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CarewarePBM Reference Pricing

CarewarePBM has assisted its client medical schemes in establishing a reference price system for appropriate risk management. CarewarePBM Reference Pricing enables the client Medical Scheme to balance its members' experience with managing the financial risks associated with Chronic Medicine Management.

Underlying the setting of such condition level / Therapeutic Class Reference Prices is a series of pricing and benefit allocation principals which was based on the Council of Medical Scheme's requirements. These requirements are defined within various Acts and Regulations, Published CDL Algorithms, as well as the Risk Equalisation Fund criteria. More information on these Council of Medical Scheme requirements can be viewed on their website, www.medicalschemes.com.

CarewarePBM Reference Pricing allows the member of the client Medical Scheme access to benefits appropriate to his / her condition. Please note that a patient / member should register his / her chronic condition at the client's Medical Scheme Clinical Department, based on the Medical Scheme's requirements. This registration of the condition will allow the patient / member access to a financial benefit limited per therapeutic class. For more information please do not hesitate to contact the applicable Medical Scheme for more information about CarewarePBM Reference Pricing.

You can view the CarewarePBM publications by clicking on the link below:

  Publications