Bringing health within your reach. Chronic Medication Designated Service Provider (DSP) Ruby. Emerald. Onyx

Transcription

1 Bringing health within your reach 2009 Chronic Medication Designated Service Provider (DSP) Ruby Emerald Onyx

2 An Overview: The GEMS Chronic Medication DSP Medipost Pharmacy is the Designated Service Provider (DSP) appointed by GEMS to look after the chronic medication requirements of GEMS members. The Scheme has an exclusive contract with Medipost to provide chronic medication to its members on the Ruby, Emerald and Onyx options. The DSP offers members a range of benefits, such as more affordable prices, convenient delivery to an address of the member s choice and clinical advice about chronic medication usage. Medipost focuses on the patient s individual medication management needs in an environment of strict patient confidentiality. Qualified professional pharmacists are on call for personal consultations to assist you with chronic medication matters, such as appropriate medication use. We are committed to the highest ethical standards and take an uncompromising stance on issues such as compliance with the Scheme rules and all laws regulating the pharmaceutical environment. 1

3 Chronic Medication What is chronic medication? Chronic medication includes: Medication for life-threatening illnesses, like diabetes; Medication used on an ongoing basis to treat disabling chronic illnesses that significantly affect productivity and quality of life; and Very expensive short-term medication that will prevent other expensive treatment, like hospitalisation. If your doctor prescribes medication which you have to use under any of the circumstances explained above you must apply to register on GEMS s chronic medication programme. This means, amongst others, that the medication (if approved) will be paid from your chronic, and not your acute medication benefit. This will ensure that you maximise the funds available for acute medication which is only required for short periods of time. How do I have my chronic medication approved? Phone GEMS on and ask for a CHRONIC MEDICATION APPLICATION FORM or download one from Each member of your family who needs chronic medication must fill in a separate application form. You only need to fill in this application form once for each member of the family. Your treating doctor must complete the form. Ensure that your application has been completely filled out and signed by you and your doctor. Fax the completed form to for consideration. If your application is approved you will receive a Medicine Access Card, listing the medication which has been approved for payment from your chronic medication benefit. How to get your Chronic Medication from the DSP Get your chronic medication in 3 easy steps > STEP 1 STEP 2 STEP 3 If you are a first-time chronic medication user, please FAX your completed GEMS CHRONIC APPLICATION FORM, supporting documentation and your six monthly repeat prescription through to If you are already registered for chronic medication, and would like to update your chronic medicine requirements, please FAX your PRESCRIPTION (membership number and contact details must be clearly stated), as per your GEMS chronic medicine access card, to A UNIQUE PROFILE will be created for you and your family. This will improve interaction with Medipost, as we will have your medication history and other details readily available. The DSP will then initiate your profile and process your medicine deliveries to the destination of your choice. 2

4 What if... 1 > There are changes to my chronic medication requirements for a particular month? If you would not like to receive certain medicine items for a particular month, please inform us by completing a GEMS Chronic Medication Delivery Amendment Form which can be downloaded from under Forms or obtained by calling You must communicate your request, at least 5 working days before your medication is due again, by: ing > [email protected] or Faxing > or calling > or Posting a letter to GEMS Chronic DSP Postnet Suite 43 Private Bag X1 Queenswood > I use my local pharmacy, instead of Medipost, to get my chronic medication? You can choose to use any chronic medication provider. However, GEMS will only pay 100% for chronic medication claims if the medication appears on the Scheme s formulary (list of approved chronic medication) and is obtained from Medipost, the DSP, subject to Scheme rules. Further, you will have to pay a 30% copayment upfront if you obtain chronic medication from any other provider such as your doctor or pharmacy. GEMS does not charge a co-payment or administration fee for dispensing and processing prescriptions for medication that appear on the Scheme s formulary and is within the MPL (Medicine Price List) reference price, when medication is obtained from the chronic DSP. Obtaining your medication from Medipost will help you save money and time and your chronic medication benefit will also last longer. 3 > My doctor changes my medication in the middle of the month? If your doctor changes the type, strength or dosage of your chronic medication, please inform us of the change by faxing your new prescription to as soon as possible. We MUST receive your new prescription together with your notification about the change in your treatment. A pharmacist will contact the Scheme on your behalf within 48 hours to ensure that your application for chronic medication authorisation is assessed. A pharmacist will also contact you to > > Explain the new medication to you (side effects/directions for use etc.). > Get your permission to provide you with a generic alternative, if applicable. >Arrange a suitable delivery date for the new medication. > Explain if the medication was fully authorised, or not. > Answer further questions about your chronic medication delivery. 3

5 What if... (continued) 4 > I need medication that is not on the formulary or within the MPL reference price? It is possible that medication prescribed by your doctor may not appear on GEMS s chronic medication formulary that is applicable to your option. If you cannot or prefer not to use an in formulary drug, you will have to make a co-payment for the item, which will be a percentage of the price of the non-formulary drug. If you cannot or prefer not to use a generic substitute, where available, you may have to make a co-payment for that item, which will be the difference between the MPL reference price and the price of the prescribed item. You can settle your co-payment in one of the following ways: a. Debit order or credit card For debit order or credit card transactions, you need to complete a form that can be downloaded from or In the case of debit orders, this form gives us the authority to proceed with the transaction. We will also supply the form to you on request. Your medication will only be dispatched once we receive the completed and signed form. If you do not want us to proceed with further transactions, you need to provide one month s written notification of termination of this agreement. However, if you still owe Medipost money on cancellation, you must make an alternative payment arrangement. You will always be informed of all payment transactions that have taken place and you will be able to see all payment transactions for your chronic medication on a statement which is included with your monthly medication delivery. b. An electronic fund transfer or direct deposit into one of two Medipost accounts We will provide our bank details to you on request. You will need to fax the deposit slip to us before we can provide you with the medication. 4

6 What if... (continued) 5 > My co-payment arrangement is unsuccessful? a. Debit order Once you have provided us with a written authorization for a debit order (on a form that can be downloaded from we will process the transaction on the date you have indicated (15th/last day of each month). If the debit order is not successful, the bank fees will be for your account. We cannot provide you with your next medication delivery, unless the outstanding amount is settled. The details of the successful transaction will appear on the statement included with your medication. b. Credit card Once you have provided us with a written authorisation, we will process the transaction on the date that we send you your parcel. If the transaction is rejected, we will contact you to make alternative arrangements for payment. We can only send you your parcel once we have received payment. 6 > c. Direct Deposits or Electronic Transfers You need to make payment before we can send you your medication. Please fax proof of payment to We will send you your medicine parcel as soon as payment is processed. My annual chronic medication benefit has been exhausted? You can continue obtaining your medication on a private basis. The payment methods under point 4 will be applicable. 7 > GEMS rejects my claim for reasons other than my chronic medication benefit being exhausted? A consultant will investigate the reason for the rejection, make you aware of the problem and will make every effort to help you solve your problem. Contact us on if you have any questions. 5

7 Frequently asked questions 1 > How often do I need to supply Medipost Pharmacy with a repeatable prescription? As with any other pharmacy, you need to supply us with a copy of your doctor s original prescription before we can provide you with medication. This is a legal requirement. A repeat prescription is valid for not more than SIX MONTHS from the date written on the prescription. We will remind you (in writing and telephonically) to provide us with a new prescription from your doctor one month before we send you your last repeat and every month thereafter. We cannot send you further medication until we receive your new prescription. 2 > Can my medication be delivered to my home or work address? Yes, your medication can be delivered to your home or work address. A responsible person must be available to receive and sign for the parcel, if you are unable to receive it. In remote and outlying areas, a to-door delivery may take longer and a post office delivery may be a better option. You do not need a post box at a post office to collect your medication there, as Medipost s courier service has an agreement with the Post Office to use any counter service throughout the country. Please note that no post office slips will be issued either. If you decide to use the post-office for delivery of your medicine, you should inform us of the name and postal code of your nearest or most convenient post office at least 5 working days before your medication is due again, by: ing > [email protected] or Faxing > or Calling > or Posting a letter to GEMS Chronic DSP Postnet Suite 43, Private Bag X1 Queenswood, 0121 or by completing a GEMS Chronic Medication Delivery Amendment Form which can be downloaded from under Forms. 3 > How will I know if my medication is ready for collection at the Post Office? You will receive an SMS with a tracking number for the parcel. If you do not have a cell phone, a GEMS consultant will contact you with the tracking number. You, or the person who collects the parcel, will have to produce your ID and sign for it at the parcel counter of the Post Office. 6

8 Frequently asked questions (continued) 4 > How will I know which items I will receive next and when I can expect delivery? Each parcel is accompanied by a delivery note which will state: the ITEMS that are on file for the next delivery; the NUMBER OF REPEATS still available for each item; the POST OFFICE or DELIVERY ADDRESS to which the medication will be sent; the DATE that the following parcel will be available for collection or delivery; and the PRICE of the medication claimed from the Scheme on your behalf by Medipost. 5 > How does Medipost ensure that the cold chain is maintained for members receiving cold storage items? Parcels containing cold storage items such as insulin are packaged and dispatched at 17h00 each day. 6 > How safe is it to courier my medication? The medication is wrapped in protective material to ensure e that it does not break while it is being transported. ted. Items that are in fragile containers are placed in plastic containers and labeled appropriately. The parcels are sent through an overnight courier service and a unique tracking number is allocated to each parcel so that it can be traced with ease. In cases where the Post Office is used, fice is used, the person who collects the par the person who collects the parcel, must sign for the medication and produce their ID as proof. See question 2 for detail on how to select the Post Office delivery option. The parcel is marked as Refrigerated and Fragile and sent with ice packs to maintain the correct storage conditions. A consultant will also contact you the day after the medication was sent to make sure that you have received your parcel. 7

9 Frequently asked questions (continued) 7 > Is my information treated confidentially? We are committed to keeping your personal and treatment details confidential. Delivery does not need to be to your work or home address only if you feel it might compromise confidentiality. To keep your medication confidential, we can deliver to a Post Office counter where you can collect when convenient to you. See question 2 for detail on how to select the Post Office delivery option. All parcels are wrapped in opaque packaging to further confidentiality. 8 > Can I easily change my delivery address? You can change your delivery address (including when you will not be at the address on our system for a short time, e.g. if you are going on holiday) by notifying us at least 5 working days before your scheduled delivery date by: ing > [email protected] or Faxing > or Calling > or Posting a letter to GEMS Chronic DSP Postnet Suite 43, Private Bag X1 Queenswood, 0121 or by completing a GEMS Chronic Medication Delivery Amendment Form which can be downloaded from under Forms. 9> Is it possible to get more than 1 month s supply of medication if I am going to be out of the country? According to GEMS s rules, we may supply you with additional medication if you are going overseas or out of the country, however, approval is subject to the Scheme s rules, requirements, conditions and protocols. 10> What are the prerequisites for the dispensing of schedule 6 and 7 medication? In accordance with legal requirements, all prescriptions for Schedule 6 and 7 medication must comply with the following rules for the prescriptions to be legal: The prescription must be written by the doctor on the doctor s letterhead. The prescription is only valid for 30 days from the date written on it. The quantity of the product to be supplied must be written in words and figures. The prescription must be signed by the doctor. Only a 30 day supply of the item may be supplied to the patient for every 28 day cycle. We can only provide you with your medication once we receive the original prescription. You should post the original prescription to us by registered mail, allowing enough time for the documents to reach us. 8

10 Frequently asked questions (continued) The prescriptions must be sent to: GEMS Chronic DSP, Postnet Suite 43, Private Bag X1, Queenswood, You can also arrange with your closest GEMS regional office to send your prescription to Medipost. No photocopies or facsimiles of prescriptions will be accepted. We can only provide you with medication, once we have your original prescription. 11> What if I do not collect my medication? A GEMS consultant will contact you to determine the reason for not collecting your medication and further arrangements will be decided upon. Bringing health within your reach 9

11 contact us Tel Fax GEMS Chronic DSP Postnet Suite 43 Private Bag X1 Queenswood 0121 GEMS is a restricted medical scheme for public service employees and has been registered as a medical scheme in accordance with the Medical Schemes Act 131 of 1998 and reports to the Registrar of the Council for Medical Schemes. GEMS is a legal entity governed by an independent Board of Trustees that is fit and proper to manage the affairs of the scheme.