Medscheme's medical management services use a Medicine Exclusion List (MEL). The objective of the MEL is to protect the Acute/Routine Medicine Benefit through the exclusion of certain drugs from payment.
Drugs are included on the MEL for the following reasons:
- Drugs with a dubious risk profile
- Position in therapy not well-established
- Benefit not clinically significant
- Non-drug therapy is the mainstay of therapy
- Product too expensive relative to its clinical value
- Cheaper alternative drugs are available
- Chronic drug not included in the Chronic Medicine Management open formulary or which is only reimbursed once strict clinical and financial criteria are met
- Newly registered product under review by the Drugs & Therapeutics Committee and the Drug Policy Forum
- Product used inappropriately or abused
Download and view full MEL
