Every registered scheme in South Africa must cover the 27 chronic conditions on the Chronic Disease List (CDL) — but the medicines, dispensing pharmacy and approval process differ by plan.
The CDL covers 27 conditions including hypertension, diabetes, asthma, epilepsy, HIV, depression, cardiac failure and chronic kidney disease. Schemes may cover more, but never less.
Usually because the prescribed medicine is outside the scheme's formulary, or you're not using a Designated Service Provider pharmacy.