Selfmed Formulary Listing

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SELFMED FORMULARY LISTING

Selfmed Formulary Lists

Mediscor PBM has been appointed by Selfmed Medical Scheme to manage your chronic medicine benefit.

In order for you to obtain authorisation for your chronic medicines your health care provider (pharmacist or doctor) needs to contact Mediscor ChroniLine^TM for authorisation.

During the authorisation process certain information will be requested from your health care provider. Based on this information your chronic condition will be registered and the appropriate medicines will be authorised.

As part of the authorisation process you will be informed whether you will be liable to pay any co-payment/s or if the medicines are not covered on you particular medical scheme benefit.

To register your chronic condition, change an existing authorisation or if you have any enquiries about chronic medicine contact:

Mediscor ChroniLine^TM:

Tel: 0860 119 553
Fax: 0866 151 509
E-mail : preauth@mediscor.co.za

Selfmed Medical Scheme:

Tel: 0860 787 372
Fax: 0860 633 277
E-mail : chronicmed@selfmed.co.za

*Please note: Within the Excel spreadsheet, please use "CTRL-F" to search for 'Medicine Name', 'Active Ingredient', 'Therapeutic Class' or 'NAPPI Code'.

Selfmed Chronic Formularies - 2011

Condition	Selfmed 80%	Med Elite	Selfsure	MedXXI
CDL conditions
Addison’s Disease	Selfmed 80%	Med Elite	Selfsure	MedXXI
Asthma	Selfmed 80%	Med Elite	Selfsure	MedXXI
Bipolar Mood Disorder	Selfmed 80%	Med Elite	Selfsure	MedXXI
Bronchiectasis	Selfmed 80%	Med Elite	Selfsure	MedXXI
Cardiac Failure	Selfmed 80%	Med Elite	Selfsure	MedXXI
Cardiomyopathy	Selfmed 80%	Med Elite	Selfsure	MedXXI
COPD	Selfmed 80%	Med Elite	Selfsure	MedXXI
Chronic Renal Disease	Selfmed 80%	Med Elite	Selfsure	MedXXI
Coronary Artery Disease	Selfmed 80%	Med Elite	Selfsure	MedXXI
Crohn's Disease	Selfmed 80%	Med Elite	Selfsure	MedXXI
Diabetes Insipidus	Selfmed 80%	Med Elite	Selfsure	MedXXI
Diabetes Mellitus Type I	Selfmed 80%	Med Elite	Selfsure	MedXXI
Diabetes Mellitus Type II	Selfmed 80%	Med Elite	Selfsure	MedXXI
Dysrhythmias	Selfmed 80%	Med Elite	Selfsure	MedXXI
Epilepsy	Selfmed 80%	Med Elite	Selfsure	MedXXI
Glaucoma	Selfmed 80%	Med Elite	Selfsure	MedXXI
Haemophilia	Selfmed 80%	Med Elite	Selfsure	MedXXI
Hyperlipidaemia	Selfmed 80%	Med Elite	Selfsure	MedXXI
Hypertension	Selfmed 80%	Med Elite	Selfsure	MedXXI
Hypothyroidism	Selfmed 80%	Med Elite	Selfsure	MedXXI
Multiple Sclerosis	Selfmed 80%	Med Elite	Selfsure	MedXXI
Parkinson’s Disease	Selfmed 80%	Med Elite	Selfsure	MedXXI
Rheumatoid Arthritis	Selfmed 80%	Med Elite	Selfsure	MedXXI
Schizophrenia	Selfmed 80%	Med Elite	Selfsure	MedXXI
Systemic Lupus Erythematosus	Selfmed 80%	Med Elite	Selfsure	MedXXI
Ulcerative Colitis	Selfmed 80%	Med Elite	Selfsure	MedXXI

Additional chronic conditions
ADHD	Selfmed 80%	Med Elite
Alzheimer’s Disease	Selfmed 80%	Med Elite
Ankylosing Spondylitis	Selfmed 80%	Med Elite
Benign Prostatic Hypertrophy	Selfmed 80%	Med Elite
Cushing’s Disease	Selfmed 80%	Med Elite
Cystic Fibrosis	Selfmed 80%	Med Elite
Deep Vein Thrombosis	Selfmed 80%	Med Elite
Depression	Selfmed 80%	Med Elite
Dermatomyositis	Selfmed 80%	Med Elite
Gord	Selfmed 80%	Med Elite
Gout	Selfmed 80%	Med Elite
Hypoparathyroidism	Selfmed 80%	Med Elite
Menopause	Selfmed 80%	Med Elite
Motor Neuron Disease	Selfmed 80%	Med Elite
Muscular Dystrophy	Selfmed 80%	Med Elite
Myasthenia Gravis	Selfmed 80%	Med Elite
Narcolepsy	Selfmed 80%	Med Elite
Obsessive Compulsive Disorder	Selfmed 80%	Med Elite
Osteoporosis	Selfmed 80%	Med Elite
Paget’s Disease	Selfmed 80%	Med Elite
Panic Disorder	Selfmed 80%	Med Elite
Paraplegia	Selfmed 80%	Med Elite
Polyarteritis Nodosa	Selfmed 80%	Med Elite
Post Traumatic Stress Syndrome	Selfmed 80%	Med Elite
Psoriasis	Selfmed 80%	Med Elite
Pulmonary Interstitial Fibrosis	Selfmed 80%	Med Elite
Quadriplegia	Selfmed 80%	Med Elite
Sarcoidosis	Selfmed 80%	Med Elite
Scleroderma	Selfmed 80%	Med Elite
Stroke	Selfmed 80%	Med Elite
Thromboangiitis Obliterans	Selfmed 80%	Med Elite
Thrombocytopenic Purpura	Selfmed 80%	Med Elite
Tourette’s Disease	Selfmed 80%	Med Elite

Members are advised to verify that their relevant conditions are covered by their Medical Scheme.

Disclaimer

Please note that the Mediscor Formularies are reviewed regularly by the Mediscor Pharmaceutical and Therapeutics Committee to ensure that they comply with the latest industry norms for the treatment of these conditions. Mediscor PBM Pty Ltd reserves the right to change medicines to comply with the latest industry norms for the treatment of the listed conditions. Mediscor PBM Pty Ltd reserves the right to change medicines included in the formulary when important or new information is made available, e.g. on new findings regarding the safety of medicine.

Reservation of Copyright

Mediscor PBM reserves its copyright and all its other rights in or in respect of the Mediscor Formularies. No part of the Mediscor Formularies may be reproduced, photocopied, recorded or stored in any retrieval system, or transmitted by any means, electronic, mechanical or otherwise, without the written permission of Mediscor PBM.

Last update: 28 February 2011