The Pretoria High Court has ordered Medihelp medical scheme to pay for an expensive drug to treat a three-year-old boy with a rare genetic disorder.
The boy’s mother applied for authorisation for the drug twice
The child’s mother took Medihelp to court earlier this year. This followed her applying twice for authorisation for a medication called Elaprase for her son. The Alberton woman’s son was diagnosed with Hunter Syndrome.
WebMD defines Hunter syndrome as a rare disorder that is passed on in families and mainly affects males. The body of the person diagnosed with the disorder is incapable of breaking down a kind of sugar that builds skin, bones, tendons and other issues. The sugar builds up in the person’s cells and ends up damaging many parts of their body.
“Exactly what happens is different for every person,”Hunter Syndrome defintion as per WebMD.
Elaprase is the only registered treatment for the boy’s genetic disorder in SA
In terms of Elaprase, this is the ONLY registered treatment for the condition in South Africa. In its court arguments, Medihelp stated that although the condition was prescribed minimum benefit, the drug use was not a ‘prevailing predominant public hospital practice’.
Over the last year, the little boy’s condition has reportedly deteriorated. Judge Anthony Millar found that if he did not get the treatment his ‘life and quality of life will be irreparably adversely affected’.
Practitioners in the public sector confirmed in affidavits that Elaprase is prescribed to people diagnosed with Hunter Syndrome in their facilities.
The Judge’s ruling in the case
Judge Millar said the affidavits made it clear to him that Elaprase was the only available treatment for the condition in both the public and private health sectors. Judge Millar ordered Medihelp to authorise the treatment and care costs for all medical interventions the little boy requires within 30 days, reports EWN.
The above is pending the outcome of a complaint the child’s mother lodged with the Council for Medical Schemes.