The GEMS Chronic Medication DSP - United Nations

1 Bringing health within your reach 2009. Chronic Medication Designated Service Provider (DSP). contact us Tel 0860 00 4367. Fax 0866 518 009 Ruby gems is a restricted medical scheme for public service employees and has been Emerald registered as a medical scheme in gems Chronic DSP accordance with the Medical Schemes Act Postnet Suite 43 131 of 1998 and reports to the Registrar Private Bag X1 of the Council for Medical Schemes. gems Onyx is a legal entity governed by an independent Queenswood Board of Trustees that is fit and proper to 0121 manage the affairs of the scheme. An Overview: The gems Chronic 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.

2 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. Chronic Medication How to get your What is Chronic Medication ? Chronic Medication Chronic Medication includes: Medication for life-threatening illnesses, from the DSP. like diabetes.

3 Get your Chronic Medication Medication used on an ongoing basis to treat in 3 easy steps >. disabling Chronic illnesses that significantly affect productivity and quality of life; and STEP 1 If you are a first-time Chronic Very expensive short-term Medication that will Medication user, please FAX. prevent other expensive treatment, like your completed gems . hospitalisation. Chronic APPLICATION. FORM, supporting If your doctor prescribes Medication which you documentation and your six have to use under any of the circumstances monthly repeat prescription explained above you must apply to register on through to 0866 51 8009. gems 's Chronic Medication programme. This means, amongst others, that the Medication (if STEP 2 If you are already registered approved) will be paid from your Chronic , and not for Chronic Medication , and your acute Medication benefit.

4 This will ensure would like to update your that you maximise the funds available for acute Chronic medicine Medication which is only required for short periods requirements, please FAX your of time. PRESCRIPTION (membership number and contact details How do I have my Chronic Medication approved? must be clearly stated), as per Phone gems on 0860 00 4367 and ask for a your gems Chronic medicine Chronic Medication APPLICATION FORM access card, to 0866 51 8009. or download one from Each member of your family who needs Chronic STEP 3 A UNIQUE PROFILE will be Medication must fill in a separate application created for you and your form. You only need to fill in this application family. This will improve form once for each member of the family. interaction with Medipost, as Your treating doctor must complete the form. we will have your Medication Ensure that your application has been history and other details completely filled out and signed by you and readily available.

5 Your doctor. Fax the completed form to 0866 51 8009 for The DSP will then initiate your consideration. profile and process your If your application is approved you will receive medicine deliveries to the a Medicine Access Card, listing the Medication destination of your choice. which has been approved for payment from your Chronic Medication benefit. 2. 2 > I use my local pharmacy, instead of Medipost, to get my Chronic Medication ? What You can choose to use any Chronic 1 > There are changes to my Chronic Medication Medication provider. requirements for a particular month? However, gems will only pay 100% for If you would not like to receive certain medicine Chronic Medication claims if the Medication items for a particular month, please inform us appears on the Scheme's formulary (list of by completing a gems Chronic Medication approved Chronic Medication ) and is Delivery Amendment Form which can be obtained from Medipost, the DSP, subject downloaded from under to Scheme rules.

6 Forms or obtained by calling 0860 00 4367. Further, you will have to pay a 30% co- You must communicate your request, at least payment upfront if you obtain Chronic 5 working days before your Medication is due Medication from any other provider such again, by: as your doctor or pharmacy. gems does not charge a co-payment or administration Emailing > fee for dispensing and processing or Faxing > 0866 51 8009 prescriptions for Medication that appear or calling > 0860 00 4367 on the Scheme's formulary and is within or Posting a letter to the MPL (Medicine Price List) reference gems Chronic DSP price, when Medication is obtained from Postnet Suite 43 the Chronic DSP. Private Bag X1 Queenswood Obtaining your Medication from Medipost 0121 will help you save money and time and your Chronic Medication benefit will also last longer.

7 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 0866 51 8009 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.

8 3. What (continued) What (continued). 4 > I need Medication that is not on the formulary or within the MPL reference price? 5 > My co-payment arrangement is unsuccessful? It is possible that Medication prescribed by your doctor may not appear on gems 's Chronic a. Debit order Medication formulary that is applicable to your option. 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 If you cannot or prefer not to use an in formulary drug, you will have to make a co-payment for date you have indicated (15th/last day of each month). the item, which will be a percentage of the price of the non-formulary drug. If the debit order is not successful, the bank fees will be for your account. We cannot If you cannot or prefer not to use a generic substitute, where available, you may have to make provide you with your next Medication delivery, unless the outstanding amount is settled.

9 A co-payment for that item, which will be the difference between the MPL reference price and The details of the successful transaction will appear on the statement included with the price of the prescribed item. your Medication . You can settle your co-payment in one of the following ways: b. Credit card a. Debit order or credit card Once you have provided us with a written authorisation, we will process the transaction For debit order or credit card transactions, you need to on the date that we send you your parcel. complete a form that can be downloaded from or In the case of If the transaction is rejected, we will contact you to make alternative arrangements for debit orders, this form gives us the authority to proceed with payment. We can only send you your parcel once we have received payment. the transaction. We will also supply the form to you on request.

10 Your Medication will only be dispatched once we receive c. Direct Deposits or Electronic Transfers the completed and signed form. You need to make payment before we can send you your Medication . Please fax proof of payment to 0866 51 8009. We will send you your medicine parcel as soon as payment If you do not want us to proceed with further transactions, is processed. you need to provide one month's written notification of termination of this agreement. However, if you still owe 6 > My annual Chronic Medication benefit has been exhausted? Medipost money on cancellation, you must make an You can continue obtaining your Medication on a private alternative payment arrangement. You will always be informed basis. The payment methods under point 4 will be applicable. of all payment transactions that have taken place and you will be able to see all payment transactions for your Chronic 7 > gems rejects my claim for reasons other than my Chronic Medication on a statement which is included with your Medication benefit being exhausted?