Prescribed Medicine and Injection Material
The following benefits will be implemented with effect from 1 January 2024.- Self-medication
Self-medication does not require a prescription, but is dispensed by a pharmacist.
Read about the self-medication rules.
do_not_disturb_on R300 per ailment, subject to the acute medication limits
100% of cost or
80%
of cost, as per acute medication benefit. - Acute medication
info Acute illnesses
Acute medication is prescribed for a short period of time, often to combat a temporary illness.
Read about the acute medication rules.
warning Subject to generic and therapeutic reference price.
do_not_disturb_on Limits:
Single: R6 800
Family M+1: R10 620
Family M+2: R12 010
Family M+3+: R13 200100% of cost, up to R1 840 per beneficiary; thereafter
80% of cost - Chronic medication
info Chronic conditions (excluding specialised medication) and daily, continuous use of oxygen for a chronic ailment, excluding the cylinder.
A chronic condition is persistent or otherwise long-lasting in its effects. The term ‘chronic’ is often applied when the course of the condition lasts for more than three months
Read about the chronic medication rules.
warning Medication in respect of PMB conditions is subject to a care plan, formulary, generic and therapeutic reference price and Appendix 1 of the Society's rules. Medication in respect of a condition that is not included in the list of PMB conditions is subject to pre-authorisation by Medicine Risk Management.
This benefit is adjusted in proportion to the number of months of membership if the member joins during the benefit year.
do_not_disturb_on Limit: R46 800 per beneficiary per annum, subject to Appendix 1 of the Society's rules. Once the limit is reached, only medication in respect of PMB chronic conditions will be paid in full according to the care plan, formulary and generic or therapeutic reference pricing.
100% of agreed tariff at a DSP
Single exit price plus the lower of the dispensing fee, as set out in medicine pricing regulations or that agreed with DSP, at non-DSP A co-payment of 20% will apply at non-DSP - Specialised medication
Specialised medication is specific high-cost medication.
Read about the specialised medication rules.
warning Subject to authorisation and clinical entry criteria.
do_not_disturb_on Limit: R172 370 per beneficiary per annum. Once the limit is reached, only medication in respect of PMB chronic conditions will be paid in full.
100%of agreed tariff at DSP
Single exit price plus the lower of the dispensing fee, as set out in medicine pricing regulations or that agreed with DSP, at non-DSP