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CHRONIC MEDICINE MANAGEMENT

Prescribed Minimum Benefits (PMBs)

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.

The aim is to provide members with continuous care to improve their health and wellbeing, and to make healthcare more affordable. This includes medical management of the 25 most common chronic illnesses on the Chronic Disease List (CDL).

Click here for more information on prescribed minimum benefits and the CDL conditions. Polmed provides cover for the 25 CDL conditions. If you have been diagnosed with a chronic condition, it is essential to claim your medication from the chronic medication benefit and not from the acute medication benefit. To access this benefit, Polmed requires members to apply for authorisation via the Chronic Medicine Management Programme.

Click the link below for an overview of the Chronic Medicine Management process:

Chronic Medicine Management

Disease authorisation

When you apply for chronic medication authorisation and the predefined criteria are met, you will receive a pre-authorisation for your chronic disease.

This will give you access to a list of pre-approved medication, referred to as a “basket” and means that changes for products included in a medicine basket previously pre-authorised will not require an update.

Medication not linked to a basket will require motivation and pre-authorisation will be subject to meeting the clinical criteria. It is important to note that not all conditions are managed with disease authorisations.

Please note:

A chronic medication formulary is applied to PMBs; medication not included in the formulary will attract a 20% co-payment.
A Designated Service Provider (DSP) will apply to chronic medication claims; if you utilise a pharmacy that is not a DSP, a 20% co-payment will apply.
Polmed Reference Pricing will apply to all medication claims; therefore, consult your pharmacy about a generic equivalent that will not attract a co-payment.

Polmed-approved formularies

To view the applicable formularies/lists, please click on the links below:

COVID acute PMB bakset October 2021

Polmed Exclusions List – April 2022
Polmed Reference Price List – April 2022
Polmed Comprehensive PMB Formulary – April 2022
Polmed Acute Out of Formulary List – April 2022
Polmed Exclusions List – March 2022
Polmed Reference Price List – March 2022
Polmed Comprehensive PMB Formulary – March 2022
Polmed Acute Out of Formulary List – March 2022
Polmed Exclusions List – February 2022
Polmed Reference Price List – February 2022
Polmed Comprehensive PMB Formulary – February 2022
Polmed Acute Out of Formulary List – February 2022
Polmed Exclusions List – December 2021
Polmed Reference Price List – December 2021
Polmed Comprehensive PMB Formulary – December 2021
Polmed Acute Out of Formulary List – December 2021
Polmed Exclusions List – November 2021
Polmed Reference Price List – November 2021
Polmed Comprehensive PMB Formulary – November 2021
Polmed Acute Out of Formulary List – November 2021
Polmed Exclusions List – October 2021
Polmed Reference Price List – October 2021
Polmed Comprehensive PMB Formulary – October 2021
Polmed Acute Out of Formulary List – October 2021
Polmed Exclusions List – September 2021
Polmed Reference Price List – September 2021
Polmed Comprehensive PMB Formulary – September 2021
Polmed Acute Out of Formulary List – September 2021
Polmed Exclusions List – August 2021
Polmed Reference Price List – August 2021
Polmed Comprehensive PMB Formulary – August 2021
Polmed Acute Out of Formulary List – August 2021
Polmed Exclusions List – July 2021
Polmed Reference Price List – July 2021
Polmed Comprehensive PMB Formulary – July 2021
Polmed Acute Out of Formulary List – July 2021
Polmed Exclusions List – June 2021
Polmed Reference Price List – June 2021
Polmed Comprehensive PMB Formulary – June 2021
Polmed Acute Out of Formulary List – June 2021
Polmed Exclusions List – May 2021
Polmed Reference Price List – May 2021
Polmed Comprehensive PMB Formulary – May 2021
Polmed Acute Out of Formulary List – May 2021
Polmed Exclusions List – April 2021
Polmed Reference Price List – April 2021
Polmed Comprehensive PMB Formulary – April 2021
Polmed Acute Out of Formulary List – April 2021
Polmed Exclusions List – August 2020
Polmed Reference Price List – August 2020
Polmed Comprehensive PMB Formulary – August 2020
Polmed Acute Out of Formulary List – August 2020
Polmed Exclusions List – July 2020
Polmed Reference Price List – July 2020
Polmed Comprehensive PMB Formulary – July 2020
Polmed Acute Out of Formulary List – July 2020
Polmed Exclusions List – June 2020
Polmed Reference Price List – June 2020
Polmed Comprehensive PMB Formulary – June 2020
Polmed Acute Out of Formulary List – June 2020
Polmed Exclusions List – May 2020
Polmed Reference Price List – May 2020
Polmed Comprehensive PMB Formulary – May 2020
Polmed Acute Out of Formulary List – May 2020
Polmed Exclusions List – April 2020
Polmed Reference Price List – April 2020
Polmed Comprehensive PMB Formulary – April 2020
Polmed Acute Out of Formulary List – April 2020
Polmed Exclusions List – March 2020
Polmed Reference Price List – March 2020
Polmed Comprehensive PMB Formulary – March 2020
Polmed Acute Out of Formulary List – March 2020
Polmed Exclusions List – February 2020
Polmed Reference Price List – February 2020
Polmed Comprehensive PMB Formulary – February 2020
Polmed Acute Out of Formulary List – February 2020
Polmed Exclusions List – January 2020
Polmed Reference Price List – January 2020
Polmed Comprehensive PMB Formulary – January 2020
Polmed Acute Out of Formulary List – January 2020

Contact details:

Polmed Chronic Medicine Management Programme

(Members): 0860 765 633
(Providers): 0860 104 111 / 0860 765 633
polmedcmm@medscheme.co.za
0860 000 320

Tel: 0860 765 633 or 0860 POLMED
Email: polmed@medscheme.co.za
Fax: 0860 104 114

Polmed Client Service Centre:

Nedbank Plaza, C/o Stanza Bopape and
Steve Biko Streets, Arcadia, 0083

Postal Address:

Polmed, Private Bag X16,
Arcadia, 0007

Emergency Services:

ER24 0800 727 772 or
084 124

Council for Medical Schemes:

www.medicalschemes.com
Polmed Fraud Hotline:
0800 112 811
SMS: 33490

information@whistleblowing.co.za
fraud@medscheme.co.za

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