ST
Storm T

1 reviews | Active since May 2016

25 Jul 2017, 11:45

Refuse's to approve meds even after DR motivation

<p>I have Relapsing Remitting Multiple Sclerosis. I have been on the Betaferon injection for 3 years. I have requested my doctor that I stop taking it as I cannot handle the marks and pain anymore, so he told me I cannot stop as I will relapse. There is a tablet form (Aubagio) of the medication I can take though. I have sent everything through and he has filled in all the paperwork and motivation for me as well. We submitted it to Medshield and now they have declined it because it is not on their medicines list. I sent them another email explining to them that the medication is specifically for MS patient ls and has been approved on the South African Medicones Council. Still they come back to me and say it's still declined as it's not on their list. The betaferon was also not on theit list so they do make exceptions. I'm not asking for both, I'm asking for a replacement. I am sick and tired of fighting for **** for a condition I did not ask for, for a condition there is no dam cure for. Yet my neurologist must try and motivate something that they; who have no idea how I feel on a daily basis or what I go through on a daily basis; just decline's anyway because they look at some stupid list which hasn't been updated in ages. It's always a fight! A battle! It's so infuriating! </p>

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Replies (5)
Medshield
Medshield's reply25 Jul 2017, 11:53
Official

Good day,

Medshield Medical Scheme has acknowledged your complaint and is currently investigating.

Kindly note that your concerns have been prioritised and feedback will be provided within 5 working days.

Yours sincerely,

Medshield

Medshield
Medshield's reply31 Jul 2017, 11:20
Official

Good day,

Medshield Medical Scheme has acknowledged your complaint and would like to thank you for bringing your concerns to our attention.

Upon receipt of the complaint the Scheme liaised with Chronic Medicine Management (CMM) and can confirm the following:

The request for Aubagio was reviewed by the Scheme's Medical Advisor. However the funding decision remains unchanged. Aubagio is not supported for funding off the chronic medicine benefit. The drug is not in the government algorithm, nor is it available in State and therefore not considered to be PMB level of care.

A detailed email reference the above will be send to your email address: ***

We trust you find the above in order.

Yours sincerely,

Karin Binstead

Medshield Medical Scheme

ST
Storm T's update31 Jul 2017, 11:31
Reviewer Update

Good Day Karin

On Friday, a lady from Medscheme called me and spoke to me regarding the medications for MS patients and said she would call me back today. Fair enough the Aubagio is not approved BUT there ha's to be an alternative medication for MS patients in tablet form than injecting ourselves!

I have been injecting myself for 3 years, every second day and honestly my body and mind cannot take it anymore. So my doctor has requested the alternative which was the Aubagio but if there is something else then please state so! I know of the Copaxone but once again, it's an injection.

Kindly advise an alater native!

Thank's

Storm Tolmay

ST
Storm T's update31 Jul 2017, 11:33
Reviewer Update

Good Day Karin

On Friday, a lady from Medscheme called me and spoke to me regarding the medications for MS patients and said she would call me back today. Fair enough the Aubagio is not approved BUT there ha's to be an alternative medication for MS patients in tablet form than injecting ourselves!

I have been injecting myself for 3 years, every second day and honestly my body and mind cannot take it anymore. So my doctor has requested the alternative which was the Aubagio but if there is something else then please state so! I know of the Copaxone but once again, it's an injection.

Kindly advise an alternative!

Thank's

Storm Tolmay

Medshield
Medshield's reply31 Jul 2017, 11:38
Official

Good day,

We have requested that a representative of CMM contact yourself urgently to discuss the alternative medication.

Kind regards,

Karin Binstead

Medshield Medical Scheme