Benefits: Chronic Medicine

What is a chronic condition?

A chronic condition is a condition that requires ongoing long-term or continuous medical treatment. However, not all these conditions are necessarily covered by the Society’s Chronic Medicine Benefits. The Society specifies the chronic conditions that qualify for this benefit.

What chronic conditions are covered by the Society?

There are two main categories of chronic conditions that are covered by the Society:

  • Chronic Disease List (CDL) of Prescribed Minimum Benefits conditions
  • Listed non-CDL chronic conditions


Chronic Disease List (CDL) of Prescribed Minimum Benefits conditions
  1. Addison’s Disease
  2. Asthma
  3. Bipolar Mood Disorder
  4. Bronchiectasis
  5. Cardiac Failure
  6. Cardiomyopathy
  7. Chronic Obstructive Pulmonary Disease
  8. Chronic Renal Disease
  9. Coronary Artery Disease
  1. Crohn’s Disease
  2. Diabetes Insipidus*
  3. Diabetes Mellitus Type 1 & 2
  4. Dysrhythmia
  5. Epilepsy
  6. Glaucoma
  7. Haemophilia*
  9. Hyperlipidaemia
  1. Hypertension
  2. Hypothyroidism
  3. Multiple Sclerosis*
  4. Parkinson’s Disease
  5. Rheumatoid Arthritis
  6. Schizophrenia
  7. Systemic Lupus Erythematosus
  8. Ulcerative Colitis

Medical conditions marked * will only qualify for benefits under specific circumstances. Please contact Mediscor for details in this regard.
In addition to the benefits available in respect of the chronic conditions included in the PMBs, beneficiaries may, subject to the conditions set out in the Benefit Schedule and other provisions of the Society’s Rules, be entitled to a chronic medication benefit in respect of the chronic conditions listed below (referred to as Listed non-CDL chronic conditions).

Listed non-CDL chronic conditions
  1. Acne
  2. Allergic Rhinitis
  3. Attention Deficit Hyperactivity Disorder (ADHD)
  4. Alzheimer’s Disease
  5. Ankylosing Spondylitis
  6. Benign Prostatic Hypertrophy
  7. Cushing Disease
  8. Cystic Fibrosis
  9. Deep Vein Thrombosis
  10. Gastro-oesophageal Reflux Disease
  1. Gout
  2. Hypoparathyroidism
  3. Hyperthyroidism
  4. Incontinence
  5. Depression
  6. Meniere’s Disease
  7. Menopausal and Perimenopausal Disorders
  8. Motor Neuron Disease
  9. Myasthenia Gravis
  10. Osteoarthritis
  1. Osteoporosis
  2. Paget’s Disease
  3. Paraplegia, Quadriplegia
  4. Peripheral Vascular Disease
  5. Pituitary Adenomas
  6. Psoriasis
  7. Pulmonary Interstitial Fibrosis
  8. Stroke / Cerebrovascular Accident
  9. Systemic Connective Tissue Disorders (incl. Scleroderma and Dermatomyositis)

In the case of the treatment of medical conditions reflected in the above table which may attract a PMB entitlement in terms of the diagnosis and treatment pairs as per Annexure A to the Regulations of the Act, they will be reimbursed as a PMB per Regulation 8.

DRM: Helping members to manage their chronic conditions

The importance of managing a chronic condition effectively is undeniably vital for long-term wellbeing. That is why the Trustees introduced a new Disease Risk Management (DRM) programme from 2023, in partnership with PPSHA.

As reported in a previous issue of Benefit Beat, the DRM programme is aimed at identifying beneficiaries who are at risk of developing chronic conditions, suffering complications due to existing chronic conditions, or experiencing an advancement of their existing chronic conditions, and then assisting them to better manage these and to maintain or even improve their quality of life.

Registration of those identified Society beneficiaries on the DRM has been completed and newly diagnosed beneficiaries are registered daily. Continuous interaction between PPSHA and the registered beneficiaries will ensure better compliance with agreed treatment plans and ultimately reduce the number of hospital admissions that the Society beneficiaries will experience thereby resulting in significant cost savings for both the Society and members in general.


When would it make sense to register for chronic medicine benefits?

If you use medicine for a chronic condition without being registered for chronic medicine benefits:

  • it will be covered from your acute medicine benefit limit (you will probably exhaust this benefit limit quite quickly); or
  • it wil not be covered at all.

However by registering your chronic condition you will have access to a far higher benefit limit for your chronic medicine. In order to encourage beneficiaries to register their chronic conditions, chronic medicine will be paid from the acute limit once and rejected thereafter.

Certain terms and conditions apply to the chronic conditions covered.

What is the benefit for chronic medicines?

A 100% benefit applies to chronic medicines dispensed for CDL and listed non-CDL conditions (see earlier in this chapter), limited to the lesser of either the Formulary Reference Price (FRP Plus) or the Mediscor Reference Price (MRP) value applicable to the medicine. This is on condition that the medicine is included in the formulary for the authorised condition treated, is below the reference price applied and is obtained from one of the Society’s DSPs. If chronic medicine is obtained from a non-DSP a 30% co-payment will apply in addition to any FRP Plus and MRP co-payments.

Overall cumulative benefit limit (both CDL PMB and listed non-CDL)
  • PRE-AUTHORISATION REQUIRED From Mediscor Chroniline®.
  • Limited to R43 940.
  • If this limit is reached before year-end, CDL medicines will continue to be covered in terms of PMB protocols, provided a DSP is used to obtain the medicine and you are registered for the condition.
  • If this limit is reached before year-end, non-CDL (chronic) medicine will no longer be paid.
  • Treatment of ADHD will only be funded until the beneficiary turns 18, thereafter a motivation from a psychiatrist will be required.
  • Managed-care protocols apply.
  • 100% of the negotiated DSP rate.
All Biologicals
  • PRE-AUTHORISATION REQUIRED From the Society’s Managed-Care department.
  • Limited to R271 380 (combined sub-limit for Chronic medicine and Oncology).
  • Subject to available limit for chronic medicine.
  • Managed-care protocols apply.

Where do I find a designated service provider (DSP) for chronic medicine?

To receive the full chronic medicine benefit, you must obtain your chronic medicines from one of the Society’s approved DSPs. These are:

  • All Dis-Chem Retail Pharmacies,
  • Dis-Chem Direct (Dis-Chem’s Courier pharmacy),
  • Cullinan Health & Home Pharmacy,
  • The Namaqualand Pharmacy in Springbok, and
  • Dr HA Burger in Springbok.

How do I register for chronic medicine benefits?

Please register your chronic condition by contacting Mediscor ChroniLine® on 086 011 9553 to obtain pre-authorisation for chronic medicine benefits. A Mediscor ChroniLine® pharmacist will check the request against the Society’s protocols and confirm whether the medicine is authorised to be funded from your chronic benefit or not. A dedicated team of experts will assist with any queries in getting your chronic condition and medicine registered.

Alternatively, you may send your prescription via fax to 086 615 1509 or e-mail to

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