As allowed by Prescribed Minimum Benefit (PMB) legislation, two formularies have been developed by medical management company, Medscheme, to manage the costs:
Medical managers advise medical schemes on the appropriate use of each formulary within each option. Typically, the more generous medical management service options are linked to the Comprehensive Formulary while the more basic cover options are linked to the Restrictive Formulary.
Reimbursement is, however, subject to medical management clinical guidelines and protocols and the Medscheme Price List (MPL).
Medicines that are out-of-formulary attract co-payments that are payable upfront at the point of dispensing.
Download and view Restrictive PMB Formulary
Download and view Comprehensive PMB Formulary
