The Medscheme Drug Reference Pricing (MDRP) is a combination of medicine management tools that are used to control medication prices. A drug reference price is a set amount that will be paid towards a specific group of medications. If you use medication that costs less than the set reference price, then it will be fully funded. However, if the medication costs more than the reference price, you will be required to pay the difference.
There is always at least one medication available that will not require a co-payment, so make sure that you discuss your options with your doctor.
The different medication management tools included in Medscheme Drug Reference Pricing are:
- Medicine Price List (MPL): This reference pricing system applies a maximum claimable amount towards a group of drugs that are generic equivalent, i.e. same ingredient and strength together. You don’t need an updated prescription from your doctor to claim the medicine in that group that does not attract a co-payment.
- Therapeutic Reference Price (TRP): This reference pricing system applies a maximum claimable amount towards a group of drugs that have the same therapeutic effect. TRP provides doctors and their patients with access to a wider range of drugs. TRP is particularly beneficial in medication for rare diseases and cancer. An updated prescription from your doctor might be needed to claim the medication in that group that does not attract a co-payment.
The MDRP is reviewed monthly by a Pricing Committee and decisions are based on clinical expertise, market experience and business input. The products listed are from reputable companies to reduce the possibility of any product shortages to ensure that you can access quality care with no co-payments.
In the healthcare environment, costly chronic diseases are increasing, and medical aid membership contributions are rising faster than general inflation. For this reason, the implementation of a price management tool plays a major role in managing medication prices within available Scheme benefits.