Independent pharmacies tussle with state over vaccine payments

SA’s biggest association for independent pharmacies says its members have been left out of pocket by the department of health’s refusal to cover the costs associated with squeezing a seventh dose out of multidose Pfizer Covid-19 vaccines.

Private sector pharmacies have played an integral role in the government’s coronavirus vaccination programme, inoculating both state patients and medical scheme members. More than 10.5-million of the 37.5-million doses administered to date have been provided at private sector sites, according to government figures.

At issue now is that when Covid-19 shots were in short supply in 2021, some pharmacies extracted an extra seventh dose from vials of Pfizer’s Covid-19 vaccine to meet demand. This was in line with guidance from the US Food and Drug Administration, which said it was acceptable to use every full dose obtainable from a vial of the Pfizer vaccine.

“We believe that at the time when vaccines were scarce, these seventh doses saved lives and we should be reimbursed for them. As the vaccine programme was rolled out on a cost recovery basis, if the national health department refuses to pay for the administration of the seventh dose our pharmacies will make a financial loss,” said Jackie Maiman, CEO of the Independent Community Pharmacy Association.

The association has 1,200 independently owned members, 272 of which have provided Covid-19 vaccinations.

The department of health said the vaccination programme was designed around extracting six doses only from Pfizer’s vaccine vials, and there is no mechanism to pay for the administration of a seventh. SA’s Covid-19 vaccination programme has been managed by the department, which has procured and distributed shots for the entire population. Vaccine recipients are registered on the government’s electronic vaccination data system.

“The vaccine is registered [in SA] for six doses per vial. No instruction nor permission was given to stretch this to seven,” said the department’s deputy director-general for National Health Insurance Nicholas Crisp, who is also in charge of the vaccination programme.

“It appears some private providers decided to follow an FDA notice [which is not valid in SA]. Be that as it may, NDOH [the national department of health] cannot reconcile to seven doses when the system is set to six per vial when calculating waste,” Crisp said.

“If we did, we would contravene the law and our own standard operating procedures. How then would we account for the discrepancy in our audit?”

Covid-19 vaccines are free at the point of service, and private sector sites seek reimbursement from medical schemes and the department of health for the cost of the jabs plus a R70 (without VAT) administration fee.

Retail pharmacy chains Clicks and Dis-Chem declined to answer Business Day’s questions about the extraction of additional doses from Pfizer vaccine vials.

The tussle over payments for the extra doses drawn from Pfizer vials comes against the backdrop of waning demand for shots. Both public and private sector providers have scaled back sharply since peak demand in August 2021.

Dis-Chem has been rationalising sites for several months, and now offers vaccination at just 33 sites, compared to the 131 it operated at peak demand. It has administered more than 1.9million doses since the vaccination programme began in May 2021, and is currently providing about 2,800 shots a week.

Maiman of the Independent Community Pharmacy Association said only 26 of its members are still providing Covid-19 vaccinations, and estimates these come to about 1,500 jabs a week.

Crisp said the department of health is working with the private sector to maintain as much capacity as possible.