Introduction of a pharmacy network for the Discovery Health Medical Scheme Oncology Benefit


Breast Cancer Survivors
Discovery Health Medical Scheme provides members with comprehensive benefits for treatment of cancer through its Oncology Benefit.

The Oncology Benefit provides members that are diagnosed with cancer with treatment options beyond Prescribed Minimum Benefits, including treatment plans that prescribe biologics.

In 2016, Discovery Health Medical Scheme funded the treatment of more than 38 000 members that have been diagnosed with cancer, at a total cost to the Scheme of nearly R1.7bn.

This represents a 103% increase in the number of claimants since 2010, and a 107% increase in the total value of the benefit.

Members receive exceptional levels of cover through the Oncology Benefit – more than 96% of cancer patients had no co-payments on their treatment in 2017.

The cross-subsidy required from the balance of the Discovery Health Medical Scheme membership to enable the Oncology Benefit funding levels in 2016 was more than R500m.

The Scheme continues to invest in initiatives to maintain and improve the levels of cover for members diagnosed with cancer, while ensuring the sustainability of funding for the growing demand for oncology care.

Pharmacy network as designated service provider for the supply of oncology medicine

2018 will see a change in funding for the supply of oncology medicine in pursuit of this aim, through the introduction of a network of pharmacies for the supply of oncology medicines. The network will both enhance service and provide significant cost efficiencies. This will have the effect of extending the cover for members receiving treatment, and reducing the cross-subsidy burden on the balance of the Discovery Health Medical Scheme membership.

The extensive coverage of the pharmacy network further allows the Scheme to make the pharmacy network a designated service provider for the supply of oncology medicine from 1 April 2018, for newly registered members on the Oncology Benefit:

  • For medicine administered in the doctor’s rooms:

  • Medicine administered in the doctor’s rooms, like chemotherapy, should be obtained from a network pharmacy. Most oncology practices already work with these network pharmacies, and we are working with oncologists to extend this to all oncology practices.

  • Funding for all oncology related medicine from non-network pharmacies will result in a 20% co-payment to the member.

  • Members should confirm with their oncologists that they make use of the designated service provider.

  • Medicine scripted and dispensed at a retail pharmacy

  • Oncology related medicine obtained from a retail pharmacy, for example, supportive medicine and oral chemotherapy, can be obtained from any MedXpress network pharmacy, which includes more than 1 500 retail pharmacies with broad national coverage.

  • Funding for all oncology-related medicine from non-network pharmacies will result in a 20% co-payment to the member.

Members should consult the MedXpress network list available on www.discovery.co.za to find the closest MedXpress network pharmacy.

How the introduction of the pharmacy network will impact members

  • Members registering for the first time on the Oncology Programme after 1 April 2018

  • All approved funding for oncology medicine for newly diagnosed patients that register on the Oncology Programme after 1 April 2018 should be dispensed from the oncology pharmacy network

  • Medicines dispensed by a non-network provider for oncology treatment (both in-rooms or dispensed by a retail pharmacy), will attract a 20% co-payment for the member.

  • Members already registered on the Oncology Programme before 1 April 2018

  • From 1 November 2018, all approved oncology medicine for diagnosed patients that registered on the Oncology Programme before 1 April 2018, should be dispensed from the oncology pharmacy network

Medicines dispensed by a non-network provider for oncology treatment (both in-rooms or dispensed by a retail pharmacy), will attract a 20% co-payment for the member.

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