Formulary
A medicine Formulary is a limited list of medicines. The Mediscor Formularies for the Chronic Disease List (CDL) are lists of medicines, registered with the Medicines Control Council (MCC), which complies with the minimum treatment guidelines (algorithms), specified by the Council for Medical Schemes for each of the 27 CDL conditions and are available without a co-payment or a ceiling. Products registered with the Medicines Control Council (MCC), for their specific indications and maximum daily dosage, are the cornerstone of Mediscor’s evidence based medicine approach to include products onto the Mediscor Formularies. The Mediscor Formulary contains, amongst others, generic equivalents as well as therapeutic alternative medicines. Some of the Mediscor Medical Scheme clients have elected to use their own Formularies and not the Mediscor Formularies.
The Formulary has been divided into four levels to accommodate for four Formularies, the Mediscor Core Formulary, the Mediscor Basic Formulary, the Mediscor Standard Formulary and the Mediscor Extended Formulary. Should your choice of Scheme Option only allow you to access Prescribed Minimum Benefits (PMBs), you may find that the current medicines you use may not be included in the Scheme’s Formulary list. In this case, as you will only qualify to obtain Formulary medicines, your current medicines may have to be substituted for Formulary medicines.
The Mediscor CDL Formularies will be updated at least once a month as new products and/or generic alternatives enter the South African market.
Designated Service Provider
A Designated Service Provider (DSP) is a healthcare provider or group of providers selected by the Medical Scheme concerned as the preferred provider or providers to provide to its members’ diagnosis, treatment and care in respect of one or more prescribed minimum benefit conditions.
Your Medical Scheme will have to identify one or more DSPs, if applicable, in their Scheme rules. Please consult your Scheme rules to familiarize yourself with your DSP/s. It is important to note that you might be penalized if you voluntarily decline to make use of the DSP.
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