CHRONIC TREATMENT GUIDELINES

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1 CHRONIC TREATMENT GUIDELINES REGISTRATION OF CHRONIC CONDITIONS You can only access benefits for chronic medication, as listed below, if your prescribing/treating doctor or pharmacist registers your chronic condition(s) with Anglo Medical Scheme on This applies to all chronic conditions recognised by Anglo Medical Scheme as per approved Rules. For registration, the Scheme requires detailed clinical information, including the condition s ICD 10 code (Diagnosis code). No chronic forms need to be completed unless specifically requested. ICD 10 CODES A detailed list of all the ICD 10 diagnostic codes applicable to Anglo Medical Scheme s eligible chronic condition list is available here CONDITION MEDICINE LIST (CML) Once your condition has been registered, you will have access to funding of medication on the Chronic Medicine List (CML) specific to your chronic condition. This is a list of drugs the Scheme will fund that is appropriate for the treatment of the condition. Some of the PMB CDL conditions have two lists of drugs in order to accommodate drugs appropriate to the severity of the particular conditions. You can only get drugs in the severity 2 list once specific clinical criteria are met. Additional information or reports may be required from the prescribing doctor. REGISTRATION The Condition Medicine List do not list all medication that may be required to treat your condition. Some medication requires specific pre-authorisation. As detailed clinical information is required to pre-authorise these drugs, the treating doctor needs to obtain authorisation from Anglo Medical Scheme on All existing Anglo Medical Scheme exclusions and limitations apply.

2 Once your condition is registered, action is only required from you when: The chronic medicine that you are taking is not included in the list for your registered condition, or If you want to avoid the co-payment resulting from Reference Pricing, ask your prescribing doctor to consider changing your medication to an alternative drug by contacting Anglo Medical Scheme on REFERENCE PRICING Anglo Medical Scheme applies two types of Reference Pricing: MMAP refers to the maximum price the Scheme will pay for generic drugs and this price is the same per product for both plans, and Therapeutic Reference Pricing refers to the maximum price that the Scheme will pay for a specific therapeutic category of drugs. This reference price is based on the cost of drugs from the same, or a similar drug class listed on the CML. The therapeutic reference price differs from one plan to another. The Scheme applies both reference pricing systems simultaneously and will only reimburse a product at the lower of the two prices applicable to the particular plan. If a product is prescribed that is above any of the relevant reference prices, you will need to pay the difference in price at the point of dispensing. Read this article for more information about reference pricing The CML is not a fixed list of products. It is constantly revised and updated in accordance with new products registered, discontinued products, price changes, as well as changes to product registration details. Use the medicine search The search tool will provide the maximum scheme liability, whether a co-payment applies as well as the availability to search for possible generic or therapeutic alternatives.

3 LIST OF PMB CDL CHRONIC CONDITIONS These are chronic conditions that require ongoing medication management out-of-hospital, that are registered on the Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL): 1 Addison s Disease 14 Epilepsy 2 Asthma 15 Glaucoma 3 Bipolar Mood Disorder 16 Haemophilia 4 Bronchiectasis 17 Hyperlipidaemia 5 Cardiac Failure 18 Hypertension 6 Cardiomyopathy 19 Hypothyroidism 7 Chronic Obstructive Pulmonary Disorder 20 Multiple Sclerosis 8 Chronic Renal Disease 21 Parkinson s Disease 9 Coronary Artery Disease 22 Rheumatoid Arthritis 10 Crohn s Disease 23 Schizophrenia 11 Diabetes Insipidus 24 Systemic Lupus Erythematosus 12 Diabetes Mellitus Type 1 & 2 25 Ulcerative Colitis 13 Dysrhythmias LIST OF DTP (Diagnosis and Treatment Pair) CHRONIC CONDITIONS These are diagnoses regarded as PMBs that require ongoing medication management out-of-hospital: 1 Auto-immune disorders 12 Parathyroid disorders 2 Bile duct disorders 13 Peptic ulcer disease 3 Cerebrovascular accident (Stroke) 14 Peripheral vascular disease 4 Cushing s disease 15 Pituitary gland disorders 5 Deep vein thrombosis 16 Polycystic ovarian syndrome 6 Endocarditis 17 Polyneuropathy 7 HIV infection 18 Prolactinoma 8 Liver disease 19 Sarcoidosis 9 Menopause 20 Spinal cord injury/disease 10 Mitral valve disease 21 Urinary incontinence 11 Organ transplantation

4 LIST OF NON-PMB CHRONIC CONDITIONS These are chronic conditions not regarded as PMBs by the Council of Medical Schemes, where Anglo Medical Scheme fund medicine for Non-PMB Chronic Conditions: 1 Acne 23 Motor Neuron Disease 2 Allergy management 24 Muscular dystrophy & other inherited myopathies 3 Alzheimer s dementia 25 Narcolepsy 4 Anaemia (Chronic) 26 Obsessive compulsive disorder 5 Ankylosing Spondylitis 27 Osteoarthritis 6 Anxiety Disorder (Chronic) 28 Osteoporosis (non-pmb) 7 Atopic Dermatitis (Eczema) 29 Osteopaenia 8 Attention Deficit Disorder 30 Paget s Disease 9 Auto-immune Disorders (non-pmb) 31 Pancreatic Disease 10 Cystic Fibrosis (non-pmb) 32 Peptic ulcer (non-pmb) 11 Chronic Cystitis 33 Polymiositis 12 Degeneration of the macula 34 Polyneuropathy (non-pmb) 13 Depression 35 Psoriasis 14 Diverticular Disease of the Intestine (non-pmb) 36 Pulmonary Interstitial Fibrosis 15 Fibrous Dysplasia 37 Restless Legs Syndrome (non-pmb) 16 Gastro-oesophageal reflux disease 38 Sarcoidosis (non-pmb) 17 Gout (Chronic) 39 Systemic Sclerosis 18 Hidradenitis Suppurativa 40 Tourette s Syndrome 19 Huntington s disease 41 Trigeminal Neuralgia 20 Liver Disease (non-pmb) 42 Urinary calculi (Chronic) 21 Meniere s Disease 43 Urinary incontinence (non-pmb) 22 Migraine Note that the above non-pmb chronic conditions are subject to annual limits as described in your Benefit Guide. CASE MANAGEMENT Certain chronic conditions will require case management and approval by a Clinical Committee. These cases will be managed individually.

5 EXCLUSIONS The following medicines are excluded from chronic cover: Vitamins and mineral preparations (including calcium, except for patients with Menopause or Osteoporosis) Homeopathic medication Hypnotics Mucolytics Antibiotics (except for patients with Bronchiectasis, Crohn s disease and Cystic Fibrosis) Muscle relaxants (except for patients with Multiple Sclerosis). NOTE Although your condition may be defined as chronic by the prescribing doctor, this condition may not meet the Schemes criteria for chronic medication cover. Access to any medication as part of the chronic medication benefit is subject to clinical entry criteria, drug utilisation reviews, reference pricing and, in the case of non-pmb chronic conditions, annual limits. SPECIAL BENEFIT AUTHORISATIONS Oncology Medication requests must be referred to the Oncology Disease Management team on Organ Transplant Medication requests must be referred to the Organ Transplant Management team on Chronic Renal Disease Medication requests must be referred to the Chronic Renal Disease Management team on HIV/AIDS Please contact OPTIPHARM on Diabetes Mellitus Type 1 and Type 2 Register with the Centre for Diabetes and Endocrinology (CDE) on

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