Pharmacy
Pharmacy Management Benefit Team
Pharmacy Benefit Management (PBM) manages medication benefits to ensure funding of cost-effective medication from the appropriate benefit within the Scheme’s respective Service Level Agreements (SLA’s). Pharmacy Benefit Management (PBM) offers acute and chronic medicine management for Thebemed. Please contact our dedicated pharmacy call centre on 086 184 3236.
Chronic Medication Benefit
PMB and Extended chronic medication benefit.
PMBs Chronic Medication Benefit:
Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. This benefit covers the conditions which are listed below:
- Addison’s Disease
- Asthma
- Bipolar Mood Disorder
- Bronchiectasis
- Cardiac Failure
- Cardiomyopathy
- Chronic Obstructive Pulmonary Disease
- Chronic Renal Failure
- Coronary Artery Disease
- Crohn’s Disease
- Diabetes Insipidus
- Diabetes Mellitus Type I
- Diabetes Mellitus Type II
- Dysrhythmias
- Glaucoma
- Epilepsy
- Haemophilia
- Hyperlipidaemia
- Hypertension
- Hypothyroidism
- Ischaemic heart disease
- Multiple Sclerosis
- Parkinson’s Disease
- Rheumatoid Arthritis
- Schizophrenia
- Systemic Lupus Erythematosus
- Ulcerative Colitis
Extended Chronic Medication Benefit
The scheme provides cover for additional chronic conditions which are scheme specific (for non-PMB conditions or PMB conditions where treatment fall outside of the treatment algorithm). All such conditions meeting approval criteria may be authorised as per Scheme rules. Approved medication may be paid up to the benefit limit of the selected option. Once your benefit limit has been reached, any further claims from this benefit for the approved medicine will be rejected. Kindly note that the Extended chronic medication does have a limit that can be reached during the year.
The Extended Chronic conditions for the Energy and Fantasy option:
- Allergic Rhinitis
- Attention Deficit Hyperactivity Disorder
- Depression
- Gastro-Oesophageal Reflux Disorder
- Gout
- Urinary Incontinence
- Osteoarthritis
- Psoriasis
The Extended Chronic conditions for the Universal option:
- Allergic Rhinitis
- Depression
- Gout
- Osteoarthritis
Members are encouraged to use Preferred Provider (PP) Pharmacies and choose cost-effective alternatives where applicable when claiming medication, so that member out-of-pocket expenses may be avoided.
Acute Medication Benefits
Acute medication is prescribed for a short period of time often to treat a temporary illness. Acute medication must be prescribed by a registered healthcare provider.
The Acute Medication Benefit is subject to applied limits, levies, and reference pricing or exclusions that may be applicable.
Quantity limitations are applied to certain medicines, categorised by drug category and dosage form. However, quantity limitations do not apply to medicine authorized as chronic medication.
Please send the completed Chronic Medication Benefit Application Form to: chronic@thebemed.co.za.
The turnaround time is 3 to 5 working days, excluding Saturdays, Sundays and Public Holidays.
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