• Introducing Mediscor

Mediscor is an independent, specialist pharmaceutical benefit management organisation with a proud track record dedicated to the effective management of medicine benefits. As the company that implemented the first ever pharmacy benefit management (PBM) system in South Africa in 1998, Mediscor is widely regarded as the home of medicine benefit management.

• Mediscor’s credentials at a glance

Mediscor is the largest independent PBM company and has been servicing the South African healthcare industry for more than 25 years. The company has weathered the changing healthcare environment successfully and emerged as the segment leader with more than 40 clients in excess of 1.6 million lives. Our client base grew from 9 – 42 clients during the past 12 years and include medical schemes registered in South Africa and Namibia, capitation management clients, sick benefit, health insurance funds; and we are integrated successfully with 16 different administration platforms.

Over the past 13 years, Mediscor has been recognised by the PMR Awards Committee, and 2014 was the fifth consecutive year that we received two Diamond Arrow awards for being the highest rated in a specialist service category. The two awards are for:

• Chronic Medication Management (8.25 out of 10.0)
• Technology Services and Electronic Medicine Management (8.50 out of 10.0).

Both these categories forms part of Mediscor's core business as it directly relates to our electronic claims processing and chronic medicine authorisation management (ChroniLine).

Mediscor is a level 5 BBBEE contributor, as independently rated by Veri-Com (31.7% BEE shareholding).

Mediscor is an accredited Managed Care Organisation, as evaluated by the Council of Medical Schemes (CMS).

• SA’s first fully accredited pharmaceutical benefit management organisation

Mediscor was the very first pharmaceutical benefit management organisation to be accredited by the Council for Medical Schemes as a Managed Care Organisation (MCO) as we are able to offer a comprehensive healthcare management solution to clients. We process more than 300 000 real-time and 30 000 doctor transactions each day and bring, through the course of our daily activities, tremendous savings to medical scheme clients and ultimately to their members.

• Fully integrated, clinically intelligent, real-time pharmaceutical claims processing

Mediscor PBM offers its clients a fully integrated, clinically intelligent, real-time pharmaceutical claims processing system. Our medicine management offering includes a wide array of services aimed at ensuring value for money, quality services and good communication. These include:

• Electronic Claims Processing – including gate-keeping, data integrity validation, eligibility management, utilisation management, clinical management, price management, formulary compliance management, provider management and benefit validation.


• ChroniLine Services – A fully integrated authorisation service, including exception management.


• Data Analysis and Reporting – Comprehensive reporting and data analysis service with our interactive reporting facility, the Mediscor Analyzer.


• Consulting and Advisory services – Our pharmaco-economic and clinical expertise is available to provide assistance, e.g. benefit design, impact analysis, formulary selection.


• Client Support Services – Includes our call centre for members and providers, available 7 days a week, on-line search facilities for members and brokers, provider communication and an SMS patient communication facility.


• Supplementary Services – Includes formulary design and management and client contact centre training.


• Quality Management Program – We apply stringent quality control measures to ensure compliance to clients' needs. These measures include rules auditing, processed claims auditing, authorisation auditing and paper claims audit.


• Pharmacy Management – We have contracts with all pharmacies in South-Africa, Namibia, Swaziland and Lesotho and receive real-time claims from them. We manage several network comprising of complex network permutations with the aim of optimising both the member experience and managing the cost of medicines.


• Patient Experience Monitor – A sophisticated analytical model that measures a patient's financial experience at the point of sale.

Our track record in delivering an efficient and effective service encompassing all areas of medicine management and control, is testimony to our systems as well as the expertise of our staff.

• Mediscor – well positioned for South African growth

With pharmaceuticals being the third highest medical scheme expense in the country, the effective management of medicine benefits is more important than ever before. Our achievements, impressive track record and economies of scale embedded in our business have positioned us ideally for aggressive expansion within the South African market.

• NHI

Mediscor supports the initiatives introduced by the Minister of Health to implement a National Health Insurance system for all South Africans.

Last update: 28 January 2015