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Table 2 Participants’ opinions on challenges experienced with formulary development and management

From: Understanding the decision making process of selection of medicines in the private sector in South Africa – lessons for low-middle income countries



issues with provision of information for decision making

“one big issue … is the lack of update on the therapeutic algorithms, which is published by the council of medical schemes, Department of health and those”.

“MCC (SAHPRA) … have failed … to indicate on a public list what products are generically equivalent”

Lack of health economic information

“You would go do a literature search to see if anything has been done, but what limits it in the South African market is that, you can’t really compare our economic situation and rand value to what’s been done in Europe and America. We do look at that but we try and consider the implications that the South African environment would have”.

“We look into their opinion but we can also extrapolate that into some more international, local publications, if available you know, sometimes that’s of course the main restriction, is the non-availability of this type of pharmacoeconomic data”.

“We don’t do the studies our self, but if somebody does submit a cost utility or cost effectiveness analysis, we would consider these. We don’t conduct them internally and they generally are viewed cautiously because it’s quite easy to manipulate the data to support their own needs. So, it’s sometimes quite difficult to interpret some of the costings they’ve used and some of the assumptions and they often base them on different economic settings which are different from a South African context”.

“You hardly ever, ever, ever see pharmacoeconomic analysis that are endorsed provided in general literature from the pharma companies, what they do have is they bring individual studies that has been conducted in the world somewhere, when they want certain high cost drugs to be paid or when they want to compare products to each other. But it’s not always comprehensive enough to make a conclusive decision of whether it’s eligible for formulary listing or not”.

Alignment of formularies with SA EML

“It’s difficult to align EDL into normal daily business when EDL is not coded and integrated and they use international non propriety names to define the EDL list and if you don’t code your database with the international non-propriety names from the WHO, ATC classification, you won’t just automatically make that relationship with that. So coding, pharmaceutical coding is a huge part of integration, costing and projections”.

Pressure from pharmaceutical industry

“Sometimes you get companies saying:

‘can you then only pay for my products, if we reduce our price?’

and only pay for you and not pay for anybody else? We sorry, can’t do that, you know, we’ve got to be fair. It’s got to be open and transparent to everybody”.