Does medical aid cover schizophrenia treatment?

Treating schizophrenia: Why your medical aid covers your treatment

As with most medical conditions, there are numerous treatment options for the diagnosed person. However, most people don't understand how medical aids can help. This is especially true for schizophrenia, a complex disorder that affects their ability to think clearly, form cohesive thoughts and function in social environments.

The symptoms of schizophrenia include,[1]

  • Delusional behaviour
  • Hallucinations
  • Confused thought patterns
  • Odd and random movements
  • Unusual posture

Unfortunately, the symptoms often affect a person's ability to consistently stick to a medication routine, which is why a monthly injectable has been developed. The injectable comes with many benefits,[2]

  • The injectable must be prescribed by a healthcare professional, which allows doctors to follow the person's progress.
  • It is easier to know whether the person is keeping up with their medication schedule.
  • By using the long-acting injectable, the risks of rehospitalisation is substantially lower and also allows the person living with schizophrenia to lead a fulfilled life.

The big question asked by loved-ones of people living with schizophrenia is, “is treatment covered by medical aid?”

Schizophrenia is part of the Prescribed Minimum Benefit (PMB) list from the Counsel of Medical Schemes (CMS) that stipulates the payment of injectables be covered by all medical aids.[3]

This is the story of Alfred*, a 38-year-old man living with schizophrenia.

After being diagnosed with schizophrenia at age 35, Alfred was placed on oral medication which seemed to help him, however, he struggled to remember to take it daily. This in turn caused him to experience some of his symptoms again. His psychiatrist recommended the injectable and proposed that he motivate his medical aid and get cover.

The process was simple,

  • He contacted his medical aid provider and requested authorisation of a Prescribed Minimum Benefit (PMB) to be allocated.
  • His medical aid required he obtain a letter from his doctor along with the prescription.
  • After approval, his treatment became part of his chronic medication benefit.

If you know anyone who struggles with schizophrenia and the treatment routines, get in touch with a healthcare provider for more info on monthly injectables, and talk to your medical aid about cover.

Living with schizophrenia is not the end. With the right treatment and cover from your medical aid, people diagnosed with the disorder can live a fulfilled life.

EM 90891

References

National Institute for Clinical Excellence. Psychosis and schizophrenia in adults: prevention and management. 2014. CG178.
APA Clinical Guidelines. American Psychiatric Association. Practice Guidelines for the treatment of patients with schizophrenia. 2004.
Hasan et al. World J Biol Psychiatry 2012; 13: 318─378.
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