Government Gazette No. 40515, related to the medicine dispensing fee to be charged by a duly licensed medical practitioner, dentist, practitioner, nurse or other person, registered under the Health Professions Act, has been published on the 23rd of December 2016.
The legislation defines the dispensing fee on SEP (Single Exit Price) items and such fee should not exceed the following:
a) Where the single exit price of a medicine or scheduled substance is less than one hundred and seventeen rand (R117.00), the dispensing fee must not exceed 30% of the single exit price in respect of that medicine or scheduled substance;
b) Where the single exit price of a medicine or scheduled substance is equal to or greater than one hundred and seventeen rand (R117.00), the dispensing fee must not exceed thirty five rand ten cents (R35.10) in respect of that medicine or scheduled substance;
* SEP items from R0 – R116.99, the FEE = 34.20% (lncl. VAT),
* SEP items from R117.00 and higher, the FEE = R40.01 (lncl. VAT)
Approval to implement the new dispensing fee structure on all claims with a service date of 1 January 2017 onwards was received from the following healthcare funders:
* PICK N PAY
* Rand Mutual
* CIGNA Administered Schemes
* SAB (South African Breweries)
* GEMS (Government Employees Medical Scheme)
PLEASE NOTE: This fee structure will be applied to all SEP governed medicine dispensing claims. This fee structure will also be applied on materials submitted as part of a tariff claim (e.g. 0200, 0201 and 0212 claims) depending on the scheme rate.
Claims submitted to these healthcare funders after the effective date should not attract medicine price related co-payments where the above dispensing fee structure is implemented.