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WHAT YOU NEED TO KNOW ABOUT NHIS MEDICINES LIST|11/7/2017

The National Health Insurance Scheme of Ghana (NHIS) was introduced in 2003 as a pro-poor social programme. The policy intent was to provide financial risk protection against the cost of healthcare delivery, and by so doing, eradicate "the cash and carry" system that had strangled access to quality healthcare delivery and accessibility, particularly among the poor in our society.


The NHIS has made steady progress over the years, with its active members standing a little over 11 Million at the close of 2016. The scheme has migrated unto an electronic platform and as a result, the NHIS membership card is now issued potentially within 15 minutes, a significant departure from the old system where it took weeks and months to issue one membership card. The scheme covers over 90% of all disease conditions that are presented in healthcare facilities in Ghana. However, the Scheme has few understandable exclusions in terms of diseases, diagnoses and treatments.


The focus of this article is on the less credited NHIS Medicines List. It will surprise many to know that the NHIS Medicines List contains as much as 517 medicine formulations as at the last review in 2016. The medicines list contains medications for every disease condition that is covered by the scheme and as such any NHIS member who requires treatment for any condition that forms part of the benefit package should be given a medication from the list. Most importantly, an NHIS accredited facility or provider that cannot offer a required treatment (due to restrictions placed on healthcare levels), or prescribe a required medicine or does not have it in stock can and must refer the patient to the next accredited facility that can prescribe or dispense the required medicine. It is therefore unfair on the part of healthcare service providers to suggest to NHIS members or patients to rather pay for medicines that are not covered by the scheme as if there is no alternative.


The Ministry of Health introduced prescribing levels as a quality of care measure to ensure that medicines are prescribed at levels of service delivery by appropriate personnel of the health facility who  can monitor and manage any event, whether desired or adverse,  that may occur as a result of taking a particular medication.


Again, there is a general attitude that seeks to fuel the wrong impression that generic medicines covered by NHIS are cheap and not efficacious. This perception and its perpetuation is wrong, unethical and unpatriotic. It is worth stating that the National Health Insurance Authority does not manufacture any of the 517 medicines on its Medicines List neither were these medicines selected solely by the NHIA. Each of these medicines has been tested and certified by the Ghana Food and Drugs Authority, the state institution with the mandate to validate the efficacy of all medicines produced locally or imported into our country.


It is instructive to learn that the NHIS Medicines List is not compiled and imposed by any single person or body. These medicines are drawn from the Essential Medicines List, which is a list of medicines selected by the Ministry of Health as essential drugs for meeting the health needs of the populace and are in line with the approved treatment protocols for each disease condition. Indeed, all drugs which find space on the NHIS Medicines List are subject to collective discussions and acceptance by stakeholders, namely, National Health Insurance Authority, Ministry of Health, Ghana Health Service, Pharmaceutical Society of Ghana, Health facilities, Ghana Medical Association, Nursing and Midwifery Council, etc.  


In conclusion, the public is encouraged to ensure that their NHIS membership remains valid always to utilize the wide variety of medicines available on the scheme. Any member asked to buy a medication because it is not covered by the NHIS must request the healthcare provider to give him/her the alternative that is on the NHIS list.



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