Chronic medicine and the consequences of not taking them as prescribed
What is considered chronic medication and how does the Scheme fund it?
If you take medication for a condition for longer than 3 months, it is considered ‘chronic’. The Standard Care Plan (SCP) and Managed Care Plan (MCP) provide a separate benefit for certain chronic medication. These benefits are not automatic, but are subject to the Scheme Rules, clinical entry criteria and protocols. For a list of these conditions, please refer to the Benefit Guide. There are Prescribed Minimum (PMB) chronic conditions and non-PMB chronic conditions. To access these benefits, your pharmacist or doctor needs to register your chronic condition with the Scheme. In most cases a telephone call is sufficient. Once your chronic condition is registered, the medication will be paid for from a separate chronic medicine benefit or by the Scheme and not from the Out of Hospital benefit on SCP or your Medial Savings Account (MSA) on the MCP. For PMB chronic conditions, you will also have access to a ‘basket of care’. This includes certain healthcare services necessary to treat your condition, for example, pathology tests or consultations.
Non-compliance and the effect on your benefits
Our medicine management team regularly reviews whether members registered for chronic condition/s use their medication. If the claims history suggests that the member is not using the relevant medication, the registration of the condition will be terminated, and the member will be informed. If the chronic condition is a PMB condition, the ‘basket of care’ will be terminated as well and health care services for this condition will then be paid out of the Member’s day-to-day benefits or MSA and not by the Scheme.
Negative consequences for your health
The effect on your health of not taking your medication as prescribed might not be visible to you immediately. It might result in poor medical outcomes, considerable health risks and potentially higher healthcare costs for you and the Scheme, such as avoidable hospitalisation. Do not take more or less of the dose prescribed, don’t skip or double up on doses, and don’t stop or start medication without consulting your doctor.
Practical tips to help you comply with the treatment for your condition
- Educate yourself about your condition and the treatment prescribed.
- Follow your doctor’s recommendation on how to monitor your treatment outcome. This can be consultations with your doctor, examinations, blood and/or other investigative tests.
- Inform your doctor if you feel different and don’t take your own measures to change your treatment.
- If you change to a generic medication, let the pharmacist write on the package which medication it replaces so that you do not to confuse when and how much medication to take.
- Simplify your medicine where possible. Ask for once-daily doses and create a daily routine for when you take them.
- Keep your medication in a dry, dark place for it to stay effective and don’t use it past its expiry date.
- Fill your prescriptions early enough and set reminders when to get a new prescription from your doctor. The law requires patients to obtain a new prescription every 6 months. It also serves to ensure that regular monitoring takes place to measure the effectiveness of the treatment.
- For any question about your medication or condition, consult your pharmacist or doctor. For questions about your medication benefits, please call our medicine management team on 0860 222 633.