Network Rules

MediKredit provides you with opportunities to participate in the creation of Scheme Specific Pharmacy Networks, being networks put together on a willing participant basis and aimed at creating positive experiences for the people that drive our industry, namely the members of medical schemes.

We have sought to enhance the member experience in pharmacies and to drive the establishment of communication lines between pharmacies and medical schemes. MediKredit has also sought to engage and collaborate with pharmacies rather than drive down a “least cost” approach to networks.

Those of you who have attended our industry information sessions will understand that the MediKredit view is to ensure that pharmacies become the point of primary care and become integral, not only to medical scheme healthcare delivery, but also to the greater National Health Insurance (NHI) debate currently underway.

The network will be run on a “willing pharmacy” basis, where participating pharmacies can commit to the following:

To charge members at the scheme specific dispensing fee;

No additional administration and non-scheme surcharges may be billed to scheme members;

At all times strive to drive generic medicine utilization for all scheme members;

To ensure that reference price co-payments are dealt with by switching members to medication below reference prices; and

To comply with such other lawful and reasonable network rules as may be notified to network pharmacies in writing,

from time to time.

 

In exchange the schemes commit to:

Consistently communicate the list of preferred pharmacies to all their members.

 

General Considerations:

Membership of the network will be subject to 90 days' notice of termination by either party, except as otherwise provided for in the Medical Schemes Act and regulations thereto.