Member obtains application forms |
Membership information verified |
Medical team reviews application |
Access card and matching valid prescription presented to supplier |
Medication listed on Medicine Access Card to be paid from Chronic Disease Benefit (Subject to availability of funds) |
Completes member/ patient details |
Patient registered on Chronic Medicine Management Programme |
Clinical guidelines and protocols applied |
||
Prescribing doctor examines patient and completes clinical details |
SMS sent to member advising of received application |
Application processed (authorised/ rejected) |
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Form faxed/ posted/ e-mailed to Chronic Medicine Management |
Clinical details captured onto system |
SMS sent to member advising that application has been processed |
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Letter and Medicine Access Card sent to patient (and doctor) |
CHRONIC MEDICINE MANAGEMENT - THE PROCESS
| How to apply: | |
| • | Phone the Fedhealth Customer Call Centre on 0860 002 153 or the Chronic Medicine Management Call Centre on 0860 108 600 and ask for an application form, or download one from the Fedhealth website (www.fedhealth.co.za). |
| • | Each family member who needs to apply will have to complete a separate application form. You only need to complete this application form once. |
| • | Once your doctor has examined you and completed the application form, fax it to Chronic Medicine Management on 0800 223 670/ 80 for approval. |
| • | Keep a copy of your completed form for your own records and ensure that your application has been filled out completely and signed by both yourself and your doctor. Kindly attach supporting tests/ special investigations and motivations to prevent delays in the processing of your application. |
| • | Once received by Chronic Medicine Management, your details, medical status, disease and proposed medication will be captured onto the system. The clinical team will review these details and if necessary will contact your doctor (either telephonically or in writing) in order to select more appropriate and/ or less costly medication. |
| • | Your request will take approximately 7 working days to process. If required, you may follow up on the progress of your application by calling the Chronic Medicine Management Call Centre. |
| Once your application has been approved: | |
| • | Once registered and your application has been approved, you will receive a Medicine Access Card, listing the medicines to be paid from your Chronic Medicine Benefit. |
| • | The Access Card will also indicate which medicines are on the Medicine Price List (MPL) and medicines that will attract formulary co-payments (if applicable). |
| • | If the medicine authorised differs from the medicine requested, a letter of explanation will be attached to your Access Card and a copy will be sent to the prescribing doctor. This may occur if a member of the clinical team consults with your doctor, and your doctor confirms such a change to the member of the clinical team. Should this take place, then you must ensure that you obtain an updated prescription which reflects the change from the prescribing doctor. |
| • | You will need a hand-written repeat script from your doctor for the medicines listed on the card. The Access Card is not a prescription and cannot be used to have medicines dispensed. |
| • | Your doctor determines the number of repeats and will advise you how often he needs to see you to monitor your condition. |
| • | Whenever you need to have your medicine dispensed, produce a valid doctor's prescription together with the Access Card. |
| • | The duration of authorisation varies from medicine to medicine - some medicines may be authorised ongoing, whilst others may only be authorised for a limited period. The Access Card will indicate the duration for which the medicine has been authorised. |
| What if your medicine request has been declined? | |
| • | If any medicine request has been declined, e.g. requesting a less costly alternative, a letter of explanation will be sent to you and a copy will be sent to the prescribing doctor. |
| • | Please ensure that the appropriate doctor provides the requested clinical information (where relevant). |
| • | For on-line clinical decisions, your doctor should contact the Chronic Medicine Management Call Centre on 0860 100 608. |
| • | Your request will be reconsidered once all the relevant information has been received. |
| What if your authorised chronic medication changes? | |
| • | If your chronic medication changes in any way, Chronic Medicine Management needs to be advised. |
| • | The quickest and simplest way would be for the prescribing doctor or dispensing pharmacist to contact the Call Centre and advise the clinical staff of the change. The change is then processed (as per the current Chronic Medicine Management Clinical Guidelines and Protocols) within 24 hours. |
| • | If approved, a temporary Access Card can be faxed to the dispenser, enabling him to dispense the medicine without delay. |
| • | An updated Access Card will be mailed to you and if the medicines authorised differ from the medicines requested, you will need a valid doctor's prescription which matches the new Access Card to enable your pharmacy to dispense the medication. |
| • | Should you wish to fax through an updated script to Chronic Medicine Management, the toll-free fax number 0800 223 670/80 may be used. These requests will take approximately 7 working days to process. |
Chronic Medicine Management Contact Details:
| Call Centre Number: | 0860 100 608 |
| Fax Number: | 0800 223 670/80 |
| E-mail address: | cmm@medscheme.co.za |
| Website: | www.fedhealth.co.za |
| For escalated queries, Fedhealth brokers may e-mail : | Tracey Fredericks or Hajiera Jacobs |
