![]() Some of the terms that appear in this document are explained below: A formulary (list of medicine) applies to the Prime network options and the MHRP list from our website at or phone our call centre onĠ86 0100 678. PMB ensure that all medical scheme members have that contains the same molecule in the same therapeutic class, and Medihelp applies anĪccess to continuous care to maintain optimal health, and Medihelp will support you on average benefit amount for that specific medicine’s therapeutic class. Doctors and pharmacies may prescribe or provide medicine ![]() Minimum benefits (PMB) on all the benefit options offered to members, in terms of the Medihelp’s benefit options. ![]() The Medicine Price List (MPL) also applies to medicines in a formulary.All registered medical schemes in South Africa must cover a set of defined prescribed Medihelp Reference Price (MHRP) – the MHRP applies to all PMB medicine on all If a formulary applies to the Chronic Disease Benefit on your option, we only cover the medicine that is listed on the formulary. This means if your doctor prescribes a new medicine for the condition, you may already be approved for it and can go straight to your pharmacy with your new script to collect your medicine.Ī formulary is an approved list of medicine for each of the chronic conditions covered by the Scheme. You’ll receive details of these treatment guidelines with your letter from Chronic Medicine Management (CMM). If you’ve applied for one of the 25 Prescribed Minimum Benefit chronic conditions, we’ve compiled treatment guidelines so that you’ll have access to appropriate treatment for your condition. Step 5: We’ll give you treatment guidelines This card records the medical condition for which we’ve approved treatment. If we approve your application for our Chronic Disease Benefit, we’ll give you a medicine access card. Step 4: You’ll get your medicine access card If we don’t approve your application, we’ll give you the reasons why, and you may ask us to review our decision. If we need more information, we’ll let you, your doctor or your pharmacist know exactly what is missing. ![]() Step 3: We’ll give you a response straight away They can either apply online or call our Provider Call Centre on 0860 100 220. Ask your doctor or pharmacist to apply on your behalf.Select the person who’s applying, click the “Chronic Authorisation” button at the bottom of the page and then select “New Chronic Application”. Once you’ve registered, click on “My Authorisations” and then select “My Chronic Application”. Apply here at You’ll need to register before you can apply.Call Chronic Medicine Management (CMM) on 0860 002 153 between 8.30am and 5pm on Monday to Thursday, and between 9am and 5pm on Fridays.You can apply for the Chronic Disease Benefit in the following ways: If you need any help gathering this information, please contact us on 0860 002 153. Total Cholesterol, LDL, HDL, glucose tests, thyroid (depending on your condition). Your prescribing doctor’s practice number.To get coverage for your chronic disease treatment, you or your doctor/pharmacist will need to apply for our Chronic Disease Benefit. To download comprehensive information about the chronic disease on your option click here If you’ve been diagnosed with a chronic condition (a disease lasting more than three months for which you’ll need ongoing treatment), we’ll cover your treatment as long as it falls on our chronic disease list.
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