Absence of own specialists troubles CGHS patients

NAGPUR : The Central Government Health Scheme (CGHS) beneficiaries are suffering due to prolonged absence of specialists in the OPD (out patient department) clinics. They have to shuttle between CGHS clinics and the other government hospitals to consult with the specialists and yet do not get the prescribed medicines for varied reasons. The additional director general (ADG) of CGHS in city Dr D O Tikas, however, says the issue will be resolved soon as the various regulations are still evolving.

CGHS clinics in city only have specialists of medicine, eye, paediatrics, obstetrics and gynaecology and skin. For treatment of all other specialities like neuroscience, psychiatry, orthopaedics, nephrology etc the CGHS clinics refer patients to either the corporation hospitals or any other government hospital including medical colleges. Unfortunately, when they come back with the medicines prescribed by them to CGHS dispensaries, patients are mostly told either drugs are not available or they are not as per combinations and formulae permitted under CGHS scheme. They are also refused medicines on the pretext that they are expensive imported medicines or are not generic formula and so not included in the CGHS list.


Whatever the reason, the patients, majority of whom are senior citizens, have to run from pillar to post for no fault of theirs. "I have a dependent daughter who has been suffering from neurological problem for many years. She is referred to the NMC OPD clinic in Sadar but the medicines prescribed by the psychiatrists and neuro-physicians are never available in Shankar Nagar CGHS dispensary. I cannot afford to buy them from private shops," a patient's father told TOI.

Dr Tikas, not denying the problem exists, assured that things would soon be streamlined. This year, the union ministry of health and family welfare issued an order on August 25 that changed the entire process of procurement, inclusion, exclusion of drugs for CGHS beneficiaries, investigations, treatment procedures, implants that has caused a lot of confusion across the country. When VIP beneficiaries in the capital protested the changes, certain drugs, especially those for chronic diseases like diabetes, blood pressure, heart diseases, that were earlier deleted were hastily included back on August 27. The present list includes 1447 generic and 622 branded medicines.

"The August 27 order is also under modification. Suggestions and lists of medicines most commonly prescribed from various cities are being compiled. A lot of medicines relating to neuro and psychiatry, cardiovascular, diabetics, gastrointestinal, analgesics and rheumatoid, vaccines, kidney diseases, ENT, eye, paediatric, antidiuretic, skin etc have been included," Dr Tikas said. Nagpur CGHS has also sent a huge list to the Centre. We hope all these will be included and in near future patients will start getting all medicines except the imported ones whose Indian versions are available, he added.

WHAT HAS CHANGED

* Restrictions brought by order dated August 25, 2014

* CGHS only supplies medicines included in its formulary. Those outside can be substituted by identical formulations or those with same therapeutic effect

* Imported anti-cancer and other drugs are to be given on case to case basis. Only medicines approved by Drug Controller General of India (DCGI) are to be issued. A cheaper Indian version, if available, will be supplied

* Only the listed investigations, treatment procedures, implants and devices with prescribed rates will be allowed in CGHS empanelled diagnostic centres and hospitals

* ADG, CGHS of city can take decisions for unlisted investigations, procedures, reimbursement etc

* In case any unlisted device or implant is installed, the reimbursement should be only as per CGHS rates

* Every CGHS beneficiary has to register his mobile number to guard against misuse of CGHS card

TIMELINE

August 27- A technical committee constituted to update mechanism and listing of medicine, inclusion and exclusion of drugs, investigations, treatment procedures etc.

Sept 9- CGHS allows ESIS, ECHS formularies to be adopted while its own is revised. Many antihypertensive drugs, lipid lowering agents, hormonal preparations prescribed by obstetric and gynaecological doctors, bronchodilators, anti-worming, eye preparations, antiviral, anti-Parkinson's, nephrology, anti-psychiatry, gliptins and insulin analogues included in the list

September 19- Cancer and kidney treatment drugs and liver and kidney transplant drugs stopped under August 25 order allowed on case to case basis

October 1- Formulary still under revision. Drugs under ex-servicemen contributory health scheme (ECHS), Employees State Insurance Corporation still not covered under the schemes will be issued provided if the prescription is for not more than seven days and cost is less than Rs1500 per week. Otherwise, permission of local ADG of CGHS is necessary

October 21- Medicines that were restricted to one month now allowed for three months and patients going abroad can avail medicines for six months

Source: http://timesofindia.indiatimes.com/city/nagpur/Absence-of-own-specialists-troubles-CGHS-patients/articleshow/44942899.cms