The public should not be blindsided by healthcare industry deals that could affect them, says Health Council CEO Ricky Brathwaite
Any deal that could disturb the delicate balance of healthcare in Bermuda should face scrutiny.
This is the position of the Health Council CEO, Dr. Ricky Brathwaite. He says, “any decision that’s going to materially impact the quality of life, access to care to the public of services or products should should obtain a review.”
He suggests that industry-impacting moves, such as a recent Allshores deal to make Phoenix their designated provider for 46 medications, should have an outside eye on them.
“As a regulator in the system,” Dr. Brathwaite continues, “things like increases in premiums above a certain amount, the closure of or merging of companies in principle… things that can materially impact the health and well-being of the public should go through a review before it happens, versus kind of an after the fact notification to the regulator saying that, you know, ‘this is happening’…”
Dr. Brathwaite says the Health Council was aware of the RFP that Allshores had published which eventually led to the Phoenix deal.
However, he found out about the final deal at the same time as the public…
He said, “The specifics around 46 drugs, and who’s getting the agreement, and whether it’s going to be exclusive or limiting, those kind of things… we would have no sight of until they were released to the media. And I think that’s a problem.”
“I think part of the concern of the public is being blindsided by significant changes… But until a body or someone objective outside of the decision making process of the entities that are making decisions is able to opine on them, then it does create some disadvantages to the public.”
“And that’s something I think the Health Council is in a good position to do.”
Mr Brathwaite told us he understood the Allshores deal to be similar to CG Pharmacy, where CG insurees can get higher coverage for some medications than at other pharmacies.
However, the original online prescription list – which includes Ozempic, Eliquis, and Adderall – stated that certain prescriptions “must be filled exclusively through Phoenix”.
Immediately after Bermuda Broadcasting broke the story in February, the language was changed to say coverage at non-Phoenix pharmacies would be subject to “the terms of individual health plans”.
Health Minister Kim Wilson instructed the Bermuda Health Council to request that Allshores implement a 60-day deferral of the deal until the 1st of May, to allow for a comprehensive review.
Dr. Brathwaite says the Health Council is using the same period to pause and review the implementation of phase II of the National Drug Formulary.
The Formulary regulates the wholesale price of certain medicines, and Phase I requirements, such as regulated pricing for generic drugs, is already in place.
Phase II was originally scheduled for March 1st, but rapid changes to the pharmaceutical market, as well as feedback from pharmacies and wholesalers regarding Phase 1, prompted a pause.
Dr. Brathwaite will expand on the review of the Formulary in a subsequent report.
