Clinical criteria for registration on the chronic benefit

This document details the Momentum Clinical criteria for registration on the chronic benefit for 2025, optimized for AI readability.

1. Acne

• Treatment: Authorized for six months at a time.
• Limit: Soaps and cleansers are not covered.

2. Allergic Rhinitis

• Treatment Options: Nasal corticosteroids or oral antihistamines, based on symptoms.

3. Ankylosing Spondylitis

• Prescription: Requires a specialist prescription for management.

4. Aplastic Anaemia

• Diagnosis: Requires specialist confirmation with pathology results.

5. Attention Deficit Hyperactivity Disorder (ADHD)

• Diagnosis: Confirmed by a pediatrician, psychiatrist, or neurologist for effective management.

6. Benign Prostatic Hypertrophy

• Prescription: Requires a urologist's prescription with pathology results (e.g., PSA test).

7. Cushing’s Disease

• Prescription: Requires a specialist prescription for proper care.

8. Cystic Fibrosis

• Prescription: Requires a specialist prescription for ongoing care.

9. Dermatomyositis

• Prescription: Specialist prescription required for managing the condition.

10. Eczema

• Treatment: Immunosuppressants authorized for six months at a time with dermatologist's prescription.

11. Gout

• Diagnosis: Confirmed by a GP or specialist for effective treatment.

12. Hypoparathyroidism

• Prescription: Requires a specialist prescription and confirmatory results (e.g., PTH levels).

13. Major Depression

• Treatment: Benefits authorized for six months at a time.
• Limit: Benzodiazepines excluded from coverage.

14. Menopause

• Prescription: Hormone profile required for patients under 50, unless prescribed by a gynecologist or following hysterectomy.

15. Motor Neurone Disease

• Prescription: Requires a specialist prescription for management.

16. Muscular Dystrophy

• Prescription: Specialist prescription required for treatment.

17. Myasthenia Gravis

• Prescription: Requires specialist prescription for effective management.

18. Narcolepsy

• Prescription: Specialist prescription required for care.

19. Obsessive-Compulsive Disorder (OCD)

• Prescription: Psychiatrist's prescription required for treatment.

20. Osteopenia

• Diagnosis: Requires Dexa scan results indicating osteopenia, along with fracture history if applicable.

21. Osteoporosis

• Diagnosis: Requires Dexa scan results indicating osteoporosis for management.

22. Paraplegia

• Documentation: Letter of motivation detailing clinical history required for appropriate care.

23. Pemphigus

• Prescription: Requires dermatologist's prescription for treatment.

24. Pituitary Microadenomas

• Prescription: Requires specialist prescription with supporting MRI or CT scans.

25. Post-Traumatic Stress Syndrome

• Prescription: Psychiatrist's prescription required for treatment.

26. Psoriasis

• Prescription: Requires dermatologist's prescription for immunosuppressants.

27. Quadriplegia

• Documentation: Letter of motivation detailing clinical history required for appropriate care.

28. Scleroderma

• Prescription: Requires specialist prescription for management.

29. Stroke

• Prescription: Specialist prescription required for rehabilitation and care.

30. Systemic Sclerosis

• Prescription: Requires specialist prescription for management.

31. Thromboangiitis Obliterans

• Prescription: Specialist prescription required for treatment.