Operational Challenges of National Health Insurance Scheme Drug Benefit Management in Selected States of North Central Nigeria

Background: The National Health Insurance Scheme (NHIS) was designed to improve healthcare access and reduce out-of-pocket expenditure in Nigeria. A critical component of its benefit package is drug provision, yet operational challenges in drug benefit management across states have limited scheme effectiveness. This study investigated operational challenges in NHIS drug benefit management across selected accredited facilities in North Central Nigeria. Methods: A qualitative study using semi-structured interviews was conducted with 40 participants including NHIS enrolees, healthcare administrators, and pharmacists at accredited health maintenance organisation facilities in Abuja, Benue, and Kogi states. Thematic analysis identified recurring operational themes. Results: Four principal challenge themes emerged: inadequate essential medicines stock in accredited facilities (cited by 82% of participants), delayed reimbursement to providers (76%), limited formulary coverage for chronic disease medications (68%), and enrolee unawareness of drug entitlements (71%). Generic substitution was perceived negatively by 59 percent of enrolees. Conclusion: Drug benefit management within the NHIS framework in North Central Nigeria faces systemic challenges that undermine equitable access. Formulary expansion, timely reimbursement, and enrolee education are priority reforms. Keywords: NHIS, drug benefit, health insurance, North Central Nigeria, pharmaceutical access