Chronic Medication
OBTAINING CHRONIC MEDICATION
Platinum Health dispenses chronic medication via the Chronic Medication Department of Platinum Health Pharmacy in Rustenburg.
PlatComprehensive and PlatCap Option members are obliged to utilise the Chronic Medication Department of Platinum Health. PlatFreedom Option members have two options to obtain chronic medication:
1. Members may utilise the Chronic Medication Department of Platinum Health
OR
2. Members may utilise their Pharmacy of Choice
PlatComprehensive, PlatCap and PlatFreedom members who choose to obtain chronic medication from the Chronic Medication Department of Platinum Health, should follow these four easy steps to ensure timeous delivery of your medication:
Register for chronic medication approval if you are a first-time chronic medication user by requesting your doctor to complete a Chronic Illness Benefit Application form. The forms are available from the Client Liaison Officers on site during scheduled visits, or it can be downloaded from the Platinum Health website (www.platinumhealth.co.za). A separate application form is required for each family member who requires chronic medication.
Both the chronic illness forms (application and delivery), along with supporting documentation and a six-month prescription has to be forwarded to the Chronic Medication Department. Platinum Health staff on site at PH facilities can assist members with submitting application forms to the Chronic Medication Department.
The completed application form and supporting documentation has to be submitted to the Chronic Medication Department via:
Tel no: 014 590 1700
Email: phscript@platinumhealth.co.za
Fax: 086 577 0274 or 014 590 1752
The Chronic Medication Department contacts the patient to confirm the details and arrange delivery. A courier service is available for the delivery of chronic medication to members who qualify for delivery. Members can request chronic medication to be delivered to their home, the Platinum Health Medical Facility for collection, or any other location convenient to them. Generally, three months’ supply is issued.
Important to remember:
Once registered, please place follow-up medication orders at least seven working days before the current batch runs out. Orders can be placed telephonically, by email or fax, and full member and contact details must be included in all correspondence.
PlatFreedom members who choose to obtain chronic medication from their Pharmacy of Choice, should follow these steps:
1. Register for chronic medication approval if you are a first-time chronic medication user by requesting your doctor to complete a Chronic Illness Benefit Application form. The forms are available from the Client Liaison Officers on site during scheduled visits; or it can be downloaded from the Platinum Health website (www.platinumhealth.co.za). A separate application form is required for each family member who requires chronic medication.
2. The completed application form and supporting documentation has to be submitted to the Chronic Medication Department via:
Tel no: 014 590 1700
Email: phscript@platinumhealth.co.za
Fax: 086 577 0274 or 014 590 1752
Upon receiving the completed Chronic Illness Benefit Application form, authorisation will be loaded on the system and the Pharmacy of Choice will be able to supply the medication to the member and submit the claim for payment to the scheme.
Please note:
- Members have to arrange collection/delivery of medication with their Pharmacy of Choice.
- Members have to place follow-up prescriptions with their Pharmacy of Choice.
OPTION GUIDE
PlatComprehensive
- 27 Chronic Disease List conditions and 53additional CDL conditions.
- 100% of scheme formulary.
- Unlimited for CDL conditions and additional chronic disease list.
- In all instances, chronic medication must be obtained from the scheme’s DSPs.
- Platinum Health will accept liability for 100% of the therapeutic reference price list as per the formulary.
- If a member elects to utilise a non-formulary drug, then the member is liable for 20% co-payment of SEP (single exit price) except if the medicine has been clinically motivated for and been approved by the Scheme – in which case the Scheme shall be liable for 100% of SEP.
- If a member elects to utilise an original drug for which a generic drug exists on the formulary, then a co-payment (price difference between formulary drug and original drug) shall apply. Admin fees or levies will not be covered.
PlatCap
- 27 Chronic Disease List conditions only.
- Unlimited for CDL conditions.
- 100% of PlatCap formulary.
- In all instances chronic medication shall be obtained from the Scheme’s DSP.
- Only CDLs covered and PMBs unlimited as per Chronic Disease Reference Price List (CDRPL).
- The Scheme shall accept liability of 100% of Therapeutic Reference Price List as per the formulary.
- If a member elects to utilise a non-formulary drug, then the member is liable for 20% co-payment of SEP (single exit price) except if the medicine has been clinically motivated for and been approved by the Scheme – in which case the Scheme shall be liable for 100% of SEP.
- If a member elects to utilise an original drug for which a generic drug exists on the formulary, then a co-payment (price difference between formulary drug and original drug) shall apply. Admin fees and levies will not be covered.
- Subject to member registration on the Chronic Medication Programme.
PlatFreedom
- 27 Chronic Disease List conditions.
- Chronic Disease List conditions up to 100% of scheme rate for approved chronic medicine on the medicine list.
- Subject to Overall Annual Limit (OAL).
- Up to 80% of Maximum Medical Aid Price(MMAP) for approved chronic medicine not on the medicine list.
- Additional Disease List conditions up to 100% of MMAP for approved chronic medicine.
- Subject to registration on the Chronic Medication Programme.
- Authorisation required.
- Refer to general Scheme exclusions.
Submission
For orders, applications and general queries email:
phscript@platinumhealth.co.za
Tel: 014 590 1700 | Fax: 014 590 1752 / 086 577 0274
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