• You do not need to complete forms or email us any documents to register new chronic conditions or update any existing ones unless your condition requires additional information, in which case we will let you know. You, your doctor, or your pharmacist can telephonically register or update any existing conditions immediately. Please call 0860 00 4367.
• For script renewal purposes, you, your doctor, or pharmacist can email chronicdsp@gems.gov.za or call the Chronic Medicine Management team on 0860 00 4367.
• Alternatively, your treating doctor may complete the chronic medicine form which can be downloaded from the GEMS website. Please note that the turnaround time for a paper-based application is five working days.
• A separate form must be completed for each member or dependant who needs chronic medicine.
• You only need to complete this application form once you have registered for the Chronic Medicine Programme.
• You will need to send us a new prescription every six months to ensure that you always receive your chronic medication.
• You do not need to send a new application form if your doctor changes your chronic medicine; however, we will need the new prescription.
• Email the completed form and repeatable doctor's prescription to chronicdsp@gems.gov.za.
• We will review your application and check it against the Scheme Rules to see if we can cover the medicine from your chronic medicine benefit.
• If we approve your application, you will receive a Medicine Access Chart, listing the medicine we have agreed to pay for from your chronic medicine benefit.
• If the medicine that we have agreed to pay for differs from the medicine your doctor has prescribed, we will attach a letter to your Medicine Access Chart that will explain the reasons for this.
• We will also send a copy of the letter to the doctor who prescribed the medicine.
• If we do not approve your application for chronic medicine, you and your doctor will both receive a letter explaining this decision.

Does GEMS pay for all chronic medicine prescribed by doctors?

GEMS will pay for chronic medicine prescribed according to the Scheme's clinical guidelines. This means that even if we cover a condition, we may NOT pay for all requested medicines from your chronic medicine benefit if it is not in line with the clinical guidelines.

Only diseases listed on the Chronic Disease List (CDL), as it appears in the Medical Schemes Act, and the Additional Chronic Disease List (ACDL) for each option qualify for chronic medicine benefits. Prescribed medicine not on the CDL or ACDL lists will be paid from your acute medicine benefit.

For more information, please read the Chronic Medicine Guide on the GEMS website (click on For Individuals > Member Guides) or call us on 0860 00 4367. You may also e-mail chronicdsp@gems.gov.za outlining the information you require.