Self, acute, chronic and specialised medication.

Self medication

Self-medication is medicine that does not require a prescription, but is dispensed by a pharmacist.

As long as these are not household medicines, the Society covers it at 100% of the cost, provided the medicine is charged for at the reference price. There are limits on this benefit and only one ailment can be claimed for at any time.

The member needs to inform the pharmacist to mark the claim as supplied on request of member, condition self diagnosed and must be signed by the member.

The Society may suspend this benefit in cases of abuse.

Acute medication

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

Acute medication must be prescribed by a registered healthcare provider and the Society covers it at 100% of the cost provided that the medicine is charged for at the reference price. There are limits on this benefit.

Chronic medication

A chronic condition is a disease that is persistent or otherwise long-lasting in its effects. The term chronic is often used when the course of the disease lasts for more than three months.

PMB conditions are covered subject to a care plan, formulary and generic and therapeutic reference price. Please review our PMB programme.

Other chronic conditions are subject to pre-authorisation by the Medicine Risk Management Department.

Please review our Medicine Risk Management programme.

Additional chronic conditions covered by the scheme are listed below.

Chronic condition-basket

BP Medical Aid Society has introduced an innovative way of providing members with access to chronic medication from their chronic medicine benefit, in the form of chronic condition basket authorisations. The chronic condition basket provides the member with a variety of authorised medications to treat chronic conditions.

PMB main list medication

The PMB main list is a list of all medication that is used mostly in the treatment of a PMB chronic disease list (CDL) condition and other chronic conditions.

These medicine items are carefully chosen to avoid items that could be used to treat an acute condition, e.g. prednisone, which could be used when you have flu. In order to preserve your acute medicine benefits, you will be able to claim for a medicine item on this list only once from the acute medicines benefit. If the Society has your cell phone details, you will receive an SMS advising you that you need to register the medicine on the chronic medicine benefit. If you attempt to claim that particular item again from acute medicine benefits, the claim will be rejected and the pharmacist will receive a message indicating that the medicine you are claiming for should be registered on the chronic medicine benefit.

Specialised medication

This benefit will provide members with access to specific high-cost medicines up to the limit of R131 900 per beneficiary per annum. It's in addition to the chronic medication benefit. Beneficiaries must meet the clinical entry requirements and obtain pre-authorisation to gain access to this benefit.

Click here to view the specialised medication list

In the event of the anticipated annual cost for the medication exceeding the benefit limit, the beneficiary may submit an ex gratia application for consideration of additional funding. Please note that the additional ex gratia benefit is not guaranteed. In the event of a PMB condition, the cost of the specialised medication will accrue to, but is not limited to the R131 900 limit.