KUALA LUMPUR, Nov 14 — MiCare Sdn Bhd has defended its generic-only policy for Hong Leong Bank staff, saying that it’s restricted by the company’s employee medical benefits.
The third-party administrator (TPA) said it was appointed by Hong Leong Bank Berhad (HLBB) and Hong Leong Islamic Bank Berhad (HLISB) to administer their employee medical benefits in accordance with the benefit structures and parameters established by the banks.
“In performing this role, MiCare is responsible for evaluating, adjudicating, processing and administering claims and benefits as directed by the Banks within the purview of applicable laws, regulations, and contractual obligations,” said MiCare general manager Fu Chwan Jye in a November 12 letter to Evan Lee Advocates and Solicitors, as sighted by CodeBlue.
“The Banks’ reimbursement obligation is governed by the limits, categories, and entitlements set under their respective employee benefit policies. MiCare does not set or alter the scope of these medical benefits.
“The associated cost in any given case will be borne or reimbursed in accordance with the employee’s entitlement or, where applicable, on a self-pay basis in cases where a prescribed medication or treatment falls outside the reimbursement parameters of the Banks.
“MiCare and the Banks operate within the contractual and regulatory framework that is relevant to the provision of health care and its related services.”
CodeBlue reported last Wednesday an October 29 letter of demand (LOD) by Messrs Evan Lee – issued on behalf of nine medical associations – that demanded a retraction of MiCare’s August 12 policy that limited long-term medication prescriptions for HLBB and HLISB employees to generic drugs.
In lieu of a retraction, the medical groups demanded that MiCare and Hong Leong Bank amend the policy to expressly allow panel providers to retain full discretion in prescribing medicine, as well as to state that the insured shall bear the cost if a medical practitioner deems generic medication inappropriate for clinical reasons.
Evan Lee, a medical malpractice firm, claimed that the generic-only policy potentially violated Section 83 of the Private Healthcare Facilities and Services Act 1998, besides numerous ethical codes and guidelines by the Malaysian Medical Council (MMC).
The law firm also contended that the generic-only policy not only put patient safety at risk, but also unfairly exposed medical practitioners to legal and disciplinary action.
The nine doctors’ groups behind the LOD included the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM), the Medical Practitioners Coalition Association of Malaysia (MPCAM), and Pertubuhan Doktor-Doktor Islam Malaysia (Perdim), besides other associations representing medical practitioners in Penang, Perak, Kuala Lumpur and Selangor, Sabah, and Sarawak.
Doctors say that although some patients may respond well to generic medications, others have allergies or require branded drugs for effective management of their condition.
