Cancer patient wins battle against medical scheme
A medical doctor's fight to get the Government Employees Medical Scheme (Gems) to pay for his cancer treatment has ended in victory after the company agreed to cover it, reports SowetanLIVE. Gems reviewed Dr Sipho Bvuma's application for it to pay for an expensive drug called Keytruda to treat his stage four cancer.
The Sowetan previously reported that Bvuma took the scheme to court after it refused to pay on the basis that the drug was not registered to treat his condition. 'The applicant's condition, unfortunately has reached an advanced stage and the cost of the treatment is not justified under the circumstances. ... Gems cannot pay for treatment that will not achieve the desired result of saving the patient's life,' it stated.
However, yesterday Bvuma's family and Gems confirmed that the company had approved the request after it was reviewed by an independent panel of oncologists.
Gems chief operations officer Dr Stan Moloabi said the decision to grant his request followed an urgent ex gratia process.
The company had previously argued in court papers that paying for the treatment, which could cost R583 000, would not be viable in Bvuma's case, as Keytruda was not registered in SA to treat his condition, and there was no scientific evidence that it could save his life.
Moloabi said the independent oncology panel had come to a different conclusion.
'On review of the funding decision, a panel of independent oncology experts recommended that this specific treatment, although not registered locally for this indication at this stage, can potentially benefit the member.'
'As a healthcare funder, Gems has a duty to exercise caution and circumspection with regard to treatment options that are not registered locally for a specific medical condition,' Moloabi said.
© Juta and Company (Pty) Ltd 2016
Article disclaimer: Juta expressly reserves the right, in its sole and absolute discretion, to alter or amend any criteria or information set out in this article without notice. Accordingly, any information, including journalistic articles, are not intended to constitute legal, financial, accounting, tax, investment, consulting or other professional advice or services. Before making any decision or taking any action based on the information contained in this article, which decision or action might affect your personal finances or business, you should consult a qualified professional advisor.