MediKredit

What is MMAP®?

MMAP® (Maximum Medical Aid Price) is a reference price model that is wholly owned and maintained by MediKredit. MMAP® serves as a guide to determine the maximum medical scheme price that medical schemes will reimburse for an interchangeable multi-source pharmaceutical product.

*       1.What is an interchangeable multi-source pharmaceutical product?

*       2.Is MMAP® formulary based?

*       3.Is MMAP® a tender system?

*       4.Are any pharmaceutical products excluded from consideration for the MMAP® process?

*       5.How are MMAP® categories of products determined?

*       6.How often are the MMAP® categories and prices reviewed?

*       7.How is the Maximum Medical Aid Price determined?

*       8.Where can the latest MMAP® Listing be viewed?

*       9.How are the categories of pharmaceutical products listed?

*       10.How does MMAP® impact on the patient?

 

1. What is an interchangeable multi-source pharmaceutical product?

An interchangeable multi-source pharmaceutical product is a product that has exactly the same active ingredient/s and salt/s combination, strength of the active ingredient/s and dosage form (for example tablets versus capsules) as other pharmaceutical products that can be obtained from manufacturers or suppliers.

2. Is MMAP® formulary based?

No, it is not. A maximum price for a category of pharmaceutical products is determined, but MMAP® does not aim to stipulate the specific pharmaceutical product to be dispensed.

3. Is MMAP® a tender system?

No, it is not. All clinically appropriate pharmaceutical products are considered by the MediKredit Clinical Committee when determining MMAP®.

4. Are any pharmaceutical products excluded from consideration for the MMAP® process?

Products are excluded from the MMAP® listing if they are designated as non-substitutable by the South African Medicine Control Council (MCC), as well as substitutability data from international sources such as Australia, USA (FDA) and Europe.

5. How are MMAP® categories of products determined?

The MediKredit Clinical Committee reviews each potential and existing MMAP® category based on a series of inclusion and exclusion criteria. For example, MediKredit will take the severity of the indicated illness/condition/s into consideration and/or whether the treated conditions are acute or chronic. The individual MMAP® categories are defined by which pharmaceutical products can be regarded as being generically equivalent.

6. How often are the MMAP® categories and prices reviewed?

MMAP categories and prices are monitored throughout the year and updated accordingly as a result of:

·         Price changes of pharmaceutical products within an existing category; and/or

·         The launch of new pharmaceutical products that prompt the creation of new categories; and/or

·         The discontinuation of pharmaceutical products and/or withdrawal of pharmaceutical products within an existing category requiring the deletion of the category.

MMAP Listings are done annually. Manufacturers/suppliers of registered pharmaceutical products are invited to submit their products and approved SEP (Single Exit Price) for potential inclusion in the MMAP® Listing. Although not all manufacturers/suppliers elect to have their products listed on MMAP®, all available products within a specific category are taken into consideration when the MMAP price is determined.

 7. How is the Maximum Medical Aid Price determined?

Prices are determined to allow flexibility when selecting a pharmaceutical product. It is also important to note that the MMAP® price levels do not necessarily equate to the prices of any specific pharmaceutical product brands.

8. Where can the latest MMAP® Listing be viewed?

The most updated version of the MMAP® listing can be accessed from the download below.

9. How are the categories of pharmaceutical products listed?

The MMAP® listing is a numbered list of items sorted alphabetically by active ingredient with accompanying strength, dosage form and where appropriate, salt. Each individual category then lists pharmaceutical products that are available in such category in the event that the pharmaceutical manufacturer or supplier has agreed to listing. The maximum allowable price per pack size, inclusive of 14% VAT but exclusive of any professional or dispensing fees which may be chargeable at the point of dispensing, is indicated on the list.

10. How does MMAP® impact on the patient?

The doctor or pharmacy must charge the actual price of the brand supplied to the patient and not the MMAP® amount. The doctor or pharmacy is entitled by law to supply any alternative interchangeable multi-source pharmaceutical product (“generic substitution”) unless:

·         Specifically indicated otherwise by the prescribing doctor; or

·         Expressly forbidden by the patient to do so; or

·         If the price of the interchangeable multi-source pharmaceutical product is higher than that of the prescribed medicine.

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MMAP issue 53 - 4 September 2018
108kb
07|09|2018
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