Abolish Co-Payments on Biologics

For many decades the vast majority of the South African population has experienced either a denial or violation of fundamental human rights, including rights to health care services.

To ensure the realisation of the right of access to health care services as guaranteed in the Constitution of the Republic of South Africa (Act No 108 of 1996), the Department of Health is committed to upholding, promoting and protecting this right and therefore proclaimed the PATIENTS' RIGHTS CHARTER as a common standard for achieving the realisation of this right. The charter, inter alia, states that everyone has the right of access to health care services that include palliative care that is affordable and effective in cases of incurable or terminal illness.

In terms of the charter, members of a health insurance or medical aid scheme are entitled to information about that insurance or medical aid scheme and to challenge, where necessary, the decisions of such health insurance or medical aid schemes, relating to members. With this in mind, we The Arthritis Foundation of South Africa petition all medical schemes in South Africa to desist the practice of imposing exorbitant co-payments on Biologic treatment and petition the Council for Medical Schemes to abolish such practice.

Patients who have experienced being without pain whilst on a biologic but who cannot afford co-pays are having to cease the use of their prescribed biologic and face returning to a life of crippling pain and disability.

It is ironic that biologics such as Interferon B for Muscular Sclerosis, at almost the same price as those for Rheumatoid Arthritis, have – rightly, long been accepted and reimbursed by medical schemes, whereas for Rheumatoid Arthritis and other immune mediated inflammatory diseases, there has and still is strong resistance to reimbursement on the part of the medical schemes. This, despite the occurrence of the diseases being fairly similar, and Rheumatoid Arthritis causing even greater handicaps than MS, according to WHO’s ICF data.

The percentage of people suffering from these diseases is approximately 1% and remains virtually the same across all nationalities and race groups. Therefore there is neither need nor justification for medical schemes to claim they cannot provide optimal cover for the immune mediated inflammatory diseases.

It is also our contention that where a medical scheme insists on immune mediated inflammatory disease patients going onto the highest package option before it will cover them should they require a biologic, it has no right to, in addition, demand a co-pay. Patients are being forced into the invidious situation of “pay or deteriorate”.