CEO of the National Health Fund (NHF) Everton Anderson has said that for the fiscal year (FY) 2019/20 NHF expenditure on drugs and medical supplies and support was $5.04 billion.

However, for FY 2020/21 expenditure on drugs and medical supplies grew to $8.51 billion driven by COVID-19 demands. Of that amount, $5.9 billion was paid out to local pharmacies participating in the NHF drug delivery system.

This compares to fiscal year 2019/20 when the NHF paid out $5.2 billion to participating pharmacies.

The government health agency added 25 new private provider pharmacies to its network in April 2020 increasing the total of 446 private provider pharmacies. Five have left the partnership since. The number declined to 441 as at October 31, 2021.

The NHF was established to provide financial support to the national health-care system to improve its effectiveness and the health of the Jamaican population mainly through purchase of specific prescription drugs.

The NHF Card Programme is without age restrictions and provides subsidies to beneficiaries for the treatment of 17 chronic illnesses. The NHF covers a fixed amount of the total cost, and users only pay the balance. The NHF card can also be combined with a private health insurance provider’s card to cover prescription costs.

The agency manages a supply warehouse and also provides grants to institutions to improve health-care delivery including infrastructure development, training, disaster preparedness, medical equipment and transportation.

The NHF was created in 2003 and is situated within the National Insurance Scheme (NIS) which also includes the nation’s pension, disability, life and other types of social insurance. It is run by a board appointed by the health ministry and is funded through three mechanisms, which are tobacco excise taxes; special consumption taxes (alcohol, petroleum and motor vehicles); NIS (mandatory payroll contributions of 0.5 per cent of salary paid by employees and employers, as well as by independent workers.

In the last decade, NHF’s revenues have been affected by a fall-off in tax revenues from cigarettes. NHF CEO Everton Anderson told the Jamaica Observer that the funding needs for the agency have increased as a result of expenditure to deal with COVID-19. Total allocation has gone up by $3 billion.

There has been a shortfall in funding received to meet this increased expenditure. There are, however, no financial challenges with private providers. Providers continue to be paid weekly, Anderson stated.

Another challenge faced by the fund under COVID has been the suspension of courtesy visits to provider pharmacies which are key to the success of distribution of benefits under the NHF Individual Benefits Programme (NHF Card and Jamaica Drugs for the Elderly Programme). To overcome this challenge, telephone contacts were increased as well as emails and virtual meetings held to provide information and sensitisation.

The Ministry of Health and Wellness (MOHW) designated the NHF as the agency responsible for the procurement of goods and services needed for the Government of Jamaica’s management of the novel coronavirus pandemic.

Anderson stated, “There were significant increases in demand for PPEs with for example over 300 per cent increase in fluid-resistant gowns and 270 per cent increase in disposable surgical masks moving from 190,000 monthly pre-COVID to 700,000 for COVID.”

Anderson said the organisation had “serious challenges in sourcing personal protective equipment (PPEs), pharmaceuticals and medical supplies making this task a complex endeavour”.

Jamaica recorded its first confirmed case of COVID-19 on March 10, 2020. Since that time, the NHF has responded to increased medication access from 30 days to 90 days for NHF card beneficiaries and up to 60 days for JADEP beneficiaries. Beneficiaries can now get up to three months’ medication which minimises the frequent visits to pharmacies to refill prescriptions.

An early refill of prescriptions was also implemented in March 2020.

Thirty-day quantities supplied can be refilled 15 days before the end of the month’s supply. Sixty-day quantities supplied can be refilled on day 45. Ninety-day quantities supplied can be refilled on day 75.

The NHF has also introduced Saturday service for pharmacies, to assist them with queries. The agency has also added a new online transaction adjustment process in September 2020 which now allows for provider pharmacies to submit transactions online.

In May 2020, the NHF also introduced the Medication Home Delivery programme for patients 65 years and older and also for patients with disabilities. As of March 2021, the total number of prescriptions delivered islandwide via the Medication Delivery Service was over 92,000.

Meanwhile, the agency pursued the merger of all the JADEP (Jamaica Drugs for the Elderly Programme) cards into the NHF card to simplify the process of accessing prescription drugs in September 2020. Another change implemented in December 2020, was the NHF online registration system introduced to enable doctors to submit NHF beneficiaries’ applications online, reducing the application process time. Glucometers can now also be requested online for swifter delivery. Beneficiaries with an NHF card enrolled for diabetes can access a free glucometer every two years.

The NHF CEO says that there has been a shortfall in funding received to meet increased expenditure due to COVID. Allocations from the MOHW/Finance for FY 2020/2021 was $7 billion while expenditure for the year to meet increased demands was $8.51 billion.

Tax revenues for the individual benefits programme for FY 2020-2021 was $8.4 billion which was a decline of $600 million compared to FY 2019-2020 when tax revenue was $9.0 billion.

The main expenditure lines for the NHF are the cost to procure and provide pharmaceuticals for the public sector drug programme; and the individual benefits programme – subsidies (NHFCard & JADEP).

Beneficiaries with an NHF card can get the subsidies and other benefits on the card irrespective of whether they have private health insurance or not.

In order to streamline the NHF Individual Benefits Programme, the benefits for all three health cards administered by the Fund (NHF Card, JADEP & GOJ) were merged into the NHF card, effective Monday, September 21, 2020.

Conditions covered include diabetes, arthritis, cancer, heart disease, high blood pressure and over a dozen other conditions listed on the NHF website. In the drugs for the elderly programme Jamaicans can obtain one drug for $40 and six for $240.