Sizwe Hosmed offers comprehensive medication benefits to support the treatment and management of various illnesses. These medications are often categorised into different groups based on their intended purpose.
Medication benefits play a crucial role in preventing, managing, and treating various health conditions, enabling members to lead healthier and longer lives. They form a core part of effective healthcare by supporting recovery, relieving symptoms, and improving quality of life.
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Chronic Medication
This medication treats chronic diseases or conditions that persist for more than three months and require ongoing management. Examples include diabetes, hypertension, asthma, and epilepsy. Sizwe Hosmed covers these under Prescribed Minimum Benefits (PMB) on all plans and additional non-PMB conditions under specific plans, ensuring that our members receive essential treatment when needed.
Using Chronic Medication Benefits
Members can activate their chronic medication by applying for and registering for Sizwe Hosmed’s Chronic Medication benefits. This process includes submitting the condition, medication and treatment plan.
The medication is paid from PMB or the chronic benefit and does not affect the day-to-day or savings benefit. The member’s doctor can update the medication script on an ongoing basis as the condition is managed and monitored.
Registering for Chronic Medication
- Complete the chronic medication application form with your treating doctor.
- Submit the application form, applicable test results and the chronic script to chronic@sizwehosmed.co.za.
- The medication script must have the ICD-10 diagnosis code.
- A new script is required every 6 months.
- Registration for the medication will not be backdated.
- Medication is paid at Scheme rates.
- The Scheme has a Medicine List (Formulary) and uses it as a guideline to pay or fund medication scripts that are not on the list/formulary.
Acute Medication
Acute medications treat sudden illnesses or symptoms, such as infections, the flu, or injuries. They are typically prescribed for a limited time or duration.
Vitamins help boost the body’s immune system, support normal growth and development, and keep cells and organs working properly. Each vitamin plays a unique role.
Since the body doesn't produce enough vitamins on its own, we get them from food and supplements. That’s why taking the right vitamins—especially when recommended by a healthcare provider—is a key part of staying healthy and preventing illness.
These drugs can be bought without a prescription directly from pharmacies, such as pain relievers, cough syrups, or antacids. These are for short-term use; if symptoms persist beyond a week of using over-the-counter medication, a doctor needs to be consulted.
Sizwe Hosmed offers vitamins as part of your medication benefits on the following plans:
GUIDELINES FOR USING MEDICATION BENEFITS
Formulary/Medication List
A formulary medication is a list of medicines approved by Sizwe Hosmed based on their safety, effectiveness, and cost-effectiveness. Members are encouraged to use medications on the approved list to avoid claim rejection and/or copayments.
Generic Medicines
The Scheme encourages members to use safe and cost-effective generic medicines where available, thereby avoiding co-payments.
Sizwe Hosmed Pharmacy Partners
Sizwe Hosmed has partnered with well-known pharmacy brands, including Dischem and Clicks, to ensure easy access to medication benefits nationwide at lower negotiated rates.
Benefits of using Preferred Pharmacies
- Continuity of Care: In addition to offering better rates, the preferred pharmacies are trusted, established brands with infrastructure that enables access to patients’ medical histories, ensuring the continuity of care.
- No unexpected charges: Members are more likely to avoid paying extra from their pocket.
- Better advice and service: Partner pharmacies are familiar with Sizwe Hosmed option benefits and can provide members with appropriate guidance.
Disadvantages of using non-preferred pharmacies
- Whilst the Scheme does not restrict members from using pharmacies of their choice, members may be charged above Scheme rates, resulting in co-payments, as the prices of medications are generally higher than those at preferred pharmacies.
- Their dispensing system may not have access to the member’s medication history, which could compromise the continuity of care.
- They may also not have the medication brand that the member is accustomed to.
Choosing Generic Medication Can Save You Money
Generic medicines contain the same active ingredients as brand-name drugs and are just as effective and safe. However, they are significantly cheaper, which can help you avoid co-payments.
Benefits of choosing generics:
- Lower or no co-payments
- Same quality, safety, and strength as brand-name drugs
- Greater value from your day-to-day medical benefits
Remember to ask your doctor to prescribe generics if available.
