Issue link: https://www.hub.camaf.co.za/i/1512930
2024 VITAL PLUS & VITAL NETWORK 16 PMB Chronic Conditions CHRONIC DISEASE LIST (PMB LIST) Where do I find a list of these conditions? The CAMAF brochure lists these conditions; alternatively consult the website www.camaf.co.za. What is the Reference Price (RP)? Reference pricing is the maximum price for which the Scheme will be liable for specific medicine or classes of medicine, listed on the scheme's Condition Medicine List (CML). The reference price varies per option and where a medicine is above the reference price it is indicated that a co-payment will apply. CAMAF's Reference Prices (RP), are reviewed regularly against a variety of factors, including, the price announcement by the Department of Health, any new medicine entries made during the year, medicine enhancements or discontinuations, clinical literature, license indications, price changes, generic influence and patent expiry, to mention a few. This ensures that the relevance and integrity of the RP structure is maintained. What is a Pharmacy Network? CAMAF has established a network of pharmacies (DSPs), that have agreed to a maximum standardised mark up on dispensed chronic medication (SEP* plus 36% up to maximum of R36.00). SEP - Single Exit Price - nationally applied pricing for medication as determined by the Department of Health and the pharmaceutical manufacturers or importers. This results in the actual cost of medication being the same no matter where in the country it is purchased; any difference in price is as a result of the dispenser's mark up. This network, which has a national footprint, includes large retail pharmacy groups, courier pharmacies and some individual pharmacies. You are encouraged to make use of such pharmacies, which will assist you in managing your chronic medication benefit as well as avoid additional co-payments, e.g. Dis-Chem, Clicks Pharmacies. From where can I get my medication? Chronic medication can be obtained from your GP (if he is a dispensing doctor) or a Network Pharmacy, including courier pharmacies. CAMAF pays for treatment and medication for these chronic conditions in full, subject to: • Registration of your condition - consult the website www.camaf.co.za • Reference pricing (RP) • Use of a Designated Service Provider (DSP) or Network Pharmacy. Should you choose not to use a DSP or medication outside of the Reference price, there could be a co-payment. What happens if I do not use a Network Pharmacy? If you choose not to use a DSP or medication outside of the Reference price, there could be a co-payment - see below. PMB / CDL Additional Chronic Member to pay cost differential at point of sale. Member to pay cost differential at point of sale. 80% of RP deducted from chronic benefit. 2024 VITAL PLUS & VITAL NETWORK BACK TO CONTENTS PAGE