Stretch your Medicine Benefits

You don’t always need a prescription.

One of the benefits offered by the Scheme is cover (depending on the Plan you have chosen) for what is referred to as Pharmacist Advised Therapy (PAT).
PAT covers medicines that are supplied by a registered pharmacist without a prescription from a GP or other healthcare practitioner. That means that you do not necessarily have to visit a GP just to get a prescription for a minor ailment such as a cold, or sinus.

The funding of compound analgesics, for example, Myprodol®, Stilpane® and Syndol® will be restricted to a maximum supply of one hundred tablets or capsules per year. If your condition requires medication in excess of this limit, you, your doctor or pharmacist can contact the Scheme on 0860 100 080. He/she will be transferred to a clinical agent who will consider a verbal motivation.

Such medicines can be claimed directly from the pharmacy; with the amount covered being subject to the benefit available on the Plan you belongs to. You can also pay upfront and claim back from the Scheme. Just remember that the benefit excludes the pharmacy’s administration fee.
This is how PAT is covered by the various Plans for 2019:

Payable from Routine Medical Benefit limit. Covered from available PMSA. R1 405 per family, subject to the prescribed medicine limit. Covered from available PMSA.

Hospital Plan has no Everyday Services Benefits.

By using generic medicine, you can get more medicine within your benefit limit.

Generic medicines are cheaper, but just as good. The difference in price between a brand name medicine and its generic version is mainly due to research costs.

Before a medicine is approved, the drug company that developed it would have spent large sums of money on research and development. Once a drug company has approval from the Medicine Control Council to sell their newly developed medicine, they have patent protection that effectively lasts between 5 and 15 years. During this time, no other company may manufacture this specific drug, and the original drug company will try to recover the research and marketing costs, and try to make a good profit on their investment while they have patent protection.

Once the patent period has passed, any other drug company may make the medicine. They use exactly the same active ingredients, but are not allowed to use the same commercial name as the original. Before they can be sold, they must also be approved by the Medicine Control Council.

Generic medicines can therefore be sold at a lower price than their brand-name counterparts, as the manufacturers don’t have the associated costs for the long and expensive process of research and development.

Note: Not all brand name medicines have generic alternatives. Always ask your doctor or pharmacist if a generic alternative is available

Use Pharmacy Direct to have chronic medicines delivered.

Pharmacy Direct has been appointed as the Scheme’s Designated Service Provider for the Hospital Plan for PMB medication. However, members on all Plans who are registered for chronic medicine should consider using Pharmacy Direct, as this holds various advantages.

Pharmacy Direct is a sister company of our Administrator and, as such, NMAS members qualify for additional discounts on this courier service. Pharmacy Direct offers the following:

  • Chronic medication delivery anywhere in South Africa
  • Experienced – established in 2004
  • Automated dispensing cycle every 28 days
  • Designated Service Provider to numerous medical schemes and government programmes – saving members effort, money and time
  • NO admin fees and NO delivery fees
  • Servicing more than 500 000 patients every month
  • Employs more than 650 staff
  • Easy access to a team of professional pharmacists
  • Reliable – 99.9% service level track record
  • You can read more about Pharmacy Direct on their website,

    You can see more about the registration process, and download an application form, here: