It is against the National Health Insurance (NHI) policy for any enrollee to purchase prescribed medications outside designated healthcare facilities, a leading health expert has said. Dr. Kunle Ewenla, Managing Director of Ultimate Health HMO, made this clarification during the Annual General Meeting of the company held in Abuja. He emphasised that enrollees are not expected to bear the financial burden of sourcing drugs externally, as the policy mandates health facilities to dispense listed medications directly to patients under the scheme. “There is no room for drugs to be procured by our enrollees outside the facility,” Dr. Ewenla stated firmly. “I’m repeating it again: there is no room for that to be done.”
Explaining the structure of the capitation model under the Federal Government’s health insurance programme, Ewenla noted that 65 per cent of the premium paid per enrollee is allocated to healthcare facilities specifically for procuring and warehousing drugs. “The capitation is N1,450 per enrollee, paid monthly in advance,” he said. “Facilities are expected to warehouse medications for a minimum of 2,500 enrollees, amounting to about N3.625 million monthly. This amount is to be used first and foremost for procuring drugs listed under the NHI formulary.”
He stressed that the policy is clear: drugs must be sourced and dispensed by the facilities, and not left for enrollees to purchase elsewhere. “Prescriptions are not meant to be written and handed over for the patient to buy drugs outside. That defeats the entire purpose of the insurance scheme,” he said. Dr. Ewenla urged stakeholders to adhere strictly to the NHI framework, ensuring that enrollees receive the full benefits of their coverage, including access to medication without additional out-of-pocket expenses. The warning comes amid growing complaints from enrollees who say they are often asked to buy prescribed medications outside healthcare facilities—a practice experts say violates the core principles of the health insurance programme.
