PMB Main List
The prescribed minimum benefit (PMB) main list replaces the acute exclusions list (AEL)
To ensure members get optimal value from acute medication benefits, an AEL was implemented in 2016. The AEL included certain medication for the treatment of chronic conditions that was being claimed from the acute medication benefit. The AEL was intended to ensure that medication, which could be registered on the chronic medication programme, was registered correctly, so that members didn’t end up paying for chronic medication from their acute medication benefits. The AEL was replaced by the PMB main list from 1 January 2018.
These medication items are carefully chosen to avoid items that could be used to treat an acute condition, e.g. prednisone, which could be used when you have flu. In order to preserve your acute medication benefits, you will be able to claim for a medication item on this list three times from the acute medication benefit before it is rejected for payment.
If the Scheme has your cell phone details, you will receive an SMS advising you that you need to register the medication on the chronic medication benefit. If you attempt to claim that particular item again from acute medication benefits, the claim will be rejected and the pharmacist will receive a message indicating that the medication you are claiming for should be registered on the chronic medication benefit.
Members should request their prescribing doctor/pharmacist to contact the Medicine Risk Management Department with the relevant clinical information in order for their pre-authorisation requests to be considered.
Please click here to view the PMB main list.
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DISCLAIMER : The material and other information provided on this website is for educational, communication and informational purposes only and does not by any means supersede the rules of the Scheme. Please note that the scope of the Scheme and all terms and conditions are set out in detail in the rules of the Scheme. In the event of any discrepancy between this website and the rules of the Scheme, the rules of the Schemes always take precedence.