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
'If ANC continues to zig-zag on e-tolls it will be punished at polls'

'If ANC continues to zig-zag on e-tolls it will be punished at polls'

Cosatu Gauteng provincial chairperson Amos Monyela says the federation is mobilising motorists to fight against the scheme.

Former Eskom CFO Anoj Singh a no-show at Saica disciplinary hearing

Former Eskom CFO Anoj Singh a no-show at Saica disciplinary hearing

Singh faces 18 charges of misconduct at SOE's Eskom and Transnet. EWN's Theto Mahlakoana reports from the Saica hearing.

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
Aunt of slain student Jesse Hess confirms murder suspect is close family member

Aunt of slain student Jesse Hess confirms murder suspect is close family member

Sandy Hess says police made a breakthrough in the double murder case after linking suspect to rape of 16-year-old on Monday.

Unions and SAA get ready for fight that threatens to break the ailing airline

Unions and SAA get ready for fight that threatens to break the ailing airline

Joanne Joseph plays audio from the media briefing over the impending strike.

White pupils at posh Kingswood College refer to black scholars as 'snoobab'

White pupils at posh Kingswood College refer to black scholars as 'snoobab'

"This problem is bigger than just a Kingswood problem. The relevant processes will unfold," says College Head Colleen Vassiliou.

Vintage car auction set to blow enthusiasts’ minds (and collectors’ budgets!)

Vintage car auction set to blow enthusiasts’ minds (and collectors’ budgets!)

There'll be Rolls-Royces, Bentleys, Jaguars, MGs and other great brands. There’s even a Ferrari like Tom Selleck's from the 1980s.

[WATCH] 'Fourth industrial revolution' braai has social media talking

[WATCH] 'Fourth industrial revolution' braai has social media talking

Khabazela shares tweets and Facebook posts that have gone viral.

[WATCH] Pre-school class erupts as boy returns from RWC, goes viral

[WATCH] Pre-school class erupts as boy returns from RWC, goes viral

Khabazela shares tweets and Facebook posts that have gone viral.

We’ll shut you down! – unions to SAA ('overstaffed by any measure globally’)

We’ll shut you down! – unions to SAA ('overstaffed by any measure globally’)

The money-pit airline is fighting for its life. Bruce Whitfield interviews Theto Mahlakoana, a senior political reporter at EWN.

[WATCH] Gay teen fights back against school bully as teachers do nothing

[WATCH] Gay teen fights back against school bully as teachers do nothing

Khabazela shares tweets and Facebook posts that have gone viral.

[VIDEO] Family saved from being hit by speeding SUV goes viral

[VIDEO] Family saved from being hit by speeding SUV goes viral

Khabazela shares tweets and Facebook posts that have gone viral.