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I am not responding to meds, on high end of moderate disease activity. Been approved by SAARA for biologics. Have any gone the Council of medical scheme route to assist in getting treatment paid for?

June 28, 2025
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myRAteam

While the search results don't contain specific information about South African medical aid coverage, here are some general tips for getting biologics coverage:

1. Speak with your rheumatologist about your financial concerns and ask them to help advocate for coverage
2. Contact your medical scheme directly to understand
- Show Full Answer

While the search results don't contain specific information about South African medical aid coverage, here are some general tips for getting biologics coverage:

1. Speak with your rheumatologist about your financial concerns and ask them to help advocate for coverage
2. Contact your medical scheme directly to understand:
- What biologics are covered under your plan
- Prior authorization requirements
- Any special applications needed for biologics coverage
- Available copay assistance programs

Remember that biologics can cost up to $6,000 per year even with insurance, so it's important to explore all coverage options. If coverage through your medical scheme is limited, consider these additional steps:

1. Check if the biologic manufacturer offers a patient assistance program (PAP)
2. Look into government assistance programs if you qualify
3. Ask your doctor about more affordable alternative medications that may be covered
4. Connect with other myRAteam members from South Africa who may have experience navigating this system

June 28, 2025

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