It is against the National Health Insurance policy for an enrollee to procure drugs outside the healthcare facilities.
Dr. Kunle Ewenla, Managing Director, Ultimate Health, a leading Health Management Organisation (HMO) in the country disclosed this at the Annual General Meeting of Ultimate Health in Abuja.
Ewenla said the health facilities are expected to procure drugs and dispense to enrollees.
He said 65% of the capitation paid to health facilities is meant to procure drugs and wharehoused for enrollees.
He said: “On the health insurance programme, I want to say it loud and clear. There is no room for drugs to be procured by our enrollees outside the facility. I’m repeating it again. There is no room for that to be done.
“On the federal government scheme that we all know, there are two identified risk managers.
“The primary provider is the risk manager at the primary level. And I know you must have been hearing about this capitation. That capitation is 65% of the paid premium being paid in advance to the primary risk manager to manage the risk at the primary level.”
He explained that “Major challenge concerning that, I’m going by you quickly, it also was designed with a particular volume of a release being assigned to each facility. And at the beginning, it was put at 2,500 a release.
“ So as we speak today, we are paying a sum of N1,450 per person per month.
“So a minimum of 2,500 releases is expected to be warehoused in a particular facility. What that means is that the facility will collect N1,450 across 2,500. That should give us about N3.625million thereabouts.
“So, that N3 million is expected and structurally to be utilised by that facility first of all to procure the required medications that are listed on the NHI drug list for warehousing to give to the few that will show within the month to access care. So they are meant to be given their prescribed medications.
“There is no room for prescriptions to be given to anyone to go and buy their medication.”
