Medical Schemes Act, 1998 (Act No. 131 of 1998)RegulationsRegulations in terms of the Medical Schemes ActChapter 5 : Provision of managed health care15I. 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. |