Cover for Medicine

What is covered?

As a Discovery Health Medical Scheme member, your cover for medicine includes cover for acute (day-to-day prescribed) and chronic medicine. The extent of this cover depends on the plan you choose.

Cover for Acute or Day-to-day Prescribed Medicine

Acute medicine is medicine that is prescribed for a short term for a condition or illness that is not long lasting. You have cover for prescribed acute medicine from your available day-to-day benefits. Note that depending on the scheduling status of the medicine your doctor prescribes, and whether it is a generic or original brand product, we pay for these differently.

An annual limit applies to prescribed medicines (schedule 3 and above.) If you join the medical scheme after January, you will not get the full limit as we calculate the amount by counting the remaining months in the year.

Preferred medicine

We cover preferred medicine up to the Discovery Health Rate (100%) from your available day-to-day benefits.

Non-preferred medicine

We cover non-preferred medicine up to 75% of the Discovery Health Rate (DHR) if the price of the medicine is within 25% of the preferred equivalent, or up to 50% of the DHR if the price of the medicine is more than 50% of the price of the preferred equivalent.

Over-the-counter medicines (schedule 0, 1 and 2) and certain lifestyle-enhancing medicine

We pay these claims from the available funds in your Medical Savings Account (MSA). These claims do not add up to the Annual Threshold and are not paid from the Above Threshold Benefit (ATB).

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount (CDA).

Medicine Cover for Additional Disease List conditions

 

On the Executive Plan, you also get cover for medicine for a defined list of conditions on the Additional Disease List. You can use up to the set monthly Chronic Drug Amount for your medicine. No medicine list applies.

To access cover for these additional conditions, you need to meet certain terms and conditions

Extended chronic medicine list

 

Members on the Executive Plan also have full cover for an exclusive list of brand medicines.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

An annual limit applies to prescribed medicines (schedule 3 and above.) If you join the medical scheme after January, you will not get the full limit as we calculate the amount by counting the remaining months in the year.

Preferred medicine

We cover preferred medicine up to the Discovery Health Rate (100%) from your available day-to-day benefits.

Non-preferred medicine

We cover non-preferred medicine up to 75% of the Discovery Health Rate (DHR) if the price of the medicine is within 25% of the preferred equivalent, or up to 50% of the DHR if the price of the medicine is more than 50% of the price of the preferred equivalent.

Over-the-counter medicines (schedule 0, 1 and 2) and certain lifestyle-enhancing medicine

We pay these claims from the available funds in your Medical Savings Account (MSA). These claims do not add up to the Annual Threshold and are not paid from the Above Threshold Benefit (ATB).

On Classic Smart Comprehensive, you are covered for over-the-counter medicine up to R800 a family a year. Cover for defined over-the-counter medicine categories from any Clicks or Dis-Chem pharmacy.

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount.

Medicine Cover for Additional Disease List conditions

 

On Comprehensive plans, you also get cover for medicine for a defined list of conditions on the Additional Disease List. You can use up to the set monthly Chronic Drug Amount for your medicine. No medicine list applies.

To access cover for these additional conditions, you need to meet certain terms and conditions

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

An annual limit applies to prescribed medicines (schedule 3 and above). If you join the medical scheme after January, you will not get the full limit as we calculate the amount the amount by counting the remaining months in the year.

Preferred medicine

We cover preferred medicine up to the Discovery Health Rate (100%) from your available day-to-day benefits.

Non-preferred medicine

We cover non-preferred medicine up to 75% of the Discovery Health Rate (DHR) if the price of the medicine is within 25% of the preferred equivalent, or up to 50% of the DHR if the price of the medicine is more than 50% of the price of the preferred equivalent.

Over-the-counter medicines (schedule 0, 1 and 2) and certain lifestyle-enhancing medicine

We pay these claims from the available funds in your Medical Savings Account (MSA). These claims do not add up to the Annual Threshold and are not paid from the Above Threshold Benefit (ATB).

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

We cover these expenses from the available funds in your Medical Savings Account.

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

Classic Smart Plan

Cover for defined acute medicine categories prescribed by a Smart Network GP. A limit of R1 500 a member a year and R2 500 a family a year for schedule 3 and above medicine, at a network pharmacy.

You also have cover for over-the-counter (OTC) medicine obtained from your network pharmacy, up to a limit of R630 per family per year.

Essential Smart Plan

If you are on the Essential Smart Plan, you will need to pay for prescribed medicine yourself.

You have cover for over-the-counter (OTC) medicine obtained from your network pharmacy, up to a limit of R420 per family per year.

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You have full cover if you use a network provider for approved chronic medicine on our medicine list. If your medicine is not on our list, we cover up to the lowest cost medicine of the same kind on our list for your condition.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

Core plans do not cover day-to-day healthcare services. You must pay for these healthcare services yourself.

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. For medicine not on our list, we cover you up to a set monthly rand amount called the Chronic Drug Amount.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on our medicine lists. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

KeyCare Plus Plan

You have full cover for a defined list (formulary) of acute medicine and only if it is prescribed by your chosen GP in the KeyCare Primary Care Network.

KeyCare Start Plan

You have full cover for a defined list (formulary) of acute medicine and only if the acute medication is dispensed by your chosen GP in the KeyCare Start Network. If you choose to go to a pharmacy to get your prescribed medication, you will then have to pay for the expenses yourself.

KeyCare Core Plan

The KeyCare Core Plan does not cover day-to-day healthcare services. You must pay for these healthcare services yourself.

Cover for Chronic Medicine

On all plans, you have access to a list of medical conditions and treatments under Prescribed Minimum Benefits (PMBs). The PMBs cover the 27 chronic conditions on the Chronic Disease List. All our plans offer benefits that are far richer that the Prescribed minimum benefits. To access PMB cover, you need to meet certain terms and conditions.

Medicine List (PDF)

Medicine Cover for Chronic Disease List conditions

 

You get full cover for approved chronic medicine on our medicine list. You will have to pay for medicine that is not on the medicine list.

Please find more information on the Chronic Illness Benefit here.

MedAdvisor Tool

We encourage the use of generic medicines that are included on the KeyCare medicine list. Your pharmacist or doctor is the best person to tell you about the benefits of substituting your prescribed item with a more preferentially priced (normally a generic) medicine, where appropriate.

What is the different scheduling statuses of a medicine?

The Medicines Control Council applies standards laid down by the Medicines and Related Substances Act, (Act 101 of 1965) which governs the manufacture, distribution, sale, and marketing of medicines. The prescribing and dispensing of medicines is controlled through the determination of schedules for various medicines and substances.

In South Africa, a doctor must prescribe medicine with a scheduling status of 3 and above. This means you cannot get these medicines without a doctor’s prescription.

Medicines that are schedule 0, 1 and 2 are called over-the-counter medicines and while your doctor may prescribe these, you can also get these without a prescription.

What is the difference between generic and non-generic medicine?

Generic medicine has the same active ingredient/s, strength and form as the original/brand medicine. This refers to medicine where patent protection has expired or where a patent has never been issued.

Non-generic medicine refers to brand-name original medicine that is or has been previously protected by a patent.

To find out how your medicine will be covered, you can make use our MedAdvisor tool

Where to get your medicine

To enjoy full cover, make sure you get your medicine from a preferred supplier. You can use our Find a Healthcare Provider tool to locate a preferred supplier near you.

Find a Healthcare Provider
 
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