Discovery Health
Chronic Illness Benefit application

I am a member of discovery health. My wife applied for the chronic illness benefits. She received confirmation, in the form of a letter, giving the medical aid no & the specific plan. It then states which medication was approved, and the amounts covered by the medical aid. However, there was an issue with 1 particular medication, namely, Abilify 10 mg. With regard to this medication, the letter states, and I quote, " As this medication is not listed on the medicine list (formulary) we will cover it up to the monthly chronic drug amount of R 1100." After have gone to the pharmacy with her prescription, it was said that the medical aid only covers about 50% of the amount for the Abilify, but the letter states otherwise, as the price of the abilify is approximately R 1100. The situation was a bit embarrassing having argued with the pharmicist. After having phoned Discovery, it was said that they only cover up to an amount of R 450 for the Abilify 10mg, with the letter clearly stating that, after reviewing the application, that they will cover up to an amount of R 1100 for the Abilify 10mg. It means that she is not able to get the medication, having to fork out R 650 every month?

Company: Discovery Health
Country: South Africa
City: Cape Town

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