If you’ve been diagnosed with a chronic condition (a disease lasting more than three months for which you’ll need ongoing treatment), we’ll cover your treatment as long as it falls on our chronic disease list.
To view more comprehensive information about the chronic disease on your option click here
- Application Process
- Chronic Conditions Covered
- Medicine Formulary
To get coverage for your chronic disease treatment, you or your doctor/pharmacist will need to apply for our Chronic Disease Benefit. Here’s what you need to do:
Step 1: Collect the relevant information
You’ll need the following to apply:
- Your Fedhealth membership number
- Dependant code
- ICD10 code of your chronic condition
- Drug name, strength and quantity
- Your prescribing doctor’s practice number
- Diagnostic test results, e.g. Total Cholesterol, LDL, HDL, glucose tests, thyroid (depending on your condition).
If you need any help gathering this information, please contact us on 0860 002 153.
Step 2: Apply
You can apply for the Chronic Disease Benefit in the following ways:
- Call Chronic Medicine Management (CMM) on 0860 002 153 between 8.30am and 5pm on Monday to Thursday, and between 9am and 5pm on Fridays.
- Apply on the Fedhealth Family Room here You’ll need to register before you can apply. Once you’ve registered, click on “My Authorisations” to view any active Chronic Authorisations. To apply simply select “Quick Actions” in the navigation bar and then select “Request Chronic Pre-authorisation” to complete the online form.
- Ask your doctor or pharmacist to apply on your behalf. They can either apply online or call our Provider Call Centre on 0861 112 666.
Step 3: We’ll give you a response straight away
If we need more information, we’ll let you, your doctor or your pharmacist know exactly what is missing. If we don’t approve your application, we’ll give you the reasons why, and you may ask us to review our decision.
Step 4: You’ll get your medicine access card
If we approve your application for our Chronic Disease Benefit, we’ll give you a medicine access card. This card records the medical condition for which we’ve approved treatment.
Step 5: We’ll give you treatment guidelines
If you’ve applied for one of the 25 Prescribed Minimum Benefit chronic conditions, we’ve compiled treatment guidelines so that you’ll have access to appropriate treatment for your condition. You’ll receive details of these treatment guidelines with your letter from Chronic Medicine Management (CMM). This means if your doctor prescribes a new medicine for the condition, you may already be approved for it and can go straight to your pharmacy with your new script to collect your medicine.
For more information on which chronic conditions are covered, please click here
Formularies: what you should know
To ensure that you have the right amount of cover you can view our medical aid options or contact a consultant.
A formulary is an approved list of medicine for each of the chronic conditions covered by the Scheme. If a formulary applies to the Chronic Disease Benefit on your option, we only cover the medicine that is listed on the formulary. The Medicine Price List (MPL) also applies to medicines in a formulary.
Want to know more? Read more about the Chronic Disease Benefit here
If there is a co-payment on your medicine:
If the medicine your doctor has prescribed has a co-payment, because it costs more than the ceiling price given in the Medicine Price List, ask your pharmacist to help you to change it to a generic medicine we cover in full. If the medicine has a co-payment because it’s not in the formulary, discuss a possible alternative with your prescribing doctor.
We will approve a chronic condition, not individual chronic medications:
Thanks to our Disease Authorisation process, you can apply for approval of a chronic condition, as opposed to a single chronic medication. The Scheme will approve an entire list of medication for your specific condition (known as a basket of medicine). So, if your doctor should ever change your medication, you will most likely already be approved for it – provided it’s in the basket. You can view the approved medication for your condition in the Fedhealth Family Room. Simply click on Health > My authorisations > Select a dependant > Track authorisation type > Submit. When you need to change or add a new medicine for your condition, you can do this quickly and easily at your pharmacy with a new prescription without having to contact Fedhealth at all.
View the March 2025 Fedhealth Basic Formulary
View the March 2025 Fedhealth Comprehensive Formulary
View the March 2025 Fedhealth Intermediate Formulary
View the March 2025 Fedhealth Medicine Exclusion List
View the March 2025 Fedhealth Medicine Price List
View the Fedhealth Medicine Price List – Review effective January 2025
