Chronic medicine claims may be short paid or rejected for a number of reasons.

The most common reasons for a short payment:

1. Voluntary use of a non-DSP (non-designated service provider)—this is when you elect to make use of a pharmacy that is not included in your Fund’s list of contracted pharmacies
2. Voluntary use of a medicine that is not included in the medicine formulary
3. Voluntary use of a medicine when there is a cost effective generic available. Please do not hesitate to speak to your pharmacist regarding alternatives.

The most common reasons for a claim being rejected:

1. Not obtaining chronic authorisation for a medicine
2. Depletion of benefit limits (not applicable to approved PMB medicines)
3. Claiming for chronic medications within 21 days without prior approval