The Ministry of Finance has hit back at criticism from medicine providers, insisting every pharmacy was informed about a change to the Government’s insurance plan that lowered the approvals threshold.

The adjustment required Government Employee Health Insurance policyholders to obtain permission for all medications of more than $500. Previously, approvals were needed for more expensive medications.

“Each pharmacy was informed of the update via e-mail and encouraged to reach out to GEHI with any inquiries or for further clarification,” the Government said. “We are grateful to those pharmacies that took the initiative to contact us, whether by phone, e-mail, or scheduling a meeting, to better understand how this new process could support their operations. This opportunity was extended equally to all, underscoring our commitment to fairness and collaboration.”

In a previous article in The Royal Gazette, Jennie Lightbourne, the owner of Northshore Pharmacy in Devonshire, complained about a lack of consultation on the matter, saying: “We were just told of the change. 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.”

The Government made the change to GEHI so it could shop around for the cheapest medication on the island.

“While pre-approvals for high-cost prescriptions have always been part of the process, incorporating the lowest quote is a new measure designed to deliver better value for both members and the scheme,” the finance ministry said, adding that GEHI has always strived to ensure responsible and sustainable coverage for its members.

“We remain committed to providing thoughtful, fair and efficient coverage that supports the health needs of our clients while safeguarding the scheme’s sustainability,” the Government said.

Ms Lightbourne said that while GEHI has promised a 48-hour turnaround for approvals, the process can take longer for the client if the initial request of the pharmacist is denied, and the policyholder has to try again at another pharmacy.

In response, the ministry said the updated process has been functioning well, and clients have not reported any delays.

The Government said that while pharmacists are not always immediately informed that they have lost the bid for a medication costing more than $500, GEHI makes it a priority to contact clients ahead of time when a prescription is being transferred.

“This allows them to make an informed decision that works best for them while ensuring their prescription information is promptly shared with the pharmacy to avoid any disruption to their care,” the Government said.

A spokesman added that if delays do occur, they are typically tied to the need for additional documentation to establish medical necessity.

“These situations can arise for prescriptions that are not automatically covered but are medically required, and we handle them with as much care and urgency as possible,” the finance ministry said.

Denis Pitcher, the owner of My Pharmacy in Paget, said that previously, once an approval was given, it lasted at least a year. Now approvals are given out for a much shorter duration.

The Government said long-term pre-approvals were no longer ideal.

“This decision was made because a client’s policy could end at any time during the year, and prescription prices often vary significantly month by month,” the ministry said.

Approvals now remain valid until there is a change in the price in an effort to prevent situations where a pharmacy receives approval but then charges higher prices in subsequent months.

“Pharmacies are provided with the approved amount and are allowed to bill only within the limits of that amount for the month in question,” the Government said. “This approach addresses issues GEHI has encountered, such as advance billing for multiple months’ worth of prescriptions when only one month’s supply is dispensed.”

The finance ministry explained that when a pharmacy requests a quote, GEHI now checks if the medication is available on the island and whether it is ready for immediate dispensing. If a lower quote is received but the medication is not yet ready for dispensing, the requesting pharmacy is granted approval for a short period, typically one or two months, to prevent delays for clients.

For urgent requests, approvals may be granted for one month at the quoted price, with the understanding that pre-approval will be needed for further dispensing.

“This updated approach ensures fairness by prioritising cost-effectiveness while preventing delays for clients and maintaining equity among pharmacies,” the ministry said.