For eight months, Yasoda Singh’s family prayed that she would live long enough to receive the life-saving drugs Discovery Health Medical Scheme had denied her.
Singh, 48, was diagnosed with an unusual combination of breast cancer and sarcoidosis (enlargement of lymph nodes) and required Ibrance, an expensive Section 21 drug, which is reputed to be best suited for her condition.
The Reservoir Hills woman eventually got her first a dose last week, but her family is worried that it might be a case of too little, too late for Yasoda.
Her husband Binesh, 49, said his wife’s condition deteriorated while the medical aid society “deliberately “dragged it heels”, and eventually agreed to supply Ibrance in November.
“Yasoda is bedridden and has no feeling from her waist downwards.
“It’s disappointing to note Discovery’s lack of respect for human life, as a medical provider, given the fact that cancer is a deadly disease that doesn’t go on holiday,” said Singh.”
He claimed that the medical aid scheme practised double standards because after the company approved Yasoda’s supply of Ibrance, he was informed that he would be required to pay R38000 each time a two-month dosage was supplied, which is approximately 50% of the cost.
Yet he was aware of other Discovery members, also with Ibrance prescriptions, who received between 80% to 100% cover; and only R192000 of his family’s annual R400000 oncology benefit was used to date.
However, Discovery chief executive Dr Jonathan Broomberg said his company had acted impartially and in accordance with its policies relating to unregistered (Section 21) drugs and clinical circumstances.
Section 21 drugs are medicines that are not registered for use in South Africa, but clearance for their usage can be obtained from the Medicines Control Council (MCC).
Singh said that through the assistance of Dr Lucille Heslop, Yasoda’s oncologist, the MCC granted approval of Ibrance, which is in tablet form.
“Dr Heslop asked me to write to Discovery to support the motivation she made for Ibrance in March. Since May, I’ve been emailing and calling the medical aid. I even spoke to some of their case managers, but they just kept ignoring me.”
Singh said that while he pleaded with the medical aid society for its approval, his wife’s condition worsened
“My wife has 47 lesions, predominantly around her spine and lungs, and it is spreading.”
Singh said she had tried various forms of treatment, which cost him hundreds of thousands of rand, but nothing had helped.
He said that when Discovery eventually issued him with a letter of approval in November, he learned that the drug would only be supplied eight weeks later.
“By my calculations, given the looming holiday season, the drugs would only arrive in February.
“I was not prepared to wait that long because I feared it cost would Yasoda her life,” he said.
Singh then, he has appealed to the manufacturers of Ibrance, Pfizer, and Southern RX, Discovery’s suppliers, to speed up the process based on his wife’s dire condition.
He was informed by both companies that he could receive the drugs in three weeks, provided he paid his portion of the cost (R38000).
Singh said that he was able to raise the cash for his wife’s first dose but he was concerned about affording future doses.
“The stubbornness of Discovery has taken a toll on my family. My wife said she’s not prepared to give up the fight. We’re pinning our hopes on the drug.”
“I’ve given Discovery all the information on why Ibrance is suited, according to her condition, but they came back asking silly questions.
“I think they have been dragging their heels because of the cost. The delay definitely worsened her condition,” said Dr Heslop.
Broomberg said Discovery only received the Singh’s Ibrance request on September11, which they declined a week later because it was an unregistered drug.
“Discovery rules prevent the funding of non-registered medicine except in a limited number of circumstances.
“The doctor (Heslop) submitted an appeal on October2 and on the basis of the information submitted, the Ibrance was due to be approved.
“However, on October 12 we received a request from the (doctor’s) rooms cancelling the treatment for Ibrance, and requesting different chemotherapy.
“The new chemotherapy approved was to be funded from the oncology benefit. This was the reason the approval for Ibrance was not communicated to the member,” he said.
Singh responded that Heslop had to order alternate intravenous chemotherapy because they still awaited the Ibrance approval.
Broomberg said that with Ibrance being an unregistered drug, their rules excluded complete cover for such medicine, and insisted that Singh was informed about the required 50% co- payment both in a letter and telephonically on November16.
On whether Discovery had acted in a discriminatory manner while handling Singh’s case, Broomberg said: “These rules are always consistently applied.
“If other members have received different funding decisions, this is because the circumstances and clinical details of those members were different.”