“With effect from 1 January 2011, reference pricing on PMB and chronic benefits will be introduced by CAMAF. This reference pricing includes therapeutic reference pricing and MMAP.
From 1 November 2010 you will receive a warning message for all patients with potential co-payments in 2011. The intention of this warning message is to encourage members to make an informed decision before Year End to:
o Change to an option with higher reference price limits before Year End; and/or
o Change their medication to a product below the reference price limits so as not to have any out-of-pocket co-payment.
CAMAF’s decision to introduce therapeutic reference pricing is in line with the industry trend to allow patients and their treating doctor’s choice and flexibility in the selection of required medication, while managing the Scheme’s financial risk. The reference pricing calculation will be applied by MediKredit at point of service and any reference pricing surcharge will be due by the patient and should be collected from the patient.
With the patient’s permission the provider may substitute the medication with a generic equivalent to reduce or negate the co-payment for the patient. In some instances, in order to reduce or negate co-payments, it may be necessary for the prescribing doctor to review the medication and prescribe a different drug from the same therapeutic class.
Alternatively, the member can investigate moving to an option which is more appropriate to the level of cover required in 2011.”