The Tribune

• Late manual switch after system meltdown

• Had wanted pharmacies to take risk/liability

• ‘Absolutely unacceptable’ before late change

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The National Insurance Board (NIB) last night went manual to preserve access to essential medicines for thousands of Bahamians after the National Prescription Drug Plan’s IT system crashed.

Philip McKenzie, the social security system’s chairman, told Tribune Business that the Plan will approve manual prescriptions and purchases “until the system comes back up” following warnings that NIB’s initial response would result in member patients being cut-off from critical medications.

Medical industry sources, speaking on condition of anonymity, yesterday informed this newspaper that NIB executives had initially wanted the Plan’s participating pharmacies to assume all financial risk and liabilities associated with issuing medicines following the technology meltdown. This was because the system shutdown had left the Plan unable to vet and approve any drug distribution to its patients.

Bahamian pharmacies were refusing to take on this risk burden, arguing it was unfair and that NIB should bear the liability because its system collapse sparked the crisis. Many pharmacies were still taking care of their patients’ needs by providing them with a reduced supply of medications - for several days or “a couple of weeks” - in the hope this would give sufficient time for the IT woes to be corrected.

Tribune Business was told the Bahamas Pharmacy Council was due to discuss the situation last night, but the need for such a meeting may have been rendered moot after Mr McKenzie confirmed the Drug Plan will switch to manual medication dispensing following his conversations with NIB executives in charge of the initiative. He added that all participating pharmacies were due to be informed of the move last night.

Describing himself as “very concerned” by the Drug Plan’s IT system woes, which began on Wednesday afternoon and lasted the whole of yesterday, the NIB chair said: “We know how critical access to medication is for persons who need them. It’s a matter we treat as very serious. That’s why we’re going to manual. We understand that a day might be too long for some persons.”

Mr McKenzie disclosing that the National Prescription Drug Plan’s computer system and IT is managed by “an independent third-party provider” but he declined to identify them. “It has just been reported to me that it is down, and the independent provider I guess has attempted to bring it back online,” he said.

“In the interim, we’ve made a decision to go to manual prescriptions and distribution of medicines. I just got off the phone with the executive in charge of the National Prescription Drug Plan. She told me we’ll go manual in 30 minutes, and I called her ten minutes ago. Patients will be able to receive their medications.”

While the system shutdown’s cause was not revealed, Mr McKenzie added: “Unfortunately, they discovered it just yesterday [Wednesday] afternoon. That was when the problem first started, and they tried to reach the service provider; the system operator. They’ve been in communication with them, and are trying to have the system rebooted and become operational.

“We are hoping that it happens tonight or certainly tomorrow, but in the meantime we decided to go to manual processes until the system comes back up. Notice is going to go out to the pharmacies that they can go to the manual dispensing of drugs.”

In 2019, the last year for which data is available, the National Prescription Drug Plan had some 32,856 beneficiaries. That number expanded by 2,002 registrants compared to the prior year, whole some $13.2m was paid to private pharmacies for medications and supplies.

However, medical industry sources yesterday branded NIB’s initial response to the Drug Plan’s system failure as “absolutely unacceptable”. They confirmed that senior executives had at first refused to switch to a manual system unless the pharmacies assumed all liabilities and financial risk associated with issuing medicines to patients who had yet to be approved to receive them.

This would have potentially exposed participating pharmacies to loss if NIB subsequently refused to approve the issuance of drugs to certain patients. One source, speaking on condition of anonymity, told this newspaper: “The National Prescription Drug Plan computer system, its IT system, has completely crashed. There’s no redundancy in place of any sort.

“What they [NIB] are telling pharmacies is that they’re not going to be held accountable for any medications distributed to patients on the Drug Plan. The pharmacies will be unable to give medications, so patients will have to buy them or go without until the National Drug Plan’s computer system is back up

“Different pharmacies and pharmacists are giving patients a couple of days’, or a couple of weeks’, medication, but NIB has said they are not going to honour that. The National Prescription Drug Plan is in a complete state of collapse because their computer system, their IT system, their infrastructure has collapsed,” the source added.

“Thousands of people in our country will not have access to their medicines, so they’re going to have to go without blood pressure medications; sugar medications; other medications they get from the pharmacies. A lot of patients are unable to afford to purchase medications because of financial constraints. What a mess. Just another reflection of what is going on behind the scenes.”

This scenario, though, will not happen now that NIB has reversed course and switched to manual processes for the issuance of Drug Plan medications. Informed of Mr McKenzie’s comments, the source replied: “Obviously they’re now making some sensible decisions for once. We’re 48 hours into crisis mode and they’ve decided to go manual. You’d have thought they’d have some mitigation and a contingency plan if something goes wrong.”

The Government earlier this year signalled its intentions to combine the National Health Insurance (NHI) scheme with the NIB-managed National Prescription Drug Plan in a bid to help curb healthcare waste and inefficiency in the public sector.

Dr Michael Darville, minister of health and wellness, said that once the 2023-2024 Budget was passed, his ministry will begin negotiations on the NHI and drug plan transition. The latter will include new medications, including anti-rejection drugs that are necessary for transplant patients that will participate in the National Organ Donor Programme expected to launch by the end of the year.

He said: “The negotiations with NIB, my ministry, NHI and the Ministry of Finance will begin shortly after the passing of this Budget. As part of this change, we will also add new drugs to the current drug list of the National Prescription Plan to facilitate improvements in clinical outcomes of patients suffering from non-communicable diseases and anti-rejection drugs for renal transplant patients.”