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.

    R280 per ailment, subject to the acute medication limits

    100% of cost or

    80%
    of cost, as per acute medication benefit.
  • Acute medication
    Acute illnesses

    Acute medication is prescribed for a short period of time, often to combat a temporary illness.

    Read about the acute medication rules.

    Subject to generic and therapeutic reference price.

    Limits:
    Single: R6 290
    Family M+1: R9 820
    Family M+2: R11 100
    Family M+3+: R12 210

    100% of cost, up to R1 700 per beneficiary; thereafter

    80% of cost
  • Chronic medication
    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.

    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.

    Limit: R43 280 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.

    Subject to authorisation and clinical entry criteria.

    Limit: R159 380 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