The Chronic Medication Benefit Explained

The Chronic Medication benefit is designed to give you unlimited access to a wide range of medication prescribed by a doctor for specific chronic conditions. The formulary is extensive and favours generics where possible.

The benefit is unlimited which means that there is no limit as to how many times you may get medication (as long as it fits the prescription).

Note that your doctor may prescribe something that is not on the formulary which will not be covered. We do not interfere with the treatment plans of the medical providers.

The approved formulary of medication is very extensive and favours generic medication.

The full list of medication available is not generally published online by the product administrator because it is extensive and is regularly updated as medical protocols change. If you are unsure or need to know about a specific medication then you are welcome to speak to us and we will assist.

The Chronic Disease List is actively maintained every year. The current list includes 24 stated conditions:

• Addison’s Disease
• Asthma
• Bronchiectasis
• Cardiac Failure
  
• Cardiomyopathy
• Chronic Obstructive Pulmonary Disease
• Chronic Renal Failure
  
• Coronary Artery Disease
  
• Crohn’s Disease
  
• Diabetes Insipidus
• Diabetes Mellitus 1
  
• Diabetes Mellitus 2
• Dysrhythmia
• Epilepsy
• Glaucoma
• HIV
• Hyperlipidaemia
  
• Hypertension
• Hypothyroidism
• Multiple Sclerosis
  
• Parkinson’s Disease
  
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
  
• Ulcerative Colitis

There is a 6 month waiting period before any new member on a policy can claim under this benefit.

The benefit is "unlimited" which means that, in general, there is no limit as to how many times you may claim for medication (as long as it fits the prescription and the formulary).

The benefit is unlimited but it is not uncapped. There are two cases where you may be required to make up a shortfall in a medication claim:

• Dispensing fees
• Co-payments

Dispensing fees are sometimes charged by a few pharmacists. We can't control this practice and do not cover dispensing fees. Fortunately, they are not usually expensive.

Co-payments may apply to specific medication. The benefit is unlimited, meaning it can be used as often as is necessary, but certain medication is capped in the amount that is covered. Other medication is fully covered.

If you are unsure or would like to know about a specific medication then you can always ask your network doctor for guidance or speak to us.