Essential Med Complaint
 SUPPLIER |
Essential Med |
 INDUSTRY |
Insurance |
| BRANCH / AREA | CHRONIC MEDICATION | COUNTRY | South Africa |
| TIME / DATE | 15:45 Sun 11 Sep | PERSON RESPONSIBLE | ESSENTIAL MED |
| CUSTOMER | wlk | View all reports by user |
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5
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| PROBLEM | REJECTION OF CHRONIC M... |
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| INCIDENT | Sun 11 Sep | ||
| HEADLINE | REJECTION OF CHRONIC MEDICATION |
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I was diagnosed with extremely high cholesterol levels approx two years back . My cholesterol level untreated with medication was almost 11. I was given Simvastatin 40mg which together with a low fat lifestyle program I needed to follow. My cholersterol level improved significantly and lowered to about 6. I have been paying for my own medication up to now although I have been a member of Essentialmed for some time. I had to move to one of the network GP's and requested that Symvastatin 40 mg be listed as chronic medication. I was informed that Essential Med rejected the approval of Symvastatin 40mg as chronic medication a recommendation of a lifestyle program was given as a reason. ESSENTIAL MED I AM ALREADY FOLLOWING A LIFESTYLE PROGRAM, WITHOUT SYMVASTATIN 40MG TREATMENT MY CHOLESTEROL JUST INCREASES AGAIN. A LIFESTYLE PROGRAM IS NOT EFFECTIVE ON ITS OWN. Symvastatin costs only approx R 40.50 yet you decide to reject Symvastation. I am currently investigating other options for a medical aid.. You cannot be trusted to make informed decisions about medication. My request for the chronic medication was also supported with a Lipogram |
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| SUPPLIER'S RESPONSE | Essential Med | Time and Date | 11:56:50 | Thu 15 Sep 11 |
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Hello wlk, As chronic medication is typically taken over a period of several months with some medications having associated side effects, our in-house medical advisor evaluates carefully each application to ensure that the treatment is both the best option and indeed necessary. Your request of 26 August was for two medicines, one of which was approved and will be couriered to you monthly. The request for the lipid lowering medication was however declined for two reasons: 1- it did not meet the minimum criteria for authorisation (a Framingham Score of 6%) and 2- we believe that your condition may be adequately managed with a lifestyle programme. We have noted your remarks about you already being on a lifestyle programme and will gladly reassess your application should your doctor be willing to provide us with a detailed motivation as to why this particular medication is being prescribed. One of our client service consultants will contact you shortly to assist with this process. Kind regards Lee Rodgers Operations manager |
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