Private primary care health clinics in Malaysia and uncontrolled drug pricing: Employer health insurance for sustainable reimbursement drug policy

Objectives Uncontrolled drug pricing in private health clinics in Malaysia leads to high costs of drug prices whilst the impact on drug use against employee medical coverage are uncertain. The study examined patterns of drug utilization and drug pricing among private medical clinics in Malaysia. The sufficiency of coverage by employer of up to RM 45(USD 10.58) per outpatient clinic visit was also investigated. Methods This retrospective study was conducted among International Islamic University Malaysia (IIUM) community who sought outpatient treatment from IIUM panel clinics serviced by general practitioners(GPs) from January 2016 to September 2019. Prescription data (type of drug, dose, quantity, duration, price for each drug and its manufacturer) and patient characteristics (age, gender, and diagnosis) were extracted from PMCare Claim Database (insurance company managing IIUM medical claims). Patterns of common drugs prescribed, drug pricing, profit margins and total charges (drug price and consultation fees) per clinic visit were measured. Results In total, 161146 prescriptions were prescribed for 10150 patients (IIUM community) during the study period (48.85% female, mean age 26.33 ±SD 17.63). The most common drug prescribed was paracetamol (25.3%) followed by chlorpheniramine (9.46%), cetrizine (7.3%), diphenhydramine.(6.13%), loratadine (4.57%) and diclofenac (4.36%), Generic paracetamol 500mg serves as a prime example, commonly sold between RM 5.00 and RM 10.00 for 10 tablets, profiteering between 2400% to 4900% calculated based on an average cost price of 0.20/10 tablets. Majority of patients were charged within the approved coverage of ≤RM 45. Only 2.41% of patients were afflicted with the exceeded coverage (>RM 45). Conclusions Uncontrolled drug pricing in private health system in Malaysia has resulted in various ranges of drug prices primarily with high profit margins. The current maximum allowable coverage for outpatient treatment for IIUM employees @RM45/clinic visit may be revised pending on the availability of further evidence