Further application of generic reference pricing
Qualsa routinely communicates with providers when generic alternatives become available in South Africa. This is in line with our contract to manage the chronic medicine benefit for our relevant client schemes whilst promoting high-quality, affordable healthcare. The generic products contain the same active ingredient at the same strength as the original products, thereby offering patients affordable access to a high-quality product.
 
Generic equivalents of the immunosuppressant agents, mycophenolic acid and ciclosporin, are currently available on the South African market. In line with accepted and legislated practice of promoting generic substitution, Qualsa’s Medicine Risk Management (MRM) Department has recommended that these agents be linked to generic reference pricing, in the form of the Qualsa Maximum Price (QMP). The QMP refers to the maximum price a medical scheme will pay for a particular generic medicine. Members are entitled to make use of any generic product within its set reference price limit. As the generic products for these agents, namely Mycophenolate-Hexal® and CicloHexal® respectively, are the only generics currently available on the market, claims for the branded products will be subject to a co-payment. This co-payment will be calculated as the difference in price between the branded product and the QMP.


 

From 1 October 2009, members who are newly registered on the Qualsa MRM Programme will be liable for a co-payment should they claim for Cellcept® and Sandimmun Neoral®.

The minimum co-payment for newly-registered members who choose to remain on the original product will be as follows:

Original brand medication Single Exit Price Quantity Generic Single Exit Price Quantity Co-payment*
Cellcept® 250mg R1 458.50 100 capsules Mycophenolate -Hexal®250mg R1 020.95 100 capsules R437.55
Sandimmun Neoral® 25mg R681.58 50 capsules Ciclohexal® 25mg R565.15 50 capsules R116.43
Sandimmun Neoral® 100mg R2 683.82 50 capsules Ciclohexal® 100mg R2 219.55 50 capsules R464.27
Sandimmun Neoral® 500mg/5ml R2 793.22 50ml Ciclohexal®500mg/5ml R1 906.43 50ml R886.79
* Note that the total co-payment is subject to change depending on price fluctuations of the products or other factors such as the launch of new generic products. Qualsa routinely adjusts the QMP every month as appropriate.

Patients already registered on Qualsa’s MRM Programme will not immediately be liable for co-payments associated with claims for Cellcept® and/or Sandimmun Neoral®. The co-payment for these members will be waivered until the end of 2009, but will take effect as from 1 January 2010.

Should there be specific clinical circumstances that would warrant an override of this co-payment for an individual patient belonging to any one of our client medical schemes, a motivation may be submitted to the relevant scheme for consideration.

The availability of the abovementioned generic products has already been communicated to members of our client schemes and we trust that prescribing practitioners will support us in encouraging patients to change to these generic alternatives.