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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Medicover prepares to manage own Pharmaceutical Benefits with CarewarePMB

20 October 2006 Boutique Marketing

CarewarePBM, a fully integrated Pharmaceutical Benefit Management module within the current Medicover administration system, will be used for the administration of medicine claims. 

The integration of this system into the current administration system has many advantages. Whilst Medicover will continue to provide an easy accessible medicine adjudication process, the Scheme will also be better able to provide real-time, relevant and accurate information to the dispensing service provider at the time of dispensing.  Furthermore, this system should reduce payment turnaround times to the service provider and reduce the cost of doing business with Medicover for both the member and service provider.

How does this impact on the members?
From a clinical perspective, this means that from 1 December 2006, authorisation of chronic benefits will be done by Medicovers in-house chronic department.  This will ensure that members will have easier access to information regarding their chronic authorisations and benefits thereby facilitating more efficient and effective service from the Scheme.  Furthermore, the dispensing service provider will have direct contact with Medicover rather than a 3rd party when obtaining authorisation for medication on the members behalf.  So in future there will be one central point of contact for both members and service providers for servicing our members medication needs.

With respect to claims processing, the integration of this system will reduce administration costs and also reduce the costs for pharmacies/dispensing service providers to do business with the Scheme, as the pharmacy administration fee (PAF) levied by the 3rd party who to date has administered Medicovers medicine claims, will fall away.  In many instances in the past, these costs were passed on by the pharmacy to our members.  Effectively, the pharmacy experience for the member will be more pleasurable as some hidden administration costs will disappear

All suppliers of medicine throughout S.A have already been advised of this impending change!

For queries regarding Medicovers Benefits and Pricing or the CarewarePBM system contact: Sandi Banks - Membership and Marketing Manager, tel: 082 414 9384 or email: sandib@medicover.co.za

Please visit our website for updated information on Medicover: www.medicover.co.za or phone us Toll Free 0800 116 243.

Medicover is a transparent, no frills medical scheme committed to strong relationships with all our partners.

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