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Masoabi Sefojane: The Real Cost of a Bleeding Disorder Is More Than Cost Alone

Masoabi Sefojane and David Mileham/LinkedIn

May 28, 2026, 17:40

Masoabi Sefojane: The Real Cost of a Bleeding Disorder Is More Than Cost Alone

Masoabi Sefojane, Geographic Expansion Lead, Africa and Asia Pacific at MicroHealth , shared David Mileham‘s post on LinkedIn, adding:

“I have a bleeding disorder.

My current treatment requires me to inject three times a week. There is an alternative, one that reduces that to once a month, with a longer duration of action and a significantly lower daily burden. It exists. It works. I cannot access it.

The reason, every single time, comes back to cost.

No one in that decision-making process has asked what it costs me, physically, psychologically, or practically, to inject three times a week for the rest of my life. That conversation does not happen, because patients are rarely in the room when these decisions are made.

When patients drop off treatment, because the burden is too high, the access too difficult, that gets recorded as a cost saving. The hospitalisations and complications that follow land in someone else’s column. No one connects the dots because no one is looking at the full picture.

Everyone, medical aids, pharmacies, clinicians, manufacturers, policymakers, optimises for their own metric because we are just numbers on a spreadsheet or dashboard. No one is accountable for the full patient journey. The patient absorbs the cost of every disconnection. Better system design is not a luxury. It is the only way out of this cycle.”

David Mileham, Founder and Principal Advisor of AQUILA LEO, Senior Procurement Specialist and Pharmacist at H&H Morningside Dispensary, shared a post on LinkedIn:

“Medical aids in South Africa are killing medicine affordability.

Not intentionally. Not visibly. But systematically.

Here’s how it actually works on the ground:

A patient walks into a pharmacy with a prescription for a newer antihypertensive. The medicine works. But the medical aid has delisted it from their formulary or placed it on a restricted benefit. The pharmacy has to call the doctor. The doctor has to phone the aid. The aid quotes a 2-week turnaround for motivation. The patient leaves empty-handed.

This happens thousands of times a month across South Africa.

The knock-on effects are invisible in a boardroom but brutal at counter level:

Patients skip doses. Treatments fail. Complications worsen. And the medical aid celebrates their cost saving.

The system treats pharmacy as a cost centre to be squeezed, not a clinical lever to be enabled.

Formulary restrictions that ignore real-world clinical outcomes. Prior authorisations that block access instead of optimising it. Reimbursement models that force generic switches without considering patient stability.

These aren’t efficiency measures. They’re access barriers dressed up as policy.

Real pharmacy strategy means working with the system. But it also means calling out when the system itself is broken.

P.S. The future belongs to medical aids that figure out that enabling pharmacy access is cheaper than managing preventable complications.”

Other posts featuring Masoabi Sefojane on Hemostasis Today.