Discovery Medical Aid Medication Cover Explained

April 2, 2018

Discovery Medical Aid covers certain medication for certain conditions depending on the plan you are on.

Acute Prescribed Medicine

Discovery offers cover for prescribed acute medicine from the day-to-day benefits of each plan. So this refers to medication that is for a specific short-term illness or condition. In addition, this cover differs depending on which plan you are on.

Smart Plan members

  • Covered for specific list of acute medicines
  • Must pay R10 towards each item
  • A network GP must prescribe the medicine
  • Limited to 12 prescriptions per person per year and
  • A network pharmacy must supply the medicine

 

Executive, Comprehensive & Priority Plan members

  • Cover subject to annual limit for prescribed medicines
  • Extended cover for generic medicines through the Insured Network Benefit after Medical Savings Account amounts run out but expenses have not yet reached the Annual Threshold and
  • Payment differs depending on other criteria such as scheduling status and generic or non-generic medication.

 

Keeping Costs Low

  • Choose generic medicines that are included in the Discovery Preferred Medicine list
  • Certain plan members must use designated service providers:
    • Delta & Core plans: MedXpress
    • Smart Series: MedXpress, Clicks or Dis-Chem
    • KeyCare plans: network pharmacy or allocated GP
  • Other plans can use pharmacies in the Discovery network (2400 member pharmacies) – they have agreed rates for medicines and
  • Use MedXpress (a Discovery ordering service that delivers or allows for collection)

 

Chronic Illness Medication

Discovery has a Chronic Illness Benefit, which covers members for a specific list of chronic conditions. Therefore, once diagnosed, members must apply for chronic medication to be covered. Importantly on all plans, the following 27 chronic conditions are covered under Prescribed Minimum Benefits:

Chronic Conditions

Addison’s disease | Ulcerative colitis|Asthma | Systemic lupus erythematosus | Bipolar mood disorder | Schizophrenia|Bronchiectasis| Rheumatoid arthritis | Cardiac failure | Parkinson’s disease | Cardiomyopathy | Multiple sclerosis| Chronic obstructive pulmonary disease (COPD) | Hypothyroidism | Chronic renal disease | Coronary artery disease | Hypertension | Crohn’s disease|  Hyperlipidaemia | Diabetes insipidus | HIV | Diabetes type 1 | Diabetes type 2 | Dysrhythmia| Glaucoma |Haemophilia | Epilepsy

Discovery gives full cover for medication on their medicine list and, for members on certain plans, will cover other medication for a set amount (referred to as the Chronic Drug Amount). The Chronic Drug Amount does not apply for those on the Smart Plan and KeyCare plans and these members must pay for any medication not on the approved list.

For members on the Executive and Comprehensive plans, there is cover for an Additional Disease list. There is no medicine list for these conditions, and members can use up to their monthly Chronic Drug Amount to pay for these medicines. Members will need to meet certain terms and conditions to access cover for these conditions.

Additional Disease List

Anklyosing spondylitis | Wegener’s granulomatosis| Behcet’s disease | Systemic sclerosis | Cystic fibrosis | Sjogren’s syndrome | Delusional disorder | Pulmonary intestinal fibrosis | Dermatopolymyositis | Generalised anxiety disorder | Psoriatic arthritis | Huntington’s disease | Post traumatic stress disorder | Isolated growth hormone deficiency | Polyarteritisnodosa| Major depression | Panic disorder | Muscular dystrophy and other inherited myopathies | Paget’s disease | Myasthenia gravis | Motor neuron disease | Obsessive compulsive disorder | Osteoporosis

 

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All info was correct at time of publishing