We are fighting a loosing battle.
The insured is on the Classic Comprehensive Plan.
Which as two benefits relating to Prescribed Medication.
One is their insured benefit network,
Which clearly states that if a generic is used for schedule 3 and above at a pharmacy in the discovery network they will pay up to the discovery rate limit when MSA is depleted.
The second is the Prescribed medicine Benefit.
Now this has a limit of R18600 on this plan, and is only currently at R 2, 547.36 which means there is another R 16, 052.64
Discovery keeps saying the MSA is depleted and there are no funds available sorry.
This is not acceptable?
How can they clearly state these as benefits and not accept this?
The medicine is for Levofloxacin-Wintrop 500, which is Schedule 4.
Their call center tells me its not a generic, yet on their website using the medicine finder it is listed as a generic.
And the pharmacy states it is a generic.
How can from two Benefits on the Second highest Plan for discovery, can they not pay for the medication?
This forced the insured to buy with cash, but the Medical Aid wont compensate, as these are antibiotics which could not have been stopped.
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