To negotiate the path of prescription medicine, especially considering the various alternatives available is a difficult process.
Hopefully this article will at the very least simplify matters. M-KEM is all about YOU and how we are able to make life easier for you.
Dispensing Administration Department:
Chronic Medication is the area where the most confusion arises. Some time ago, M-KEM created a department whereby specialised staff members, among other tasks, act as a go between or buffer between the member, the medical aid and the prescription as prescribed by a doctor.
In most cases problems are resolved once they have consulted with the medical aid personnel. Other problems such as annual limits, generic substitutions, alterations to existing medications and doses are regularly addressed and resolved. By virtue of the above, pharmacists are able to spend more time with their patients
Every medical aid has its own set of rules. This often leads to confusion for their respective members. M-KEM’s Medical Aid Administrative department has been established to specially help you to circumvent the red tape enabling you to obtain your prescription without having to deal with all the ‘nitty gritty’. Medical aids have separate benefits namely, Acute, Chronic, Oncology and Surgical Appliances. By making sure that a claim is made through the correct benefit the members’ total annual benefit may be ‘stretched’. Our Chronic Department communicates with the doctor and medical aid and is often successful in having products shifted to Chronic or Oncology instead of Acute benefits.
Below are some brief descriptions of terminology used:
ACUTE BENEFIT: Medication required to treat a temporary illness or ailment e.g. Bronchitis, various infections and other short term illnesses. Medical Aids generally have an annual limit allowed per person or per member. A certain portion can also be deducted from a members ‘savings’.
PMB BENEFIT: This would cover life threatening illnesses for example cardiac diseases and diabetes. Medical Aids are obliged by law to pay for PMB items, but not necessarily the item prescribed. Very often negotiation with the Medical Aid is necessary in this regard.
CHRONIC BENEFIT: This refers to a prescription for non-life-threatening medicine that is required to be taken for at least 6 months – e.g. asthma or depression would be classified as chronic.
PACK MY MEDS: A system created to save you time via you giving prior authorization to prepare your prescription in advance thereby sparing you the time standing in a queue while details are taken and prescriptions are filled at the time instead of beforehand. A SMS would be sent to you beforehand offering the opportunity to select which products are required at the time, and another sent when the prescription is ready for collection.
BLISTER PACK: At a nominal fee M-KEM will pack individual doses of medicine for you so that each dose is packed separately thereby limiting the possibility of taking the medication incorrectly,
GENERIC MEDICINE: These are medications that are identical copies of an original brand of medication in terms of formula but not necessarily in terms of preparation. They are generally much cheaper than the original and may only be marketed to the public once the patents of the original medication have expired. Our pharmacists will gladly assist you in making the choice between the different options available.
COVID 19: The pandemic we are all currently facing has introduced yet another dimension – that is the necessity to receive medicine without risking infection to yourself and others. M-KEM offers 2 possibilities – the first is being to have your medication delivered to your door at a nominal fee or the second is that you can park in an allocated area of M-KEM’s parking area where an attendant will bring your items to you. Alternatively you can email your prescription to firstname.lastname@example.org before your hand and an attendant can bring your package to you on arrival.
Please note that your medical aid may not, unlike the past, force you to purchase your medication from a specific pharmacy – you now have the opportunity to select the pharmacy of your choice.
As has always been the case M-KEM 24 Hour is there for you 24 HOURS a day, 7 days a week and we will do whatever we can to lighten your load!
Hylton Mallach (Mr M)