A medicine formulary is a list of prescription medicines, both generic and originator medicines, that are reimbursed (preferred list) by a medical scheme. A medical scheme may only pay for medications that are on this "preferred" list.

The portion of the value of the medicine, in terms of the rules of the medical scheme, for which the beneficiary is personally responsible for payment to the provider.

MRP sets a maximum reimbursable price for a list of generically similar products with a cost lower than that of the original medicine. If you opt to use a medicine that is more expensive that the MRP reference price, you may have to pay the difference between the price of the chosen medicine and that of MRP. This is applicable to both formulary and non-formulary medicines. You can avoid this co-payment by using a generic equivalent that costs less than the reference price. We encourage the use of generic equivalent medicines in the interests of cost-effective care.

You may be required to get authorisation for selected medicines or be required to register for specific conditions before your medical scheme will pay for certain medicines.

A set of minimum benefits which, by law, must be provided to all medical scheme members, regardless of the benefit option they have selected, and include the provision of diagnosis, treatment and costs of ongoing care. Chronic disease list The Prescribed Minimum Benefits require medical schemes to cover the diagnosis, medical management and medicine for a specified list of 27 chronic conditions known as the Chronic Disease List. This means that the medical scheme not only has to cover medication, but also doctors' consultations and tests related to the condition. The scheme may make use of protocols, formularies (lists of preferred medicines) and Designated Service Providers (DSPs) to manage this benefit.
The CDL list consists of the chronic conditions listed below:

	Addison’s Disease
	Asthma
	Bipolar Mood Disorder
	Bronchiectasis
	Cardiac Failure
	Cardiomyopathy
	Chronic Renal Disease
	Chronic Obstructive Pulmonary Disease
	Coronary Artery Disease
	Crohn’s Disease
	Diabetes Insipidus
	Diabetes Mellitus Type I
	Diabetes Mellitus Type II
	Dysrhythmias
	Epilepsy
	Glaucoma
	Haemophilia
	HIV/AIDS
	Hyperlipidaemia
	Hypertension
	Hypothyroidism
	Multiple Sclerosis
	Parkinson's Disease
	Rheumatoid Arthritis
	Schizophrenia
	Systemic Lupus Erythematosus
	Ulcerative Colitis

To find out what the Council for Medical Schemes say about PMBs follow this link:
www.medicalschemes.com/medical_schemes_pmb/index.htm

Protocol means a set of guidelines in relation to the optimal sequence of diagnostic testing and treatments for specific conditions and includes, but is not limited to, clinical practice guidelines, standard treatment guidelines, disease management guidelines, treatment algorithms and clinical pathways.

Reference pricing involves a pricing system that groups together products that are generically or therapeutically equivalent or similar into reference-pricing group and sets a maximum reimbursable price for such a group of products. Different reference pricing models include Mediscor Reference Price (MRP), Formulary Reference Price (FRP) and Maximum Medical Aid Price (MMAP^®).

Co-payments that may result from reference pricing are calculated as the difference in price between the medicine purchased and the applicable reference price. Members can avoid co-payments by using products that are less expensive than the applicable reference price. The use of the most appropriate alternative should be discussed with you doctor or pharmacist.

Medicines can be classified into different groups according to the organ or system on which they act and/or their therapeutic and chemical characteristics.