Reference Pricing

Medicine formularies
A medicine formulary is a preferred list of prescription medicines that are reimbursed by the Fund for a specific chronic condition.


Reference pricing
Transmed applies reference pricing to the medicine formularies in order to support access to cost-effective medicines.


Reference pricing is a pricing model that groups together products that are generically or therapeutically equivalent into reference-pricing groups and sets a maximum reimbursement price for such a group of products.


If you obtain medicines that exceed the cost of the applicable reference price, you will be liable to pay the difference between the cost of the medicine and the reference price.


Below is further detail on the two reference pricing systems that Transmed applies:


Generic reference price (GRP)
GRP sets a maximum reimbursement price for a list of generically identical products (products that contains the same active ingredient at the same strength and in the same dosage form).


Therapeutic or formulary reference price (FRP)
FRP sets a maximum reimbursement price for a list of therapeutically equivalent (products that have the same therapeutic effect in the body).


For example:
In the event that an original brand name medicine (e.g. Panado®) has one or more generic alternatives available (e.g. Dolorol®, Painamol® and Adco-Paracetamol®), the generic reference pricing will be applied. Should you wish to use the original medicine (i.e. Panado®) or any other generic medicine that costs more than the GRP for this class, you will be liable for a co-payment (calculated as the difference in price between the generic and the original) at the point of sale. You are therefore encouraged to make use of generic medicines in order to prevent out-of-pocket expenses. Your pharmacist will be able to advise you on generic alternatives.


How to avoid Reference Pricing co-payments
Reference pricing co-payments can be avoided by using medicines that fall within the reference price. The use of such appropriate alternatives should be discussed with you doctor or pharmacist.


Please click here to view the reference pricing for the relevant Transmed plans.