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Medicines List NATIONAL HEALTH INSURANCE SCHEME Your access to healthcare MEDICINES LIST JULY 2018 Table of Contents 1.0 Introduction ...................................................................................................................................... ii 2.0 Methodology ...................................................................................................................................... ii 3.0 Exclusions ......................................................................................................................................... iii 4.0 How to use this document ............................................................................................................... iii 4.1 Local codes (Nine Alpha-numeric characters)............................................................................. iv 5.0 Level of Prescribing ......................................................................................................................... vi 6.0 Prescribing Guidelines .................................................................................................................... vii 7.0 Dispensing Guidelines ................................................................................................................... viii 8.0 Labelling ......................................................................................................................................... viii 9.0 List of Medicines and Prices ............................................................................................................. 1 NHIS Medicines List- July 2018 Page i 1.0 Introduction This is the revised version of the NHIS Medicines List (ML), which takes effect from 1st July, 2018. The original list of medicines in this schedule was developed using a process that involved evaluation of evidence for the management of health problems commonly seen at health facilities in Ghana. A Specialists Group comprising medical doctors, pharmacists and a midwife reviewed the evidence for the management of the health problems and selected the appropriate medicines. A Core Group of clinicians assisted the specialists in the selection of medicines and did the final review of the selected medicines. The current reviewed Medicines List contains a total of five hundred and twelve (512) formulations. 2.0 Methodology The NHIS ML review process involves national medicine price surveys, extensive stakeholder engagements and technical committee deliberations in order to arrive at the final list of medicines and their reimbursable prices. This July 2018 reviewed version is however the product of a different methodology brought about by the implementation of the policy on removal of Value Added Tax (VAT) from medicines by the Ministry of Health (MOH). The objective of this policy, passed into law in November 2017, was to reduce the prices of medicines as part of achieving Universal Health Coverage (UHC) since appropriately priced medicines that are affordable play an important role in access to medicines. A technical committee under the leadership of the Deputy Minister of Health and made up of representatives from the Ministry of Health, Ministry of Finance, Ghana Health Service, Ghana Revenue Authority, National Health Insurance Authority, Pharmaceutical Society of Ghana, World Health Organization, United Nations Industrial Development Organization, Ghana Chamber of Pharmacy, Community Practice Pharmacists Association, Pharmaceutical Manufacturers Association of Ghana and Christian Health Association of Ghana were assembled for this task. The output of the committee’s deliberations, among a number of recommendations for the reform of pricing in the pharmaceutical sector, is this price review document to be implemented by the National Health Insurance Authority effective 1st July 2018. NHIS Medicines List- July 2018 Page ii 3.0 Exclusions The original development of the Medicines List concentrated on diseases covered by the benefits package under the National Health Insurance Scheme. Medicines used for specific healthcare intervention programmes are considered as exemptions and are thus excluded from the List. These include childhood immunizations, tuberculosis and mental health care. Some medicines used in mental health, however, may be used in general practice as well. Such situations have been recognized and medicines have been listed for such conditions. The list also does not include medical devices and supplies, and all anesthetic agents because their prices are included in the tariffs for services for which they are used. 4.0 How to use this document The medicines on this list are described in their Generic or International Non-Proprietary Names and include the dosage form and strength. For example: Paracetamol Tablet, 500mg. The proprietary names of very few medicines are used as the ‘generic’ name as a result of long standing common usage, for example, Aspirin Tablet instead of Acetyl Salicylic Acid Tablet. Medicines should be prescribed by the names on this list. Personal abbreviations of names of medicines must be avoided, for example, P’mol for paracetamol would not be accepted on the claims form for reimbursement. The Unit of Pricing column provides information on the basis of the price quoted in the Price column. Examples of the units of pricing are tablet, capsule, suppository, pessary, vial, ampoule, weight (for creams, ointments, granules etc), and volume (for liquids). It is important that prescribers indicate the quantity of medicines to be supplied on the prescription. This is a normal requirement for prescribing and will be very helpful in claims processing for reimbursement. A prescription for two (2) Paracetamol Tablets, 500mg to be taken three times a day for 3 days must indicate the quantity to be supplied as 18 (6 tablets a day for 3 days). Thus, the reimbursed amount will be the price of one tablet of Paracetamol (0.04 Ghana Cedis) multiplied by 18, which is 18 x 0.04 Cedis = 0.72 Ghana Cedis. This basic principle can be applied to all the medicines. Be aware that for those NHIS Medicines List- July 2018 Page iii medicines used as part of procedures, the tariffs developed for the procedures include the cost of the relevant medicines. In calculating the cost of medicines supplied, particular attention should be paid to the unit of pricing. Where a unit of pricing is stated as a course by volume, the price indicated is for the whole course, not per tablet or ml. For example for AMOARTTA1, the GH¢ 2.45 price quoted below is for the one full Course of six tablets, not per tablet. Code Generic name, dosage form, strength Unit of Pricing Price 1. AMOARTTA1 Amodiaquine + Artesunate Tablet, 75 1 Course 2.45 mg + 25 mg (6 tabs) 2. ARTLUMSU1 Artemether + Lumefantrine Suspension, 100 mL 5.63 (Powder For Reconstitution) 20 mg + 120 mg / 5 mL 4.1 Local codes (Nine Alpha-numeric characters) The code generated for each medicine item was limited to a fixed length of NINE alphanumeric characters. A system of classification based on the first six characters of the generic name of the medicine (with variations), formulation (which is the next two characters) and strength being the last character, was designed to provide each medicine on the NHIS Medicines List a unique identity. Where there is more than one strength of the same formulation, the medicine’s code was arranged numerically in ascending order of strength. In designing the codes, consideration was also given to the practicality of filling forms within diverse health institutions (public and private); with different staff strengths and capabilities. For example, the code for Albendazole Tablet, 200 mg would be ALBENDTA1, with ALBEND from its generic name, TA- indicating that it is tablet and 1 as the lower strength; as opposed to 2 for the 400 mg which is a higher strength. Exceptions to the ‘First 6 character’ rule apply when the generic name of the medicine is made up of two or more words. Thus where the generic name has two words, the first three characters of each word are joined to form the first six characters of the code. NHIS Medicines List- July 2018 Page iv For example, the code for Magnesium TrisilicateTablet, 500 mg is MAGTRITA1. On the other hand, where the generic name has three words the first two characters of each word are joined for the first six letters. An example is Magnesium Trisilicate + Aluminium Hydroxide Mixture with code MATRALMI1. The two character designation for the dosage forms are given in Table 1. Table 1 Abbreviations for dosage forms used in the coding CA - CAPSULE OG - ORAL GEL CR - CREAM OI - OINTMENT DT - DISPERSIBLE TABLET PO - POWDER/GRANULES DR - DROPS RE - RECTAL (Suppository) ED - EAR DROPS* RS - RECTAL SOLUTION (RECTAL TUBES) EL - ELIXIR SH - SHAMPOO EO - EYE OINTMENT SP - SPRAY GA - GASEOUS SU - SUSPENSION GE - GEL SY - SYRUP ID - EYE DROPS* TA - TABLET IN - INJECTION TD - TABLET DISPERSIBLE LI - LIQUID VC - VAGINAL CREAM LO - LOTION VP - VAGINAL PESSARY MI - MIXTURE ND - NASAL DROPS MW - MOUTH WASH *Note that where two words describe the dosage form the initials are used. In this case, Eye Drop is coded ID to distinguish it from Ear Drops which is ED. NHIS Medicines List- July 2018 Page v A few of the medicines with identical codes have had the principle of the first six characters modified in order to avoid confusion. Identical codes occur when: • medicines appear under more than one therapeutic class • the first six characters of a medicine name and the dosage form are identical Below are some examples:
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