1 reviews | Active since Feb 2024
Bestmed will not assist until I am terminal
I received correspondence from Bestmed refusing to put the Trelegy onto Chronic, with the reason: Only Funded As Last Line Treatment. May I ask who the specialist pulmonologist at Bestmed is? Or why Bestmed seems to know better than my specialist pulmonologist?
The Trelegy has been motivated by Dr Shar. Many motivations and forms have now been submitted. Why is my doctor's treatment being declined? Does your specialist pulmonologist have a better treatment plan?
Am I supposed to deteriorate more before treatment for this PMB is considered? I am already at stage 3 COPD. Would you prefer me at a terminal/end of life state before considering the specialist pulmonologist treatment (and motivation for this treatment)?
Please explain in detail the funding criteria for Trelegy Ellipta and provide guidance on the next steps to be treated for the PMB condition, including the rehabilitation as well as the oxygen and related benefits.
Please ensure that your reponse is clear, citing the relevant documentation and guildelines used.
Please also advise on the outcome of the pulmonologists' motivations as well.
Please see the NUMEROUS documents sent, including but not limited to: PMB form, Motivation for Trelegy and oxygen treatment, motivation for pulmonary rehabilitation, lung function tests (for motivation), Chronic script by Pulmonologist, Motivation for pulmonary rehabilitation, script for oxygen cylinder & ABG Emailed to Bestmed on ***
Would you prefer I am terminal before considering the healthcare professionals' advice?
Dear Genevieve Pawlik
Thank you for bringing your concerns to our attention.
We sincerely regret the frustration and distress caused by the outcome of the application for funding of Trelegy and the difficulties you have experienced in obtaining clarity regarding your COPD-related benefits and treatment requests.
Please be advised that your concerns regarding the declined Trelegy application have been escalated to our Medicines Management Department for a comprehensive review and investigation.
As part of this process, the department will review all relevant documentation received, including any specialist motivations and clinical information in support of your application. Once the investigation has been concluded, detailed feedback regarding the funding decision and any applicable benefit criteria will be communicated to the member's email address registered on our record directly.
We kindly request your patience while this investigation is underway. Please allow approximately 3 to 5 working days for the review to be completed and for feedback to be provided.
We understand the importance of receiving timely assistance in relation to your healthcare needs and apologise for the concern this matter has caused. We appreciate the opportunity to investigate your query thoroughly and ensure that all relevant information is considered.
Kind regards
Bestmed Member Services Team
Dear Genevieve Pawlik
Thank you for bringing your concerns to our attention.
We sincerely regret the frustration and distress caused by the outcome of the application for funding of Trelegy and the difficulties you have experienced in obtaining clarity regarding your COPD-related benefits and treatment requests.
Please be advised that your concerns regarding the declined Trelegy application have been escalated to our Medicines Management Department for a comprehensive review and investigation.
As part of this process, the department will review all relevant documentation received, including any specialist motivations and clinical information in support of your application. Once the investigation has been concluded, detailed feedback regarding the funding decision and any applicable benefit criteria will be communicated to the member's email address registered on our record directly.
We kindly request your patience while this investigation is underway. Please allow approximately 3 to 5 working days for the review to be completed and for feedback to be provided.
We understand the importance of receiving timely assistance in relation to your healthcare needs and apologise for the concern this matter has caused. We appreciate the opportunity to investigate your query thoroughly and ensure that all relevant information is considered.
Kind regards
Bestmed Member Services Team