Funding structure from 1 July 2025

Managing chronic conditions needs a good healthcare funding system. To use resources better and make healthcare more accessible, changes are being made to how chronic medicines are funded. These updates will affect how medicines are paid for and approved. Here’s what you need to know

What’s Changing?

New Funding Structure
We’re changing how we pay for chronic medicines. Instead of using the Maximum Medical Aid Price (MMAP), we’ll use the Chronic Drug Amount (CDA) and Therapeutic Reference Price (TRP). These new methods will decide how we fund medicines and items not on the standard list or formulary. The goal is to use the Fund’s resources efficiently and sustainably.

Introduction of the Additional Disease List (ADL)

A defined Additional Disease List (ADL) of conditions is being introduced, covering specific chronic conditions. For conditions included in this list, approved medicines or items will be funded up to the CDA applicable to each condition.

What Does This Mean for You?

• Improved Access to Medicines
  Patients will have the option to obtain medicines that are not on the standard medicine list, although a co-payment may be required.
• Changes in Payment and Authorisation
  The CDA and TRP models will apply to both Prescribed Minimum Benefit (PMB) chronic conditions and those listed under the new ADL. Additionally, some medicines may now be funded from the day-to-day benefit rather than the Chronic Illness Benefit.

What You Need to Do

• Stay Informed
  Keep an eye out for updates and further details regarding the CDA and TRP funding structure, as well as the conditions covered under the new ADL.
• Review Your Medicines
  Once you have more information about how these changes affect your specific condition and medication, consult your doctor to review your treatment plan. This will help ensure that you continue to receive the best possible care while making the most of the new funding structure.

Article credit: https://www.discoveryhealthmedicalscheme.co.za/portal/embf/understand-the-changes-to-chronic-medicine-funding?utm_source=chatgpt.com