The PESA Exclusion Categories are part of an extensive medicine management system intended to protect the Acute/Routine Medicines Benefit. The PESA File is an industry exclusion list based on 64 categories of pharmacy-dispensed items (e.g. oral contraceptives, aphrodisiacs).
Medscheme's medical management services advise schemes on the categories that may be most appropriate for their specific membership and for their particular circumstances.
For example, where a scheme does not cover the treatment of osteoporosis against the Chronic Medicines Benefit, the medicines management strategy should at least give the member access to payment of such treatment via the Routine Medicines Benefit. Exclusion category 59 (osteoporosis-specific products) should thus not apply, and in this instance, Medscheme's medical management services would make this recommendation.
