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Understanding your chronic medicine benefits and Prescribed Minimum Benefits (PMBs) is half the battle when it comes to managing your health. The good news? With Bestmed, you don’t have to feel like you’re trying to crack a secret code just to access the care you need.

Let’s break it down.

What are chronic medicine benefits?

If you live with a long-term (i.e. chronic) condition like diabetes, asthma, epilepsy and many more, you may require ongoing medication to treat your condition.

That’s why you have chronic medicine benefits, which ensure you get the medication you need without worrying if you’ll be able to afford it. Approved chronic medication is paid for by the Scheme, so even if you don’t have any funds in your savings account, you can still get your medicine.

However, it’s essential to note than not all chronic medications will be covered under the chronic medicine benefit. On all options, Bestmed will pay for medication for conditions and diseases listed on the Chronic Disease List (CDL).

Non-CDL conditions are additional chronic conditions which may be covered by the Scheme, going above and beyond the legal requirement, but only on certain benefit options. It is not compulsory for the Scheme to fund treatment of these conditions. This includes conditions such as gout, acne and more.

What are PMBs?

Prescribed minimum benefits (PMBs) are a set of defined minimum benefits that every medical scheme in South Africa is legally required to cover. There are 271 medical conditions and 26 chronic conditions (which you now know as the CDL list) that make up the PMBs. 

These PMBs ensure that members with certain chronic conditions or members experiencing an emergency, receive a minimum level of care, regardless of their benefit option.

How to access your chronic medicine benefits

Getting access to your chronic medicine benefits isn’t complicated at all. You just need to follow these steps.

1. Get a diagnosis: Visit your GP or specialist will confirm your chronic condition and give you the script for your chronic medication.
2.  Apply for your chronic medicine benefits: You and your doctor will complete the Chronic Medicine Application Form, which you’ll submit to Bestmed.
3. Use a designated pharmacy: To avoid any possible co-payments, get your medication from Bestmed’s designated service provider (DSP) pharmacy network.
4. Stick to the formulary: Bestmed only pays for chronic medication listed on the Scheme’s approved medicine list (also known as the formulary). If your doctor prescribes medication that differs from what is listed to treat the chronic condition, you might need to pay a portion of the medicine cost out of your own pocket.

Important things to remember

• Make sure your script is up to date and take note of any last refills. Most prescriptions are for a maximum of six (6) months.
• Ask for help. Our Personally Yours promise means we’re always here for you. For claims, chronic illness and medicine information, call 086 000 2378, email claims@bestmed.co.za or medicine@bestmed.co.za.