Prescribed Medicine and Injection Material

The following benefit enhancements were approved by the Board of Trustees and will be implemented with effect from 1 January 2019.
  • Self-Medication

    Self Medication is medicine that does not require a prescription but is dispensed by a pharmacist

    Read about the Self Medication rules

    R220 (2018) or R230 (2019) per ailment, subject to the acute medication limits

    100%of cost or

    80% of cost, as per acute medication benefit.
  • Acute Medication
    Acute sickness conditions. Acute sickness conditions

    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: R5,220
    Family M+C: R8,140
    Family M+C+C: R9,220
    Family M+A: R8,140
    Family M+A+C: R9,220
    Family M+A+C+C: R10,130

    100% of cost up to R1 420 per beneficiary, thereafter

    80% of cost
  • Chronic Medication
    Chronic sickness conditions (excluding specialised medication). Includes daily, continuous use of oxygen for a chronic ailment, excluding the cylinder.

    A chronic condition is a disease that is persistent or otherwise long-lasting in its effects. The term chronic is often applied when the course of the disease 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 preauthorisation by Medicine Risk Management.

    Benefit is adjusted in proportion to the number of months of membership if the member joins during benefit year

    Limit: R35 900 (2019) 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 For non-DSPs, the single exit price, plus the lower of the dispensing fee at a non-DSP, as set out in medicine pricing regulations, or the fee that has been agreed upon with the DSP
  • Specialised Medication

    Specialised Medication is specific high-cost medicines

    Read about the Specialised Medication rules

    Subject to authorisation and clinical entry criteria

    Limit: R139 000 (2019) 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 at a non-DSP, as set out in medicine pricing regulations, or the fee that has been agreed upon with the DSP