Pharmaceutical policies used by private health insurance companies in Saudi Arabia

Saudi Pharm J. 2013 Jul;21(3):267-76. doi: 10.1016/j.jsps.2012.10.005. Epub 2012 Nov 12.


Background: Currently, the Council of Cooperative Health Insurance (CCHI) is the body responsible for regulating health insurance in the KSA. While the cooperative health insurance schedule (i.e., model policy for health insurance) is available on the CCHI web site, policies related to pharmaceuticals are ambiguous.

Aims: The primary objective of this study was to assess the impact of health insurance policies provided by health insurance companies in KSA on access to medication and its use.

Settings and design: This study was descriptive in design and used a survey, which was conducted through face-to-face interviews with the medical managers of health insurance companies.

Methods and material: The survey took place between March and June, 2011. All 25 insurance companies accredited by CCHI were eligible to be included in the study. Out of these 25 companies, three were excluded from this survey as no response was received.

Results: All the 16 companies responded "Yes" that they had a prior authorization policy; however, their reasons varied. Eight (50%) of the companies were concerned about the duration of treatment. While 10 (62.5%) did not offer additional coverage over the CCHI model policy, the other 6 (37.5%) reported that they could reconcile certain conditions. The survey also demonstrated that 10 insurance companies allowed refilling of medication but with certain limitations. Six out of the 10 permitted refilling within a maximum time of three months, whereas the other four companies did not have any time-based limits for refilling. The other six companies did not allow refilling without prescription.

Conclusions: Although this paper was primarily descriptive, the findings revealed a substantial scope for improvement in terms of pharmaceutical policy standards and regulation in the health insurance companies in KSA. Additionally, the study highlighted such areas to augment the overall quality use of medication, over-prescribing and irrational use of medication. Further research, thus, is definitely needed.

Keywords: Delivery of health care; Health care policy; Health insurance; Saudi Arabia.