Chronic medication funding

If you have been taking medication for longer than three months, the Scheme might regard it as chronic in nature. The Scheme funds all PMB and certain non-PMB chronic medication according to your Plan, as detailed in the Benefit Guide and on the Scheme website. Follow the simple process to confirm whether your condition is on the list of funded chronic conditions and if so, obtain authorisation. This will ensure funding from the correct benefit and not from your day- to-day or out-of-hospital benefits.

Effective management of your condition requires you to take your chronic medication regularly as prescribed by your doctor. The Scheme assesses the frequency and allocation of medication claims for members' registered conditions on an annual basis to ensure they are still being taken continuously and are correctly paid from the available chronic medication limit. Should you get a letter from the Scheme requesting you to contact us to confirm your chronic condition, please act on it as your chronic authorisation might not be renewed automatically. Should you, for whatever reason, have stopped taking your chronic medication, it is advisable to consult your doctor again before restarting it as your condition may have changed, requiring a different treatment regimen.

Published: February 2022.