Medicine
Prescribed medicine is medicine that you generally do not have to take for a long time and the condition you are taking it for clears up. In this section you can read more about the prescribed medicines the Scheme will cover in 2024. It also explains the difference between generic and non-generic medicines as we pay for these differently.
Prescribed medicine is paid from the Acute medicine benefit
The Scheme pays for medicines up to the Medicine Reference Price which is also known as the Scheme Tariff.
There is a 20% deductible co-payment on all acute medication and payment is limited to:
- Single member and per dependant R 5 500
- Member plus one dependant R 10 150
- Member plus two dependants R12 700
- Member plus 3 or more dependants R 16 250
The medicine categories are:
- generic medicines
- non-generic medicines
- over-the-counter and lifestyle enhancing medicines
- excluded items, like contact lens solutions.
Paying for over-the-counter medicine
We pay for schedule 0, 1 and 2 (over-the-counter) medicines up to R1 550 for a single member or R2 050 per family, with a maximum of R320 per beneficiary per day from your Acute medicine benefit.