Reference price is the maximum amount that the Scheme is willing to pay for drugs from a similar drug class listed on the Condition Medicine List for that condition. This reference price may differ on each benefit option.
Reference price is about patient choice. Medication priced above the reference price may be substituted with a clinically appropriate alternative product (a generic substitute), where applicable, that is less expensive and does not incur any additional out-of-pocket costs. However, if the member chooses to remain on the existing more expensive product when appropriate alternatives are available, a co-payment will apply.
Reference price is reviewed once a year. This review process considers all the new drug entries during the year, drug discontinuations, new enhancements, clinical literature, licensed indications, price changes, generic influence, patent expiry etc.
Please refer to MediKredit to determine the reference price of the medication currently used. If the medication displayed on the screen is above the reference price, the member will then be required to pay a co-payment at the point of dispensing.
The reference price is based on the cost of drugs from a similar drug class listed on the formulary to which no reference price applies. The patient is required to pay the difference between the cost of the drug and the reference price of the formulary drug at the point of dispensing.