Self-medication

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

As long as this is not household or homeopathic medication, the Society covers it at 100% of the cost, provided the medication 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 medication 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, medication formulary and generic and therapeutic reference price. Read more about the PMB programme.

Please review our Medicine Risk Management Programme.

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

*Prescribed minimum benefits (PMBs) are a set of limited conditions which medical schemes are legally required to cover.

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 their chronic condition(s).

Specialised medication

This benefit will provide members with access to specific high-cost medication and there are limits on this benefit. 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.

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, a per beneficiary per annum limit.