the right to regulate the fees charged by pharmacists, the quantum it had set was inappropriate. It ordered the department to revise pharmacists’ dispensing fees, which had been capped at R26 for prescription medicines. Pharmacists rejected the department’s revised fee structure, and launched a fresh legal challenge. The matter is due to be heard next month.

Tamar Kahn, www. businessday.co.za