| Prescribed Minimum Benefit Chronic Disease List (CDL) conditions | Further information or tests required |
| Addison’s disease | Diagnosis by a specialist physician, paediatrician or endocrinologist |
| Asthma (adult) | Diagnosis confirmed by a GP or specialist |
| Asthma (child <7 years) | Diagnosis made or confirmed by a specialist paediatrician |
| Bipolar affective disorder | Psychiatrist prescription. Benzodiazepines excluded on Chronic Benefit |
| Bronchiectasis | Diagnosis confirmed by a specialist (entry criteria for pre-existing conditions will apply eg COPD) |
| Cardiac failure | Diagnosis confirmed by a specialist physician |
| Cardiac dysrhythmia | Diagnosis confirmed by a specialist physician |
| Cardiomyopathy | Diagnosis confirmed by a specialist physician |
| Chronic obstructive pulmonary disease | Diagnosis confirmed by a GP or specialist. Emailed copy of Lung function test performed to American Thoracic Society (or similar) criteria demonstrating FEV1/FVC<70% and FEV1 post bronchodilator <70% of predicted |
| Chronic renal disease | Diagnosis confirmed by a GP or specialist. Copy of lab results required: serum creatinine clearance value <30ml/min or a Glomerular Filtration Rate estimate of <30ml/min |
| Coronary artery disease | Diagnosis confirmed by a specialist physician |
| Crohn’s disease | Diagnosis by a specialist physician, paediatrician, surgeon or gastroenterologist |
| Diabetes insipidus | Diagnosis by a specialist physician, paediatrician, neurologist, neurosurgeon or endocrinologist |
| Diabetes mellitus type 2 | Diagnosis confirmed by a GP or specialist physician. Confirmatory lab results: - HbA1c >6% or
- x2 random glucose >11mmol/l or
- x2 fasting blood >7mmol/l or
- x1 blood glucose >I5mmol/l or
- GTT (fasting glucose of 7mmol/l or more and/or 2 hours post prandial glucose load of 11.1mmol/l or more)
|
| Diabetes mellitus type 1 | Specialist initiation and confirmatory lab results as above |
| Epilepsy | Diagnosis confirmed by a GP, specialist physician, neurologist or neurosurgeon |
| Glaucoma | Diagnosis confirmed by an ophthalmologist |
| Haemophilia | Diagnosis confirmed by a specialist physician. Copy of lab results of Factor VIII or Factor IX levels of 5% or less |
| Hyperlipidaemia | Diagnosis confirmed by a GP or specialist physician. Copy of lipogram results and documentation related to the risk assessment (Framingham Risk Score). Details of patient history: established vascular disease and details of any procedure performed eg angioplasty, stent, etc. Details of family history from prescribing doctor (to include details of cardiovascular events in member’s first degree relatives, including age of onset) |
| Hypertension | Diagnosis by a GP or specialist physician |
| Hypothyroidism | Diagnosis confirmed by a GP or specialist and thyroid function test (e.g. TSH,Free T4) |
| Multiple sclerosis | Diagnosis confirmed by a specialist physician or neurologist. Initial application must be accompanied by a motivation which details disease progress, the EDSS score and an MRI report. |
| Parkinson’s disease | Diagnosis confirmed by a neurologist |
| Rheumatoid arthritis | Diagnosis confirmed by GP and a tick sheet to be completed, or diagnosis confirmed by a specialist physician, paediatrician or rheumatologist. We also require the following clinical information: Serum rheumatoid factor (RF), anti-CCP, ESR or C-reactive protein (CRP) and relevant x-rays |
| Schizophrenia | Diagnosis confirmed by a psychiatrist or paediatric psychiatrist |
| Systemic lupus erythematosus | Diagnosis by a specialist physician, paediatrician or rheumatologist |
| Ulcerative colitis | Diagnosis by a specialist physician, surgeon or gastroenterologist |
