The PESA file is a medicine management system. It is an industry-developed list of 64 categories of pharmacy-dispensed items, used as a method of identifying items that a Scheme will or will not fund as per Scheme’s rules and applied managed care protocols.
The PESA list has been put together to protect your acute or routine medicine benefits and includes items such as:
- Oral contraceptives
- Slimming preparations
- Food products
- Anti-smoking products
- Vitamins and supplements
These are considered as inappropriate medication claims within the medicine management system.
Medscheme advises medical aids on which categories may be most appropriate for members and particular circumstances. For example, where a Scheme does not cover the treatment of osteoporosis from the chronic medicine benefit, members should have access to payment for this treatment from the routine medicines benefit. Medscheme would therefore make a recommendation that exclusion category 59 (osteoporosis-specific products) should, in this case, not be applied.