Understanding Juvenile Idiopathic Arthritis and Its Coverage Under Medical Schemes in South Africa

By Staff Writer

September 4, 2023

Juvenile Idiopathic Arthritis (JIA) is an autoimmune disease where the body’s immune system mistakenly attacks its own healthy cells and tissues, leading to inflammation in the joint membrane or the synovial membrane. This condition is the most prevalent type of arthritis in children under the age of 16.

JIA is included in the Chronic Disease List (CDL) of the Prescribed Minimum Benefit (PMB) regulations under Rheumatoid Arthritis in South Africa. This means that medical schemes are obligated to fully fund the diagnosis, treatment, and care costs of this condition, according to the Council for Medical Schemes (CMS). However, the treatment guidelines for JIA reference the algorithm for Rheumatoid Arthritis for adults, which can differ significantly from the needs of children with JIA.

With JIA, an alternative paediatric clinical management protocol must be included within this benefit if it is supported by evidence-based medicine, considering cost-effectiveness and affordability. Sources to use include the American Academy of Orthopaedic Surgeons, Arthritis Kids South Africa, Johns Hopkins Medicine, Mayo Clinic, Medline Plus and National Institutes of Health.

Medical schemes may use medicine formularies – a list of specific medicine for the treatment of the condition. Therefore, it’s crucial to check with the medical scheme which medicines are included in the medicine formularies to avoid a co-payment on the chronic medication. If a member or beneficiary of a medical scheme chooses to use medicines not on the formulary, a co-payment on the treatment may be applied. This update from the CMS does not include specific information regarding the use of biologics in JIA.

Medical schemes are also allowed to put in place baskets of care that allow for a specific number of consultations, blood tests and other tests to monitor the condition. However, when care outside of the normal basket is required, the medical scheme cannot completely refuse to fund it. The treating doctor should send a letter of motivation to the medical scheme indicating the required care and the reasons. If clinically appropriate, the medical scheme must fund it as PMB.

Reference url

Recent Posts

Novartis patent cliff layoffs
     

Engineering Resilience: Mastering Pharma Patent Expiration Strategy

🚨 Are you still reacting to pharmaceutical patent expirations with layoffs and litigation, or are you ready to engineer a strategy that turns the patent cliff into your next competitive edge?

Patent expirations don’t have to derail your pharma portfolio. Learn how to outmaneuver generics and transform challenges into advantages. Dive into our latest insights and take control today.

#SyenzaNews #pharmaceuticals #innovation #PharmaStrategy #patentcliffs

diabetes medicine access
               

Improving Diabetes Medicine Access: Key Changes in the Pharmaceutical Benefits Scheme

🚀 Are we on the verge of a breakthrough in diabetes medication accessibility?

The latest updates to the Pharmaceutical Benefits Scheme (PBS) are set to transform type 2 diabetes management by expanding access to essential medicines like empagliflozin and streamlining the prescribing process for glucagon-like peptide 1 receptor agonists (GLP-1 RAs). These changes not only prioritize equity for high-risk populations but also align with global trends in cost-effective healthcare.

Dive deeper into how these revisions could reshape diabetes care and promote better health outcomes for all.

#SyenzaNews #HealthcareInnovation #healthcare #MarketAccess

HPV testing HNSCC
    

HPV Testing in Head and Neck Squamous Cell Carcinoma

🔍 Are you up-to-date with the latest advancements in HPV testing for head and neck cancer?

Our comprehensive article looks into the innovation of diagnostic methods for HPV status determination in head and neck squamous cell carcinoma (HNSCC). From traditional p16 immunohistochemistry to innovative liquid biopsies, discover the critical role these advancements play in prognosis, treatment planning, and improving patient outcomes.

Look into this essential topic and see how these insights could revolutionize clinical practices.

#SyenzaNews #oncology #HealthTech #HealthcareInnovation

When you partner with Syenza, it’s like a Nuclear Fusion.

Our expertise are combined with yours, and we contribute clinical expertise and advanced degrees in health policy, health economics, systems analysis, public finance, business, and project management. You’ll also feel our high-impact global and local perspectives with cultural intelligence.

SPEAK WITH US

CORRESPONDENCE ADDRESS

1950 W. Corporate Way, Suite 95478
Anaheim, CA 92801, USA

© 2025 Syenza™. All rights reserved.