Availability of medical schemes’ formulary medicines in community pharmacies in Durban, South Africa

Abstract

Abstract Objectives This study aimed to calculate the percentage availability of medicine brands for 24 active ingredients across community pharmacies, to establish which brands are listed on medical scheme (MS) formularies and to determine availability trends and patterns among the findings. Methods A quantitative cross-sectional survey was carried out at 30 community pharmacies located in the eThekwini area of Durban, KwaZulu-Natal. The basket of medicines included 24 active ingredients randomly selected from the Abbreviated Primary Health Care Essential Medicines List of South Africa. Medicine formularies from South Africa’s top five MSs, according to the number of dependants, were investigated. Data were collected using an electronic survey and distributed via e-mail to participating pharmacies. All statistical analyses, observations and data collation were performed using tools on Google Forms and Microsoft Excel 2015. Key findings A total of 188 medicine brands were found to be available for sale at 30 community pharmacies. Only 71 medicine brands were on the formulary across all the investigated MSs, indicating that only 37.8% of the available brands were reimbursable. Of the 71 formulary-listed medicine brands, only 17 presented with high percentage availabilities (80% and over). This indicates that only 9.04% of the available medicine brands showed the most desirable results, which is the high availability of formulary medicines that would likely not result in any extra out-of-pocket payments to patients. Conclusions The majority of medicine brands that were identified as available were in fact not reimbursable by the five investigated MSs. Patient confidence in the use of generic medicines should be addressed with the intention of lowering their health expenses and improving treatment adherence. Further studies on formulary medicine availability are encouraged to include a larger basket of medicines, a wider geographical area and more MS plans.