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Medicine Lists
This is the list of acute medicine payable from the Primary Healthcare Benefit should the Acute and Over-The-Counter (OTC) benefits be depleted. Remember to ask the pharmacist to include the appropriate diagnosis (ICD10) code when submitting the claim.
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This formulary applies to medicine used for some of the 270 Diagnosis Treatment Pairs (DTP’s) like endometriosis, menopause, polycystic ovarian syndrome and stroke.
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This is a list of medication that are excluded from funding for various reasons, including:
- Medicines that have not been proven to have relevant clinical value
- Medicines that are more expensive compared to equally effective, safe and cheaper alternatives
- Some expensive chronic medicines that require pre-authorisation
- Some combination products, where it is more appropriate to use single ingredients products
- Newly registered products under review
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This is a list of antidepressants that are excluded from the routine benefit. Funding will only be considered from the chronic medicine benefit.
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This is a list of analgesics with a limited quantity that can be claimed per annum. Quantities above the specified limit will have to be motivated for.
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The Medicine Price List (MPL) is a reference pricing system that benchmarks the price of a type or group of similar products. This Benchmark price limits the amount that will be paid by the Scheme for this type or group of medicine. It often applies to a medicine that has one or more generic equivalents that can be considered in its place.
The reference pricing system does not restrict your choice of medicines as there are always alternatives available at no extra cost, subject to your available benefits.
MPL is used for the following reasons:
- to manage medicine costs
- encourage you to be aware of the costs
- to make use of generics
- to make sure you get the maximum use out of your chronic medicine benefit limits
Click here to download
The Medicine Price List (MPL) is a reference pricing system that benchmarks the price of a type or group of similar products. This Benchmark price limits the amount that will be paid by the Scheme for this type or group of medicine. It often applies to a medicine that has one or more generic equivalents that can be considered in its place.
The reference pricing system does not restrict your choice of medicines as there are always alternatives available at no extra cost, subject to your available benefits.
MPL is used for the following reasons:
- to manage medicine costs
- encourage you to be aware of the costs
- to make use of generics
- to make sure you get the maximum use out of your chronic medicine benefit limits
Click here to download
