Member guide: How to register chronic conditions

Step 1:
Ask your treating doctor or pharmacist to call us

Your treating doctor or pharmacist can initiate the registration process by calling us on 0860 222 633. Where applicable, we will require the necessary diagnostic results related to your condition, especially for new registrations.

Step 2:
Provide required clinical information

For registration, the Scheme requires detailed clinical information, including the condition(s) ICD-10 code (diagnosis code). In most cases, no chronic forms need to be completed unless specifically requested.

Frequently asked questions (FAQ)

Q: What if my doctor refuses to call?

If your doctor is unable to call, you, as a member, can contact us at the above number, and we will assist in the registration process.

Q: Can the pharmacist call on my behalf?

Yes, the pharmacist can call if they have all the necessary information mentioned earlier, and to update existing authorisations.

Q: My current results are now normal.

No worries. The laboratories keep a copy of your cumulative results, and we can obtain the initial results from these reports.

Step 3:
Accessing chronic medication

Once your condition is registered, you have access to the basket of medicines listed on the Condition Medicine List (CML). These medications are automatically approved upon condition registration. Please note that some Prescribed Minimum Benefit (PMB) CDL conditions have two lists of drugs to accommodate severity levels. Specific clinical criteria must be met to access drugs on the severity two list, which may require additional information or reports from your prescribing doctor.

Step 4:
Ongoing management

Your doctor will only need to take action in specific situations:

• When your current approval expires due to exceptional circumstances.
• If your doctor changes your medicine after you've already claimed for the month.
• When diagnosing you with a new chronic condition that requires new medicine.
• If the chronic medicine you are taking is not included in the CML for your registered condition.
• If you prefer not to pay the difference between the cost of different drugs and request a possible upliftment of the copayment. For co-payment-related queries, your prescribing doctor can contact the Anglo Medical Scheme Chronic Medicine Department on 0860 222 633.

Special cases - Oncology or HIV conditions

For Oncology or HIV conditions, contact us on 0860 222 633, and we will direct you to the specific department for detailed and specialised information. Case managers will work with your healthcare provider team to assist in the registration process.

Published August 2023