The Government Employee Health Insurance plan has increased its scrutiny of high-cost prescriptions in an effort to save money.

On March 3, GEHI sent a letter to 7,000 clients announcing tighter controls on its pharmacy benefit.

The letter stated: “The update aims to enhance the efficiency and equity of prescription medication coverage by ensuring that GEHI pays for the lowest price quote when fulfilling a prescription.

“To support this policy change effective March 31, all singular prescriptions costing $500 or more will require prior approval from GEHI before being fulfilled.”

The policy changes apply to more than 2,500 pensioners and 4,500 active government employees on GEHI.

In response to questions from The Royal Gazette, a spokeswoman for the Ministry of Finance said the update was designed to improve efficiency and equity in coverage by ensuring that GEHI selected the most cost-effective option when paying for prescriptions.

She said: “Pre-approvals have always been required for high-cost medications to maintain responsible and sustainable coverage.”

She added that the insurer was now taking a more “thoughtful approach” by obtaining price quotes to identify the cheapest options and selecting the pharmacy with the best price.

“This step was not previously part of the process, but aims to make prescription coverage more equitable and financially responsible while continuing to support the wellbeing of GEHI members,” a statement said.

The spokeswoman added: “GEHI is committed to ensuring that all members have access to the prescription medications they need in a way that is both fair and financially responsible.”

The statement said if one pharmacy charged $3,000 for a medication, and another offered it for $400, it would not be sustainable, or fair, to pay the higher price for the same treatment.

The policy was approved by GEHI’s management committee and the Minister of Finance to deliver greater value for money and safeguard the scheme’s long-term sustainability.

GEHI commonly receives at least one or two requests daily for medications exceeding $500.

Requests for approval must be submitted in writing, and GEHI promises a 48-hour turnaround.

The spokeswoman said: “Pharmacies typically notify GEHI in advance of weekends or holidays for new prescriptions or medication refills that require approval, ensuring that members receive their necessary medications without disruption.”

The responsibility for pre-approval rests with the pharmacy, not the client.

“Pharmacies are required to secure pre-approval before dispensing prescriptions, ensuring a seamless process for those in need,” the ministry said. “If a client is awaiting treatment or requires urgent medication fulfilment, their prescribing physician will communicate this, allowing pharmacies to prioritise their care and ensure timely access to essential treatments.”

The Government said the goal is to ensure fair, sustainable access to essential treatments for everyone, while carefully managing resources to support the wellbeing of all members.

“GEHI remains committed to making prescription coverage as accessible, equitable and cost-effective as possible, so that all clients receive the care they need.”

Correction: this article has been corrected to clarify the statement came from a spokeswoman for the Ministry of Finance