Fedhealth Medical Scheme
Just interested in the bottom line

Please assist! I have a chronic condition which requires monthly infusions. This disease is a PMB so it should be covered 100% but it isnt (another story for another day).
The medication I receive (Polygam) gives me the most terrible side effects, causing migraines that last a week, kidney stones, kidney infections, aseptic meningitis to name a few.
Recently a new medication has become available in South Africa (Octagam) which studies have shown reduce the side effects as well as are more effective for immune deficiencies (still struggling to get my Igg levels up to a normal level after 2 years). We applied this month to have this medication authorised and it was declined because the new medication is more expensive. Without even looking into the side effects etc. How expensive are my hospital visits with kidney infections? A weeks worth of pain killers? Kidney stones and more? What about whats best for the patient? It feels like fedhealth didnt even look into my personal file but just looked at the bottom line before declining medication. What are my next steps?

Company: Fedhealth Medical Scheme
Country: South Africa
City: Jhb

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