Pharmacy Management Benefit Team
Pharmacy Benefit Management (PBM) manage 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:
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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 medicine may be paid up to the benefit limit of the respective 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 do es have a limit that can be reached during the year.
The Extended Chronic conditions for the Energy and Fantasy option:
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The Extended Chronic conditions for the Universal option:
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Members are encouraged to make use of Designated Service Provider (DSP) Pharmacies and, opt for the more cost-effective alternatives where applicable, when claiming medicine; so that member out-of-pocket expenses may be avoided.
