Stock - Aster Pharmacy Healthcare
Clear guidelines on what a Basic policy can - and won't - cover. But some more medicines, including branded drugs, could be reinstated, healthcare sources say. Image Credit: Virendra Saklani/Gulf News

Dubai: Residents in Dubai with a basic insurance policy are getting partial relief. Some of the prescription medicines that were removed from the Dh600 ‘Essential Benefits Plan’ have been reinstated – and more could be added to the list, according to top healthcare industry sources.

It was in February that the list of medicines eligible under basic was dropped from more than 2,000 to about 700. It meant that these insurance policyholders had to pay out of their pockets if they still wanted to have those meds. The other option, equally expensive, would have been to upgrade their insurance policy.

Now, the authorities “have been updating the list on a weekly basis and the current count is 960,” said Bala N.S., CEO at Aster Retail, part of the Aster DM Healthcare Group. “We understand that the list could be further expanded. The [Dubai healthcare] authority is committed to including a comprehensive formulary to support the needs of patients.”

All of which will remove a major worry for affected policyholders. Many were caught completely off guard by the action taken in February. (Even bringing in lower cost options from outside is just about impossible.)

It also meant that pharmacies were taking a severe hit as well, because the number of basic policyholders remain a sizeable chunk of Dubai’s resident population.

Bala N.S. of Aster Retail
Bala N.S. of Aster Retail: "Unfortunately, if the prescription medicine sought is out-of-plan of the basic policyholder, the only option to get it is via a self-payment. This may not be a desirable..." Image Credit: Virendra Saklani/Gulf News

What next

According to healthcare industry sources, the authorities could even be thinking of adding a few branded medicines too under basic.

“Drugs that currently make up the list are mostly generics,” said Bala. “As a healthcare provider, we would like to see at least two branded products for the same molecule be added to provide clinicians and patients a wider choice. We understand manufacturers of branded products are working with the authorities to have this.

“If the prescription medicine sought is out of plan of the basic policy, the only option to get it is via self-payment, which may not be a desirable. Patients are reluctant to shift from their current medication to generics or substitutes. This has been a challenge for healthcare providers.

“There is an acute issue as some of the products on the list are not available in Dubai, which makes filling prescriptions a challenge. We expect this to change soon as more items are listed and the medicines become locally available.”

Rework the list

Vikas Katoch, Chief Operating Officer of Right Health group, which keeps adding to its network of clinics in the UAE, is another who believes that there will be more changes ahead on what basic policyholders can – and cannot – access.

“We are not working directly with DHA on this, but pharma companies would have made the approach since their products or stocks could no longer be in use,” he said. “And this move also impacted working-class patients who have to bear that burden to pay from their pocket. We are positive DHA will look into all the aspects if any changes are required.”

Vikas Katoch - Right Health Group
Vikas Katoch of Right Health: "Pharma companies would have made the approach to DHA since their products or stocks could no longer be in use..." Image Credit: Antonin Kelian Kallouche/Gulf News

Reasons behind basic's cut down

The primary reason for the February move was to prevent misuse of the basic policies. There are many such policyholders who could easily afford to take up more value-added coverage, but wouldn’t. Because paying only Dh600 was such a powerful hook as long as they had access to the medicines they wanted.

This is what the health authority wanted to stamp out. “Insurance companies had also been making requests to the authorities for some time to cut down the number of medicine formulas covered by the basic plan,” said an insurance industry source.