Preferred Medicine List – preferentially priced, generic and brand medicines

From 2014, members of the Discovery Health Medical Scheme

• Will have access to a wider range of medicines and
• Full cover will be extended to certain cost-effective original brand medicines 

In 2013, Discovery Health Medical Scheme covered generic medicines (schedule 3 and above) in full and original brand medicine at 75% of the Discovery Health Rate for medicines, from the available day-to-day benefits, subject to the prescribed medicine limit. On the Executive, Classic Comprehensive and Classic Delta Comprehensive plans we extended cover for generic medicine through the Insured Network Benefit when members have used up their annual Medical Savings Account allocation and have not yet reached their Annual Threshold.

Discovery Health Medical Scheme members have access to a wider range of medicines

Discovery Health Medical Scheme constantly negotiates favourable prices with pharmaceutical manufacturers for original brand and generic medicines. This, together with the medicine price fluctuations in the market where some original brand medicines prices are reduced significantly, gives us the opportunity to look at ways of enhancing the cover for our members.

We have developed a list of preferred medicines that will offer members real value for their money, because we cover them in full up to the Discovery Health Rate for medicines under certain conditions.

The Preferred Medicine List is made up of schedule 3 and above preferentially priced generic medicines and a defined list of preferentially priced original brand medicines. This means that in 2014, certain generic medicines will not be included on the Preferred Medicine List while certain original brand medicines will now be included on the list. There is a better priced alternative medicine on the Preferred Medicine List for every medicine that is not on this list

Getting full cover for medicine when members claim from their day-to-day benefits

There are many benefits for members of Discovery Health Medical Scheme using medicines on the Preferred Medicine List. These include:

• Access to a wider range of day-to-day medicines at 100% cover: Members will find that most generic and certain original brand medicines on the Preferred Medicine List are covered at 100% of the Discovery Health Rate for medicine
• Full cover choice: Members have greater certainty when it’s time to claim, reducing shortfalls in cover
• Preservation of members' Medical Savings Account: Saving through a wide range of better priced medicines
• Extended cover in the Above Threshold Benefit: 100% cover for medicine from the Above Threshold Benefit
• Extended day-to-day cover during the Self-payment Gap: When members have spent their Medical Savings Account allocation for the year and before they reach their Annual Threshold they enjoy access to full cover for medicine at a network pharmacy through the Insured Network Benefit on the Executive, Classic Comprehensive and Classic Delta Comprehensive plans. Providers in our network include certain independent pharmacies, MediRite Pharmacy, Pick n Pay Pharmacy, Clicks Pharmacy, Dis-Chem and MedXpress.

Members are advised to always speak to their doctor and pharmacist about cost savings

We encourage the use of generic medicines that are included in our Preferred Medicine List. A member’s pharmacist or doctor is the best person to tell them about the benefits of substituting their prescribed item with a more preferentially priced (normally a generic) medicine where appropriate.

Click here for the Insured Network Benefit Preferred medicines.

Members can find out how their medicine will be covered by logging on to www.discovery.co.za and using the MedAdvisor tool.