Medinol Practice Management | Medical Billing Software South Africa
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2020 07 28

How Does MMAP (Maximum Medical Aid Price) Work

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MMAP DESCRIPTION AND PATIENT IMPACT: MMAP® (Maximum Medical Aid Price) is a reference price model that is wholly owned and maintained by MediKredit.

MMAP® serves as a guide to determine the maximum medical scheme price that medical schemes will reimburse for an interchangeable multi-source pharmaceutical product.

An interchangeable multi-source pharmaceutical product is a product that has exactly the same active ingredient/s and salt/s combination, strength of the active ingredient/s and dosage form (for example tablets versus capsules) as other pharmaceutical products that can be obtained from manufacturers or suppliers.

Products are excluded from the MMAP® listing if they are designated as non-substitutable by the South African Medicine Control Council (MCC), as well as substitutability data from international sources such as Australia, USA (FDA) and Europe.

Prices are determined to allow flexibility when selecting a pharmaceutical product. It is also important to note that the MMAP® price levels do not necessarily equate to the prices of any specific pharmaceutical product brands.

The provider must charge the actual price of the brand supplied to the patient and not the MMAP® amount. The Provider is entitled by law to supply any alternative interchangeable multi-source pharmaceutical product (“generic substitution”) unless:

· Specifically indicated otherwise by the prescribing doctor; or

· Expressly forbidden by the patient to do so; or

· The price of the interchangeable multi-source pharmaceutical product is higher than that of the prescribed medicine.

 

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