The Chronic Medicine Management Programme

Medicine cover for Chronic Disease List conditions (List A)

The Chronic Medicine Management Programme covers approved medicine and items for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Approved medicine will be funded up to the Generic Reference Price (GRP) up to an annual Chronic Medicine Benefit limit per beneficiary.

List A
Addison's Disease
Asthma
Bipolar Mood Disorder
Bronchiectasis
Cardiac Failure
Cardiomyopathy
Chronic Obstructive Pulmonary Disease
Chronic Renal Failure
Coronary Artery Disease
Crohn's Disease
Diabetes Insipidus
Diabetes Mellitus Type 1
Diabetes Mellitus Type 2
Dysrhythmia
Epilepsy
Glaucoma
Haemophilia
Hyperlipidaemia
Hypertension
Hypothyroidism
Multiple Sclerosis
Parkinson's Disease
Rheumatoid Arthritis
Schizophrenia
Systemic Lupus Erythematosus
Ulcerative Colitis

Medicine cover for additional conditions (List B)
You have further cover for 38 additional conditions. Approved medicine and items for these conditions will be funded up to the Generic Reference Price (GRP) up to an annual Chronic Medicine Benefit limit per beneficiary.

List B
Allergic Rhinitis
Alzheimer's Disease
Ankylosing Spondylitis
Aplastic Anaemia
Attention Deficit Hyperactivity Disorder
Barrett's & Erosive Oesophagitis
Cushing's Syndrome
Cystic Fibrosis
Depression
Dermatomyositis
Dystonia
Eczema
Endocarditis
Gastric Ulcer Disease
Gastro Oesophaegal Reflux Disease (GORD)
Gout
Hyperuricaemia
Hypoparathyroidism
Menopause
Motor Neuron Disease
Myasthenia Gravis
Narcolepsy
Osteoarthritis
Osteoporosis
Paget's Disease
Para-/Quadriplegia
Pemphigus
Peripheral Vascular Disease
Pituitary Adenomas
Post-Traumatic Stress Disorder
Prostatic Hypertrophy(benign)
Psoriasis
Psychosis
Scleroderma
TB (Tuberculosis)
Thrombocytopaenia
Thyroid disorders (other than Hypothyroidism, which is covered in List A above)
Tourette's Syndrome

Where to obtain your chronic medicine
You can obtain your chronic medicine from any pharmacy or from your dispensing doctor.

How to access the Chronic Medicine Management Programme
If you want to access cover from the Chronic Medicine Management Programme, you must apply for it. Your doctor can contact the Libcare Chronic Medicine Management Programme Department by calling 0800 12 CARE (2273) to request access to the benefit.

You may need to meet the benefit entry criteria to be registered on the Chronic Medicine Management Programme. Your doctor may need to provide certain test results or extra information.

Changes to your approved treatment plan
Your doctor or pharmacist can call us to let us know about any changes to your treatment plan so that we can update your authorisation(s). If we are not made aware of these changes to your treatment plan, we may not pay your claims from the correct benefit.

Your doctor will need to call us and request cover should you be diagnosed with a new chronic condition.

Treatment plans for your approved List A (CDL) conditions
If you have recently been diagnosed with and approved for cover for a PMB CDL condition, we will pay certain tests, procedures and consultations in the diagnostic basket in full. We will only pay for these tests, procedures and consultations provided that you were an active and valid member of the Scheme at the time of the diagnosis and the relevant ICD-10 diagnostic codes are on the claim.

The Chronic Medicine Management Programme will also cover a limited number of selected tests, procedures as well as general practitioner and specialist consultations each year in full for the ongoing management of your approved condition(s). Please refer to the Prescribed Minimum Benefit treatment baskets document to view what is covered for your approved PMB CDL condition(s) and how we fund for these.

The procedures, tests and consultations covered in the treatment baskets are pro-rated based on the date of approval of the condition. Where you have cover for the same procedure in more than one treatment basket, funding will be limited to the number of procedures in the basket that has the highest quantity.

To make sure that we pay your claims from the correct benefit, we need the claims from your healthcare providers to be submitted with the relevant ICD-10 diagnostic codes.

Request for additional funding for List A (CDL) conditions
Your doctor may call us to request for additional funding for your approved List A (PMB CDL) condition(s). We may require clinical information to support the request

Advance supply of medicine
You may get only one month's supply of chronic medicine at a time. However, if you are travelling overseas and need your chronic medicine in advance, please submit a Request for extended supply of medicine form at least 14 days before departure to chronicmed@libcare.co.za.

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