Prescribed Medicine

Prescribed medicine is normally taken when your condition is acute and will clear up within a short space of time, such as when you have influenza.

Over-the-counter medicine (OTC)

Schedule 0 - 2 medicine, whether prescribed or not, is also known as over-the-counter medicine. We will only pay for medicine bought over-the-counter if you have available funds in your Medical Savings Account.

We will only pay for acute or over-the-counter medicine if:

  • It is prescribed by a registered healthcare provider with a valid practice number, in the case of acute medicine.
  • You get the medicine from a registered healthcare provider with a valid practice number;
  • The claim displays a valid ICD-10 and medicine dispensing code.

How prescribed medicine is paid out on the LA Health Benefit options

 

Benefit OptionCover for Prescribed Medicine 
LA ComprehensivePaid at 100% of the LA Health Medicine Rate from the Medical Savings Account and the Above Threshold Benefit, subject to available funds and the applicable limits for medication that is on the Scheme's list of Preferred medicine. Cover is at 90% of the LA Health Medicine Rate if medication is used that is not on the Preferred list of medication. Please refer to your benefit brochure for the applicable limits.
LA CorePaid at 100% of the LA Health Medicine Rate from the Medical Savings Account and the Extended Day-to-Day Benefit, subject to available funds and limits. Cover is at 90% of the LA Health Medicine Rate if medication is used that is not on the Preferred list of medication.
LA ActivePaid at 100% of the LA Health Medicine Rate from the Medical Savings Account and the Extended Day-to-Day Benefit, subject to available funds and limits. Cover is at 90% of the LA Health Medicine Rate if medication is used that is not on the Preferred list of medication.
LA FocusPaid at 100% of the LA Health Medicine Rate from the Medical Savings Account, subject to available funds and limits. Cover is at 90% of the LA Health Medicine Rate if medication is used that is not on the Preferred list of medication.
LA KeyPlusOnly covers acute and non-PMB chronic conditions subject to a formulary when the medicine is prescribed by the member’s chosen General Practitioner (doctor) working in the KeyCare provider network.