Chronic medication (CDL) application letter template

The CMS says PMBs include 26 chronic conditions in the Chronic Disease List. A CMS slide dated 17 August 2026 says 27, the regulations copy on the CMS site names 25, and one 2026 scheme guide counts 27 including HIV. We could not reconcile these, so ask your scheme for its current list.

The conditions named in the regulations copy include asthma, bipolar mood disorder, cardiac failure, chronic renal disease, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus types 1 and 2, epilepsy, glaucoma, hyperlipidaemia, hypertension, hypothyroidism, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, schizophrenia and ulcerative colitis. Many schemes also cover other chronic conditions on some plans, but that is a plan benefit, not a legal guarantee. See the chronic disease benefits guide.

Ask your doctor to confirm the clinical details.

[Your full name]
[ID number]
[Membership number]
[Cellphone] | [Email]
[Date]

To: The Chronic Medicine Department
[Scheme name]

Subject: Chronic medication application - membership number [MEMBERSHIP NUMBER]

Dear Sir or Madam

I apply to register a chronic condition for medicine cover.

Patient: [NAME AND DEPENDANT CODE]
Condition: [CONDITION, FOR EXAMPLE HYPERTENSION]
ICD-10 code: [ICD-10 CODE]
Date of diagnosis: [DATE]
Treating doctor: [NAME AND PRACTICE NUMBER]

Medicine prescribed (one line each):
[MEDICINE NAME, STRENGTH, DOSAGE AND ITEM CODE]

The attached script and motivation support this application. If this condition is on the [Chronic Disease List](/guides/chronic-disease-benefits/), please fund it as a prescribed minimum benefit, in full and without a co-payment.

Please confirm in writing:
1. That the condition is registered, and from what date.
2. Which formulary medicine and which pharmacy or courier I must use.
3. The reference number and when the approval must be renewed.

Yours faithfully
[Full name]
[Signature]

Doctor's confirmation: [DOCTOR'S NAME, SIGNATURE AND PRACTICE NUMBER]

• The doctor's script, with the medicine, strength and dosage.
• A short doctor's report with the diagnosis and ICD-10 code. Ask the doctor to add test results if the scheme's protocol needs them.
• If the doctor has chosen a non-formulary medicine, a motivation explaining why the formulary option is not suitable.
• Your membership number and dependant code on each page.

Email it to the chronic medicine address on your scheme's website, or upload it through the app or portal, and ask for a reference number. Save the sent email or confirmation screen. If the doctor's rooms send the application for you, ask for a copy and check with the scheme that it arrived.

After any phone call, write down the name, date and reference.

The regulations let a scheme use pre-authorisation, treatment protocols and formularies for PMBs. Refusing a formulary drug can lead to a co-payment. If your doctor believes the formulary drug does not suit you, ask for a motivation to be reviewed in writing.

A co-payment can also be charged if you use a non-DSP provider by choice, but not if the use was involuntary, for example when the DSP could not provide the service without unreasonable delay or there was no DSP within reasonable reach of your home or work. See designated service providers.

If your approved medicine is coming off your savings, ask the scheme why. Do not assume it is correct. The savings account letter covers that query.

We found no national deadline for a scheme to approve a chronic application, so ask for a reply date in your letter and follow up in writing. Ask when the registration must be renewed and what you must send if the dose or medicine changes.

Waiting periods may apply if you have just joined. After a gap of 90 days or more, a scheme may impose a condition-specific waiting period of up to 12 months. Shorter gaps are treated differently, and PMB treatment is carved out of those. See the waiting periods guide.

If you move scheme, register again with the new scheme. Use the switching letter for the certificate. If the application is refused, get the reason in writing and use the appeal letter. The PMB letter covers the wider rules.

• Sending a script with no diagnosis or ICD-10 code.
• Waiting until the medicine has been paid from savings before applying.
• Not asking which pharmacy and formulary apply.
• Missing the renewal, so the registration lapses.
• Treating a plan's extra chronic conditions as if they were legal PMBs.