Discovery Health
Prescribed medication

I've been battling to quit smoking and my pharmacist recommended Champix. I looked it up and saw that it was a schedule 5, non-generic medicine so should be covered on my plan at 75% of the health rate. I spoke to my GP about it who also highly recommended its success and wrote me a prescription. However, when I collected the medicine there was no payment.

I queried the claim with the call center this morning. Apparently the medicine is in a tier that is not covered at all, they described 6 different tiers rates to me. This is the first I've heard of tiers and it is not mentioned in any of the plan rules. The rules distinguish between
a) generic (schedule 3), or
b) non-generic (schedule 3), or
c) over-the-counter (schedule 0-2) and "certain life-style enhancing medicine (schedule 2 )".

So I guess Champix is seen as life-style enhancing - but how can I possibly know that? The medicine advisor tool on the website is no help. It gives the exact same message regardless of what type of medicine is entered (if not for chronic condition). I feel that Discovery must then make their full medicine formulary available describing their tiers so that we can make an informed decision!

Company: Discovery Health
Country: South Africa
City: General

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