Perceived impact of reimbursement policies on accessibility to PCSK9 inhibitors in the South African private healthcare sector

Abstract

The South African private healthcare sector is confronted with the challenge of the limitation of adoption and access to proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), a cholesterol-lowering medicine. At the heart of this is the complex nature of the reimbursement policies that are failing to yield favourable outcomes for patients, investors and practitioners alike. The long-term implications of these current medical reimbursement policies include resistance to medical cover, a decline in innovative drug adoption, a decline in optimal medical outcomes, decline in human capital development, loss in productivity, global drug companies pulling out of the South African market, and an extra financial burden to the patients. This study, employing a qualitative approach, aims to investigates barriers limiting adoption and access to PCSK9i in the South African private healthcare sector with a focal focus on reimbursement policies implemented by medical funders and insurances. The study also explores the market access and commercial success of PCSK9i hindered by reimbursement policies. Through semi-structured interviews as the main method of primary data collection, and using a thematic analysis, the explores the barriers, challenges and burdens that impede market access and entry for the PCSK9i and how this affects the economy, commercial success and stakeholders involved. The findings of this study indicate that reimbursement policies can have far-reaching impacts on businesses and the economy, affecting everything from cost management and innovation to employee satisfaction and market dynamics. Businesses must carefully navigate these policies to optimize their operations and remain competitive in the marketplace. Finally, the study proposes evidence-based recommendations for broadening accessibility to PSCK9i. These include encouraging medical funders to adopt a “risk-sharing” concept, value-based healthcare, patient advocacy groups, and review single exit pricing regulations. The significance of these recommendations is their potential to aid policy makers and other important stakeholders in decision making and ensuring access to the most deserving hypercholesteremia population.