Managed Care and Chemotherapy:

Treatment authorisation

Before treatment can be started, we have to obtain authorisation from your medical aid. In an emergency, we will start treatment before obtaining authorisation.

Most medical aids in South Africa have sub-contracted with managed-care organisations to administer their members’ oncology benefits. Each medical aid has different processes in place to manage this. The time needed to obtain authorisation varies from 24 hours to as long as 10 days depending on the efficiency of the medical aid, and on whether special motivations are required.

Your medical oncologist may elect to start treatment before authorisation is obtained, if this is deemed in your best interest. This will be discussed with you. In most instances, where standard care is given, obtaining authorisation is a formality, and the efficiency of your medical aid determines when authorisation is obtained. You may contact your medical aid directly about your authorisation, if you feel it necessary.

Benefit structure

The treatment available to you, depends on your medical aid option. Different tiers of treatment are available for different benefit options. In some instances, your medical aid option may not give you access to the best available treatment. If, in the opinion of your medical oncologist, this will materially affect the outcome of your treatment, your medical oncologist will discuss this with you. In most instances, this will not be of great importance, as the treatments available on the standard options are reasonable to treat most cancers. This may change as new treatments become available.

Cost of Drugs

Many of the newer oncology drugs are very expensive. Most of these drugs are only available on the higher treatment plans of medical aids, often with substantial co-payments. With few exceptions, the cost of a drug is not a reflection of the value of the drug. Not having access to very expensive drugs may have no material effect on the success of your treatment. In a few instances it may. In those instances your medical oncologist will discuss this with you.

Chemotherapy supply and preparation

By law, since 2004 in South Africa, medicines have to be sold at cost price by doctors and pharmacists. A small dispensing fee may be added to the price. Given the high cost of chemotherapy, many oncology practices have opted to no longer supply chemotherapy. They rely on courier pharmacies for delivery of drugs, or rely on outside parties to provide chemotherapy and mixing services.

At Mary Potter, we believe that it is our responsibility to ensure that the drugs used are of good quality, have been transported and stored under controlled conditions, and have been correctly selected, mixed, and prepared prior to administration. We therefore continue to supply a full medical oncology chemotherapy service, controlled by oncology trained pharmacists.

In some instances, medical aids have contracted with courier pharmacies to supply drugs for their patients. Should you not make use of their services, you are subjected to punitive penalties by your medical aid.

Due to the logistics involved in receiving, and the responsibility of caring for chemotherapy drugs once received, we are unable to accept deliveries from various courier pharmacies. We have made arrangements to receive such deliveries from one such pharmacy, namely Medipost. If your medical aid prefers to use another courier pharmacy, the delivery has to be made to you directly. We will then mix and prepare the chemotherapy for you on your treatment day.

You are responsible for storing the chemotherapy under appropriate and safe conditions until your treatment day. The courier pharmacy is responsible for informing you of such conditions.

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