Medication

- Where can I collect acute medication?

If you live in the vicinity of the Healthcare Pharmacy in Kimberley, Lime Acres Pharmacy, Premier Mine Hospital Dispensary in Cullinan, or the Namaqualand Pharmacy in Springbok, you may collect your acute medication from these pharmacies (or directly from Dr HA Burger in Springbok) at an agreed lower tariff, and no additional administration levies will be charged (as is generally the case with other retail pharmacies). You can also obtain your acute medicine from any retail Clicks pharmacy anywhere in the country.

If this is not convenient, you may also collect your acute medication from any other retail pharmacy in South Africa. If you choose this option, it is important that you check that the pharmacy charges the current SEP with a professional fee added at 26%, limited to a maximum of R26 per item dispensed. If a higher pricing structure applies, you will have to pay the difference as an additional administration levy. This is in addition to the normal 30% co-payment in terms of the Rules of the Society for acute medicines.

It is also possible to have long term acute medication delivered with your chronic medication, provided that it is available from CDM and ordered along with your chronic medication. However, please note that this may result in a delay of the delivery of your chronic medicine. Please see the information on chronic medication below for more information.

- Where can I obtain my chronic medication?

DBBS members can collect their chronic medication from one of the following DSP’s: Healthcare Pharmacy in Kimberley, Lime Acres Pharmacy, Premier Mine Hospital Dispensary in Cullinan, the Namaqualand Pharmacy in Springbok or directly from Dr HA Burger in Springbok. If collection is not possible, your chronic medicine will be delivered to you free of charge by CDM, either via courier or to your nearest post office or Clicks pharmacy. You will be notified via SMS by CDM when medicine is dispatched. In the event that you obtain your chronic medication from any other source than that listed above, (also known as out-of-network), this will carry a co-payment of 30% plus the difference between the supplier charges and the contracted price that the Society has with its DSPs. Please note that all oncology medicine must also be obtained from Clicks directmedicine.

- How do chronic medication benefits work?

If you or any of your dependants suffer from the chronic conditions listed below and require chronic medication, your doctor must register the affected person (beneficiary) on the Society’s Chronic Medication Programme and obtain authorisation before prescribing chronic medication by calling 053-807-3593.

Once the beneficiary has been registered on the programme and the proper authorisation has been granted, the Society will pay 100% of the cost, on condition that you obtain your chronic medication from the DSPs listed above and subject to the limits. Please note that if you or your Doctor insists on original brand-name medicine, and not a generic equivalent (subject to GRP), you will be liable for a co-payment. If you do not register on the Chronic Medication Programme the cost of the medication will be deducted from your chronic medication benefits and you will be liable for a 30% co-payment.

Notes:

Please remember to re-order your chronic medication at least 10 days prior to your current supply being depleted. Chronic medication is not automatically dispensed.
All chronic medicine prescriptions are only valid for six months from the date of issue. Members must obtain a new prescription before this period expires.
Please note that homeopathic medication does not qualify for chronic medication benefits.

- What process must be followed before I can obtain my chronic medication?

Once you have been registered on the Society’s Chronic Medication Programme and the proper authorisation has been granted for your medication, fax your prescription to 0861 444 414 or email it to clicks.directmedicines@dirmed.co.za. Please note that this does not automatically instruct CDM to forward your chronic medication. You have to give them specific instructions via the call centre (0861 444 405) or by fax or e-mail (see contact details on the first page of this Guide) detailing each item required and providing your preferred delivery method, address and contact numbers. For members accessing the other DSPs noted above, the prescription should be handed in at the relevant pharmacy.

- What chronic illnesses are covered?

Prescribed minimum benefit (PMB) chronic conditions (as per the CDL):

1. Addison’s Disease

2. Asthma

3. Bipolar Mood Disorder

4. Bronchiectasis

5. Cardiac Failure

6. Cardiomyopathy Disease

7. Chronic Obstructive Pulmonary Disease

8. Chronic Renal Disease

9. Coronary Artery Disease

10. Crohn’s Disease

11. Diabetes Insipidus*

12. Diabetes Mellitus Type 1 and 2

13. Dysrythmias

14. Epilepsy

15. Glaucoma

16. Haemophilia*

17. HIV/AIDS

18. Hyperlipidaemia

19. Hypertension

20. Hypothyroidism

21. Multiple Sclerosis*

22. Parkinson’s Disease

23. Rheumatoid Arthritis

24. Schizophrenia

25. Systemic Lupus Erythromatosis

26. Ulcerative Colitis

In addition to the above chronic conditions, the Society will also cover the following conditions (which do not qualify for PMBs and are subject to the annual chronic medication limit):

1. Acne*

2. Allergic Rhinitis*

3. Alzheimers Disease*

4. Ankylosing Spondylitis

5. Benign Prostatic Hypertrophy

6. Cushing’s Disease §

7. Cystic Fibrosis*

8. Deep Vein Thrombosis

9. Gastro-Oesophageal Reflux Disorder*

10. Gout*

11. Hyperpara-thyroidism §

12. Hyperthyroidism §

13. Hypoparathyroidism §

14. Major Depression §

15. Ménière’s Disease*

16. Menopausal and Peri-menopausal Disorders §

17. Motor Neuron Disease

18. Myasthenia Gravis

19. Osteoarthritis

20. Osteoporosis*

21. Paget’s Disease

22. Paraplegia, Quadriplegia* §

23. Peripheral Vascular Disease §

24. Pituitary Adenomas §

25. Psoriasis

26. Pulmonary Interstitial Fibrosis

27. Stroke / Cerebro-vascular Accident §

28. Systemic Connective Tissue Disorders (incl. Scleroderma & Dermatomyositis)

29. Attention Deficit Hyperactivity Disorder

Medical conditions marked * will only qualify for benefits under specific circumstances. Please contact the Society for details in this regard.

Medical conditions marked § may attract prescribed minimum benefit entitlement in terms of the diagnosis and treatment pairs as per Annexure A to the regulations to the Medical Schemes Act.