PMB main list


The prescribed minimum benefit (PMB) main list replaces the acute exclusions list (AEL)
To ensure members get optimal value from acute medication benefits, an AEL was implemented in 2016. The AEL included certain medication for the treatment of chronic conditions that was being claimed from the acute medication benefit. The AEL was intended to ensure that medication, which could be registered on the chronic medication programme, was registered correctly, so that members didn't end up paying for chronic medication from their acute medication benefits. The AEL was replaced by the PMB main list from 1 January 2018.

What is the PMB main list?
The PMB main list is a list of all medication that is used mostly in the treatment of a PMB chronic disease list (CDL) condition and other chronic conditions.

These medication items are carefully chosen to avoid items that could be used to treat an acute condition, e.g. prednisone, which could be used when you have flu. In order to preserve your acute medication benefits, you will be able to claim for a medication item on this list three times from the acute medication benefit before it is rejected for payment.

If the Scheme has your cell phone details, you will receive an SMS advising you that you need to register the medication on the chronic medication benefit. If you attempt to claim that particular item again from acute medication benefits, the claim will be rejected and the pharmacist will receive a message indicating that the medication you are claiming for should be registered on the chronic medication benefit.

Members should request their prescribing doctor/pharmacist to contact the Medicine Risk Management Department with the relevant clinical information in order for their pre-authorisation requests to be considered.

Please click here to view the PMB main list.

Newsflash
21 February 2020

With effect from 1 April 2020, Medscheme Holdings (Medscheme) will take over the administration and managed care services from our current administrator - Momentum Health Solutions (MHS).

We will share more information around the change in administrators and any matters that you will need to be aware of over the next few weeks as we draw closer to 1 April.

Click here for a copy of our May 2020 Newsletter.

 

Contact Us

Client Services
Tel: 0860 100 078
Fax: 086 566 1372

Managed Care Services (including hospital pre-authorisation & ICON)
0860 100 078

MEDiPOS Anti-fraud Hotline
Tel: 0800 112 811

Email
enquiries@medipos.co.za

 

MEDiPOS Medical Scheme