Invitation to participate in the GEMS Medicine Provider Network

The Government Employees Medical Scheme (GEMS) recently announced that it would be making changes to its chronic medicine provisioning structure. A brief overview of the changes was communicated to pharmacy stakeholders.

GEMS was established in 2005 to provide public service employees and pensioners with equitable access to comprehensive and affordable healthcare benefits. Since its registration, the Scheme has grown at an unprecedented pace to become South Africa's largest restricted medical scheme. GEMS now has well over 660 000 principal members and around 1.8 million beneficiaries, with over 348 000 beneficiaries currently registered on the Scheme's managed care programmes and making use of chronic medicine. The Scheme continuously strives to expand its network reach to members through the provision of additional servicing points in conjunction with healthcare service providers.

With the aim of sustaining member value and excellence, GEMS is establishing a Medicine Provider Network (MPN) through which medicine provisioning will be expanded for beneficiaries that are registered on the various Scheme programmes. To this end, the Scheme's procurement exercise of key operational services undertaken earlier this year took cognisance of this envisaged change.

The Scheme hereby informs you that the implementation of the operational changes to support the expanded medicine provisioning structure is underway, with a great deal of work being performed by all of our operational service providers. The Scheme is implementing the roll out of the MPN with this invitation. The enrolment of participating pharmacies will be implemented without delay to ensure that wider access is available to beneficiaries in 2013.

To assist GEMS in making this transition as efficient as possible with minimum disruption of healthcare services for its members, kindly be advised that participation will be limited to pharmacies that are contracted and registered on the GEMS Medicine Provider Network (acute and chronic):

• This letter serves as an invitation to the pharmacy industry to participate in the enrolment exercise for those entities willing to participate.
  
  
• An application, receipt and registration process has been put in place to provide for participation on either the acute and/or chronic elements of the MPN.
  
  
• Click here for an application form.
  
  
• Upon receipt of the completed application form, pharmacy information will be captured on the GEMS database and assessed against the applicable criteria and existing claims profile of each applying pharmacy.
  
  
• Preliminary acceptance will be communicated to each pharmacy subject to the signing and acceptance of the applicable MPN agreement and addendum.
  
  
• Confirmation of registration and effective date of claiming will be communicated upon the Scheme's receipt of a signed agreement by participating pharmacies.

Access by beneficiaries during the transition period will require authorisation by the Scheme and a new claim period linked to your pharmacy with the effective date for each patient.

Enrolling pharmacies with any questions, queries or comments are encouraged to contact GEMS Chronic Medicine Management on the following contact details:

• Call Centre: 0860 00 4367
• Fax number: 0861 00 4367
• Email: [email protected] 
• Postal address: GEMS, Private Bag X782, Cape Town, 8000

Please be advised that the dedicated contact centre will be active with effect from Wednesday, 2 January 2013 to handle all MPN-related questions, queries or comments.

Through this roll out exercise GEMS is committed to ensuring that the care rendered to our members is accessible, cost-effective, clinically appropriate and excellent. Participation by pharmacies in this enrolment process is encouraged.

As GEMS implements these changes, communication to all beneficiaries is being undertaken to inform of and explain the applicable requirements as well as process changes.

Please note that the GEMS rules, tariffs, clinical protocols and benefits entitlements will continue to apply and these may result in a different outcome with regard to the application handling and processing of requests.

Click here for a summary of the Scheme's 2013 Chronic Medicine Provisioning Structure. The document highlights the operational environment and requirements for the roll out of the 2013 chronic medicine structure.