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Medical Schemes Act, 1998 (Act No. 131 of 1998)


Regulations in terms of the Medical Schemes Act

Chapter 5 : Provision of managed health care

15I. Formularies


If managed health care entails the use of a formulary or restricted list of drugs –

a) such formulary or restricted list must be developed on the basis of evidence-based medicine, taking into account considerations of cost-effectiveness and affordability;
b) the medical scheme and the managed health care organisation must provide such formulary or restricted list to health care providers, beneficiaries and members of the public, upon request; and
c) provision must be made for appropriate substitution of drugs where a formulary drug has been ineffective or causes or would cause adverse reaction in a beneficiary, without penalty to that beneficiary.