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1
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2
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- BDS established in 1980
- SBS established in 1981
- Operations governed by Drug Service Act and Financial (Drug Service)
Rules both of (1980)
- Designated WHO Collaborating Center in 1983
- Originally there was co-payment
- Moved from three chronic diseases to five
- Extended to children under 16 rather than six
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3
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4
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- The Barbados National Drug Formulary (BNDF)
- The Supply Service
- The Special Benefit Service (SBS)
- The Barbados Drug Service Pharmacy Service
- The Drug Inspectorate (DI)
- The Drug Information Centre (DIC)
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5
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- Current situation
- Advantages
- Disadvantages
- Cost Analysis
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6
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- 5 Pharmacists
- 4 Clerical Officers
- 2 Data Entry Operators
- Apart from data entry operators, there is hardly a full compliment of
staff at any time
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7
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- No limit to amount to be claimed
- No criteria for participation
- No end to Contractual Agreements
- No proper auditing of PPPs
- Too many discrepancies after auditing
- Late submissions of claims
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8
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- Backlog and Repetition of data entry
- Too many problems with refills
- Too many participating pharmacies
- Abuse of the system/protocols
- Oversees nationals with ID cards
- Multiple Electoral Cards
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9
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- Hoarding by patients
- Claims for refills not made
- Claims for drugs paid for by patients
- Claims for brand instead of generic drug
- Doctors giving multiple prescriptions
- Protocols not being adhered to
- Data entry errors
- More than one prescription for the same patient being serviced at the
same time
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10
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11
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12
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- Introduce co-payment
- Introduce zoning
- Abolish private sector participation
- Restrict private sector usage
- Introduce health/drug levy
- Introduce compulsory health insurance
- Introduce electronic submission (cost cutting)
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13
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- Will still require Data Entry Operators and Computer Operators
- Limit the number of Pharmacists
- Free up Pharmacists for auditing
- Allow reconciliation before payment
- Flexibility to allow annual charges
- Cost saving measure (59,000 monthly, 708,000 annually)
- Eliminate staff shortage
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14
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- Convenience to patient
- Work load sharing between public and private sector pharmacies
- Provision of employment
- Public/private sector partnership
- A model to be emulated
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15
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- Inability to adequately budget
- Abuse by all parties
- Shift to private during financial difficulties
- Lack of control
- Political implications
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16
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- Corrupted
- Monies paid, not claims submitted
- Extrapolations made
- Still being fine tuned
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17
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18
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- Best Case Scenario
- Cost of drug 1.99 + 9.99 + 19.99 + 70.99 = $102.96
- Amount paid = 5 + 14.99 + 26.99 + 80.99 = $127.97
- Profit by PPP = 25.01/102.96 = .2429 which is = 24.3% profit (assuming
cost of $70.99)
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19
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- Worse Case Scenario for the BDS
- Cost of drug 0.1+2.00+10.00+20.00=$32.10
- Amount paid =5 + 7 + 30 =$59
- 26.9/32.1 = 83.8
- 83.8% profit by PPP
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20
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- Inquiry about draft contract
- BAPO lawyers to look at contract
- Concerns about BDS requesting additional information on patients
- BAPO request that for auditing purposes, only pharmacist to contact
patients in order to ensure confidentiality
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21
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- More request for info by BDS with no review of contracts
- Abuse of the system by patients and doctors
- Verbal agreement for end of month payment
- Concerns by BDS re: late submissions
- Concern by PPPs about BDS scripts requiring more attention
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22
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- Delays in receiving statements by PPPs
- Nomination of Ms. Morris at BDS stakeholders workshop
- Concerns about submissions made by privately insured persons by DBDS
- Computerization as a criteria for PPPs
- BAPO as official rep. of PPPs and to be communicated to P.S. and
Minister
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23
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- Deletion of request for authorization for prescriptions more than $60.00
- Amendment to payment made not later than 14 days after submission
- Retention and enforcement of 8 (e) (this relates to private insurance)
- Contractual agreement to last 3 years
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24
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- Expansion of the formulary
- Rising cost of drugs
- Fear of the demise of the SBS program
- Necessity and cost effective concerns
- Frequency of unavailability of drugs
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25
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- Recurrent delay in payments
- Smart Stream
- Verbal agreement of end of month payment
- Commitments to bankers, VAT office, suppliers, etc.
- Assistance to rectify problems
- Written 5th Sept. for payment of 31st Aug. 2001
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26
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- Set criteria for participation in BDS program
- Experience in managing a business (2-3 years)
- Make records available for review by BDS
- Computerisation – versatile to changes if necessary
- Payment of re-certification of premises fee
- Payment of re-registration fee (pharmacists)
- No hiring of BDS Staff without permission
- Provide a ceiling to each pharmacy
- Give notice and terminate all contracts
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27
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- Award new, dated contracts
- Limit number of refills (5)
- Late submissions to be paid late
- Allow non-PPP’s to benefit from contracted prices
- Repeats from old prescriptions to be made void once a new one is written
- Travelling patients to pay in excess of two months
- Travelling patients to only benefit two months allowance when declared
within 25 days of last repeat/ prescription
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28
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- QEH prescriptions to be filled at QEH Pharmacy only
- QEH to contribute to a Fast Tract Pharmacy
- Overlap of contracts to be for only those drugs not back on formulary
- Merger of smaller pharmacies (economy of scale)
- PPP’s to find other measures to avoid cash flow problems
- Give six months (or one year) grace period for those PPPs already in the
system to get computerized
- After that, charge a fee for keying data in BDS Office
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29
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- BDS to have Pharmacists detailing to Doctors re: Protocols,
interactions, cost-effective and rational prescribing habits
- Provide prescription pads for all BDS beneficiaries (public and private)
- Request the original copies to be submitted with claim forms
- Introduce electronic submission
- Limit number of PPPs
- Limit patients to a pharmacy of choice
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30
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- Adopt policies that will bring control and order to the system
- Provide educational programs to inform the general public of changes
- Keep reviewing and modifying the program as necessary
- Look for political agreements, enshrined in legislation that will
support BDS mandate
- Due to limitations in the architecture of the old software, rewriting or
finding a robust software will be the way for the future
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31
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- Protocols
- Authorisations
- Doctors No.
- Pharmacist’s No.
- ID No. change
- Changes in number of Repeats
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Notes
