A Government Employee Health Insurance policy change has left some pharmacists fuming as they struggle to maintain continuation of care for the government employees and pensioners on the plan.

It has also been a problem for patients, who just want prescriptions filled.

Jennie Lightbourne, the owner of Northshore Pharmacy in Devonshire, said that approval was previously required from GEHI for prescriptions over $2,000. In March, the approval ceiling was lowered to $500.

“That is very low for some medications,” Ms Lightbourne said. Some highly specialised heart drugs, for example, cost $75,000.

Another pharmacist questioned the fairness of the policy’s implementation.

A notice sent to GEHI policyholders, gave less than a month’s warning of the March 31 changes.

The letter stated: “The update aims to enhance the efficiency and equity of prescription medication coverage by ensuring that GEHI pays for the lowest price quote when fulfilling a prescription.”

Ms Lightbourne said the change was implemented without consultation with pharmacists.

“We were just told of the change,” she said. “That was problematic because we had to order a very expensive drug. It was approved and now has to be re-approved on a monthly basis.”

Medications like this are typically ordered in advance so the patient can take them without interruption. Failing to take medications on schedule can mean the end of treatment for some people.

The policy change could lead to financial hardship for small pharmacies.

Ms Lightbourne explained that if the pharmacist has an expensive, specialist medication in stock for the client and then has their approval withdrawn or denied, they cannot send the medication back to the wholesaler for reimbursement and it is usually not needed by another client.

She said, so far, GEHI, had made good on its pledge to turn around approvals within 48 hours. However, the process can take longer if the request is denied.

In that case, the patient must go to another pharmacist and start the process all over again. When the patient finally gets approval from GEHI, it can take two or three more weeks for the pharmacist to bring the medication to the island and dispense it.

Lengthier approval windows would allow pharmacists to stock up on speciality medicines needed by specific clients.

Denis Pitcher, who runs My Pharmacy in Charities House on Point Finger Road in Paget, said that in the past if the pharmacist won the business for a medication, they would have the approval for at least a year.

“Now, it seems that this GEHI policy is a once-off,” he said. “You might have it for three months. They have not really given much clarity on how long it is valid for, which makes it very challenging.”

Pharmacists are never told who actually has the cheapest product on offer, so they cannot simply recommend a patient go to another pharmacy to simplify the procedure.

Ms Lightbourne believes that policies such as this one ultimately lead to less choice for patients.

“Our clients notice for sure, because they sometimes have to go to multiple pharmacies before they can get their prescription,” she said. “They might be on a number of different medications that they have to do this with.”

She said that many customers found it difficult to take their medications as they should and policies like this one added another barrier to them doing so.

Mr Pitcher, questioned the overall fairness and consistency of the approvals process.

“One of the challenges we have had is that we have had customers come in and tell us that they have been directed elsewhere,” Mr Pitcher said. “We were not even given an opportunity to bid for the medication, despite us being the client’s preferred pharmacist.”

Mr Pitcher claimed that in other situations their bid was approved and then cancelled because the client said they wanted to stay at their preferred pharmacy.

“It has been a bit odd,” Mr Pitcher said.

He has complained to the Bermuda Health Council about some of the issues with GEHI.

“They told us they do not regulate insurers,” Mr Pitcher said. “It is unclear who does. Pharmacies owned by insurers may not have these problems but for a small, family owned business, it can be challenging.”

In November 2023, Mr Pitcher and his wife, Olivia Benyak-Pitcher, a pharmacist, won a Supreme Court case against the Government, after My Pharmacy was wrongfully listed as not being registered.

• Have you or your loved ones been affected by this policy change? Write to jmhardy@royalgazette.com