Medication

Over-the-counter (OTC) medication

Over-the-counter medication is medicine that does not require a prescription, but is dispensed by a pharmacist over the counter, classified as schedule 1 and 2.

Also included in this benefit is the flu injection as well as homeopathic, herbal and natural medication.

This is covered at 100% of Single Exit Price (SEP) and Generic Reference Price (GRP), subject to the overall annual limit.

Acute medicine

Is prescribed medication for a temporary condition or illness or prescribed medication to relieve the symptoms of infections or sprains.

Any general practicioner may be used. 100% of Single Exit Price (SEP) and Generic Reference Price (GRP) is covered. There are limits on this benefit.

Chronic medicine

A chronic condition is a disease that is persistent or otherwise long-lasting in its effects. The term chronic is often applied when the course of the disease lasts for more than three months.

This benefit covers medication for certain specified conditions, as approved by the Fund. These conditions are often life threatening and require medication for a period of more than six months.

Chronic medicine may be purchased from either your pharmacy or dispensing network doctor. The original prescription is required when medicine is dispensed.

Chronic medication needs to be approved by the Medicine Risk Management Programme.

Chronic medication is covered at 100% of Single Exit Price (SEP) and Generic Reference Price (GRP). There are limits on this benefit.

  • The Fund covers the following chronic conditions
  • Addison's disease
  • Asthma
  • Bipolar mood disorder
  • Bronchiectasis
  • Cardiac failure
  • Cardiomyopathy disease
  • Chronic obstructive pulmonary disease
  • Chronic renal disease
  • Coronary artery disease
  • Crohn's disease
  • Diabetes insipidus
  • Diabetes mellitus, types I and II
  • Dysrhythmias
  • Epilepsy
  • Glaucoma
  • Haemophilia
  • Hyperlipidaemia
  • Hypertension
  • Hypothyroidism
  • Multiple sclerosis
  • Parkinson's disease
  • Rheumatoid arthritis
  • Schizophrenia
  • Systemic lupus erythematosus
  • Ulcerative colitis
  • Allergic rhinitis - only in patients with asthma
  • Long-term oxygen therapy
  • Cystic fibrosis
  • Deep vein thrombosis
  • Gout
  • Major depressive disorder
  • Menopausal hormone dysfunction
  • Severe/chronic eczema and psoriasis
  • Osteoporosis
  • Peripheral vascular disease
  • Pituitary adenoma/hyperfunction of pituitary gland
  • Systemic connective tissue disorders
  • Motor neuron disease