Medical scheme Gems experts to review decision on funding cancer drug Keytruda

Government medical scheme, Gems, has responded to allegations that it refused to pay for treatment for one of their clients who has stage four cancer.

Chief Operating Officer at Gems, Dr Stan Moloabi says the cancer treatment drug, Keytruda, which Dr Sipho Bvuma's oncologist recommended is not registered for specific cancer that Bvuma suffers from.

He says the medical scheme rules do not allow for funding of drugs that are not registered for specific ailments.

Read: Bara doctor takes medical aid to court for denying him 'pricey' cancer treatment

In this instance, there were two panels of experts who had to consider this request and both are panels of oncologists and they came to the conclusion that it will not be appropriate to fund this said treatment.

Dr Stan Moloabi, Chief Operating Officer at Gems

This is the second time that Gems denies payment of treatment for Bvuma. He says he initially took them to court and the court ruled in his favour.

He has approached the courts for the second time now for the funding of the drug Keytruda which he believes will prolong his life and move him into remission stage.

There are clinical decisions that are taken by the doctors that are treating and we need to separate them from funding decisions. This is a difficult concept but that is how funding is done.

Dr Stan Moloabi, Chief Operating Officer at Gems

The funding decision is based on the scheme rules...

Dr Stan Moloabi, Chief Operating Officer at Gems

If medication is not proven to work in that category, then Gems will not be acting responsibly to be funding something that is ultimately not going to work.

Dr Stan Moloabi, Chief Operating Officer at Gems

Moloabi says the latest update sees the court setting aside Bvuma's application to have Keytruda administered.

He says Gems panel of experts will again relook at the funding of Keytruda and make a decision because this is a "matter of life and death".

The lawyer representing Dr Sipho Bvuma, Linda Skhosana, denies that the court set aside the matter. He says that the court has referred the matter to the Council for Medical Schemes Appeal Board and if they are not satisfied with the outcome they should return to court.

To hear the rest of the conversation, listen below:


Recommended

by NEWSROOM AI
Read More
'Mathematics syllabus is enormous to be covered within a year,' says expert

'Mathematics syllabus is enormous to be covered within a year,' says expert

Wits University mathematics lecturer Dr Jacques du Plessis says teachers are racing against time in the classroom.

Former Reserve Bank deputy governor Daniel Mminele appointed Absa CEO

Former Reserve Bank deputy governor Daniel Mminele appointed Absa CEO

Absa head of corporate communications Songezo Zibi says Mminele has pedigree both in terms of policy and commercial banking.

Momentum to pay all violent crime claims, regardless of previous medical history

Momentum to pay all violent crime claims, regardless of previous medical history

The Money Show’s Bruce Whitfield interviews Johann le Roux, CEO at Momentum Life.

Life insurance 101: Mention every detail of your medical history - consumer guru

Life insurance 101: Mention every detail of your medical history - consumer guru

The saga involving insurer Momentum has many South Africans thinking twice about their current life insurance policies.

Bara doctor takes medical aid to court for denying him 'pricey' cancer treatment

Bara doctor takes medical aid to court for denying him 'pricey' cancer treatment

Dr Sipho Bvuma says Gems has refused to pay for his expensive brain cancer treatment, which he believes will prolong his life.

Momentum explains why it refused to pay shooting victim's life insurance

Momentum explains why it refused to pay shooting victim's life insurance

The insurer faces huge criticism over that decision, based it says on the fact that Nathan Ganas had high blood sugar levels.

Popular articles
Student climate activist challenges Dept of Environmental Affairs

Student climate activist challenges Dept of Environmental Affairs

Raeesah Noor-Mahomed has joined schoolkids around the world by embarking on a Friday school boycott over climate inaction.

Dead wrong! US cops bust driver using carpool lane with fake skeleton passenger

Dead wrong! US cops bust driver using carpool lane with fake skeleton passenger

An Arizona man dressed up a fake skeleton in the back seat to fool the traffic cops, but didn't do a very convincing job.

Meet the inspirational creative duo behind 'Tonic Design'

Meet the inspirational creative duo behind 'Tonic Design'

Greg Gamble and Philippe van der Merwe join Refiloe Mpakanyane in studio.

Fitness was a career that chose me - 'Queen Fitnass'

Fitness was a career that chose me - 'Queen Fitnass'

Mapule Ndhlovu opens up about her life journey and how exercise changed not only her body, but her mindset for the better.

EFF issues one-line apology to journos after court order

EFF issues one-line apology to journos after court order

Anton Harber and Thandeka Gqubule won their defamation case over Mbuyiseni Ndlozi's party statement implying links to Stratcom.

Ugandan climate activist accuses media of racism after Davos photo crop

Ugandan climate activist accuses media of racism after Davos photo crop

WEF youth climate delegate Vanessa Nakate was cropped out of a group pic with her white peers, also featuring Greta Thunberg.

Letting go of your child who's headed for university and independence

Letting go of your child who's headed for university and independence

Nikki Bush has valuable tips on preparing not only your school-leaver but yourself for the journey into adulthood ahead.

Right to Sight pleads for more donations to conduct cataract surgeries

Right to Sight pleads for more donations to conduct cataract surgeries

Right to Sight trustee Dr Matt Young says they get donations at the most time but now need big sponsors.

Remains of Cato Manor 9 returned on anniversary of their hanging

Remains of Cato Manor 9 returned on anniversary of their hanging

The Cato Manor 9 were hanged in 1961 by the apartheid after taking part in an uprising on 24 January 1960.

Zakes Bantwini opens up about his latest single 'Amanga'

Zakes Bantwini opens up about his latest single 'Amanga'

The musician says he never writes songs about his personal life but this latest single is too personal for him.