ABU DHABI //A service that will ensure patients will be written prescriptions that will cure not harm them has been launched by the national insurance company Daman.
Pharmacy Benefits Management (PBM) will ensure that every drug dispensed by prescription will be cross-checked with rules set by the health authority and insurance companies.
These rules include making sure that the drug fits the diagnosis, that there will be no negative interactions with other prescribed medication and that the patient receives the drug at the correct time.
The standard for PBM was introduced by the Health Authority - Abu Dhabi (Haad) in September 2011.
Last year, prescription medication accounted for 9 per cent of poison cases, putting it third place with food poisoning and just behind over-the-counter medication and pesticides and cleaning products.
"PBM uses clinical tools aimed at reducing inappropriate prescribing by physicians, reducing medication errors and improving consumer compliance and health outcomes," a statement from Haad said. "It provides automated checks for possible negative drug-to-drug interaction to avoid possible health hazards."
According to Haad, most of the 39 insurance companies in the emirate have implemented, piloted or started the set-up for PBM.
Daman, which covers nearly a third of the market in the emirate, officially rolled out PBM this month for members falling under the basic plan, the minimum insurance coverage required by law for residents of Abu Dhabi.
Every time prescription information is entered into the system, it runs through Haad's interface, called Shafafiya, as well as Daman's rule engine, which contains nearly three million parameters set by medical professionals. Within minutes, the system will respond with either a rejection or approval to dispense the drug.
"The advantage of this exercise is that first, the pharmacist is getting more guarantee that whatever he's dispensing is being paid for by Daman," said Dr Jad Aoun, chief medical officer at Daman. "Second, is that the patient is getting a guarantee that the drug the pharmacist is taking from the shelf does not interact with any of his previous or current drugs."
However, this only applies to purchases made through the system. Patients can still choose to pay for drugs themselves, at which point the insurance company holds no responsibility.
More than 50 per cent of Daman's members are covered by its basic plan, at 1.2 million of its 2.1 million members. About 170 private pharmacies are covered - nearly a third of the market - with about 5,000 transactions a day. The prescription rejection rate has increased from 10 per cent to 22 per cent under the new system. This is mostly attributable to negative drug-to-drug interactions, requesting a refill too soon, exceeding the pharmaceutical coverage limit or errors in submission.
Among the other benefits of PBM, Haad said, is the reduction of overall claims costs which in turn "reduces exhausting the insurance policy annual pharmaceutical sub-limit". Through the system, the payer can monitor prescription claims for fraud, waste and abuse.
However, doctors warned that insurance companies must not be preoccupied with the cost of prescriptions.
"This must be discussed and validated so that insurance companies don't find this an opportunity to reject medicine unnecessarily," said Dr Abdulazim Mabrouk, a paediatrician at the Muwaiji Primary Health Care Centre in Al Ain. "This is very important as it may make doctors more conservative when prescribing drugs, and this might affect patient treatment.
"We must not forget the vital purpose, which is to treat human beings."
Daman plans to start rolling out the programme to Thiqa members and enhanced coverage participants in phases by the first half of next year.
The biggest challenges for the PBM programme included setting up the technical infrastructure and changing the attitudes of patients and medical professionals.
Daman provided pharmacies with free software that can work with any insurance provider. Dr Aoun said education was the only way to change attitudes.
"Before the customer was not feeling the rejection because we were basically rejecting from the pharmacist's side - the patient already took the drug and went home… now they call to complain," Dr Aoun said. "I think this will go away once we get bigger awareness that what we're doing is for the patient's favour."
Al Noor Hospital's Khalifa branch pharmacy was among the first to try PBM. Dr Anas Jammal, assistant director of Al Noor pharmacies, said the clear advantages of the system motivated the pharmacy to push through the adjustment period.
"It gives the pharmacist confidence that he is dispensing a drug that won't harm the patient," he said.
If the request is rejected due to a medical error, Dr Jammal said he refuses to dispense the medication. This is the ethical responsibility of the pharmacist.
"We usually call the physician, confirm medical necessity and try to resolve the issue right away," he said. "If it's simply an issue of the insurance not covering this type of medication, we give the patient an opportunity to pay for it himself."