UPDATES TO OVER-THE-COUNTER (OTC) MEDICINE BENEFIT

In 2021, LA Health introduced a limit of R1 200 per person for OTC medicine across the LA Comprehensive, LA Core, LA Active and LA Focus Benefit Options.

A forensic analysis conducted last year, identified a concerning pattern of excessive OTC medication use. In some cases, members were claiming for more unscheduled OTC medicine than what a family could safely consume in a year.

By means of an example, in two separate instances:

• A family claimed 1, 152 sachets of Bioplus under each of the registered beneficiaries on the membership, totalling R4, 154.08 by 1 January 2021.
• Another family claimed numerous sachets of Turbovite, Gavison, Bioplus, Citris Soda and Grandpa to the value of R3, 448.62 by 2 January 2021.

The Scheme has an obligation to its entire membership base to provide benefits that address as many needs as possible, without increasing contributions at a level that is unsustainable for members. If left unchecked, excessive claims can result in the need for higher contribution increases in the future.

REVIEW OF BENEFIT CHANGE FOR 2021

The Scheme would like to acknowledge the concerns raised by members regarding the introduction of this limit on OTC medicine.

The increased use of OTC medicine is undoubtedly linked to the choice of members to increasingly self-medicate during the COVID-19 pandemic period. Given this increased utilisation and based on recent claims data, the Board of Trustees has reviewed member requests for an OTC limit increase, and have approved the following benefit change:

• The current OTC medication limit of R1 200 per person per year will be increased to R1 500 per person per year with effect from 1 March 2021. This increase will provide an additional R300 per beneficiary for the year for OTC medicine.

MEMBERS HAVE SUFFICIENT ACCESS TO OTC MEDICINE

The value of the OTC Benefit cannot be underestimated and the Scheme fully supports the use of scheduled OTC medicine to treat minor ailments. Whilst members must have adequate access to OTC medication, excessive claims of unscheduled medication can be detrimental to a member's health and negatively impact the Scheme's long-term sustainability.

We believe the increased benefit limit will provide adequate access for our members who are using the benefit in a responsible manner.