Health Matters

I'm just chasing up chemists and health funds here.

HCF, my health fund for over a decade or so, stopped paying for my meds last year. I complained, queried phoned and asked to speak with the managers, I need to spend some time either writing complaints in letter /fax form .. phone doesn't work, and probably getting letters for doctor for verification.... OR switching to different health fund.

They will not give a list of what prescriptions they will pay for and apparently they don't have to. They will tell you if you let them know of each individual scripted items, whether or not they will pay. They will no longer cover any of my prescriptions. The only form of oestrogen they cover is an oestradiol implant. The other oestrogen on their list that I was imnformed by my chemist hadn't been [generally] available in Australia for 15 years.

I have phoned consumer affairs and the govt authority dealing with health funds..and apparently they can pay on whatever they like and don't have to disclose their list.:-)
I was told its supposed to be on the TGA list for approved meds, but not on the PBA list..as that is subsidized by govt. to the best of my knowledge all these meds are both not on the PBS list (sure Of) . The TGA when I phoned them said their list doesn't cover he compounded meds. Their list is here
https://www.tgasime.health.gov.au/SIME/ARTG/ARTGPublicWeb.nsf/MEDpublic?OpenView___##0##___ or by going to
https://www.tgasime.health.gov.au/SIME/ARTG/ARTGPublicWeb.nsf?OpenDatabase and clicking on Medicine Information.

Apparently the health funds can choose at their discretion NOT to cover the meds... like its only what they put on their own list!

Do any Aussies know of health fund that will give rebates for hormone replacement therapy meds.. like oestriol, oestradiol, progesterone, biest, triest, thyroid meds compounded if you are in the top extra cover. HCF may do it, but only as a special case with a doctors letter explaining why I need them. Just a script won't do, and I hate to bother the docs. The last doc who wrote me a script was the head professor at the bladder clinic at St George Hospital..they should have better things to do with their time, than write letter to health funds stating that I needed the med they prescribed and why??

I did have a docs letter for thyroid, but it was lost on a computer upgarde and the replacement note..after hours.. was not entirely accurate..and only covered THYROID 1./4 grain.. so HCF noow rejects anything with T4, T3, etc or a differening amount.. sigh. It always takes a LOOONG time every time I try to claim thryoid meds back..and to-ing and fro-ing with chemist for it to be written out with at least the words..these meds are for treatment of THYROID. ..and then sometimes they will only pay what I was charged for the 1./4 grain a long time ago. They also have difficulty finding the note on the computer,..so that takes up to hours as well.. until the one person who can find it comes in usually :-) each time I try for a refund.
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EDITED to ADD 15/3/06

I just paid another 6 mths with HCF and got a letter from the Professor at the teaching hospital saying I need the oestradiol cream; so I'll see how it goes. I was almost up to my 2 month limit for continuing as a member , so I had to do something. I did phone the other health company and they didn't phone me back the first day , but must have phoned my mobile the next day (I can never hear it and its turned off during lectures). The no they phoned me on from Melbourne is not a correct no for me to ring in on, so I give up.

I will try HBA though if still no luck with HCF. I've faxed them the letter from the Prof... who also is insisting I have physiotherapy..so I'd better be in a fund
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Also it looks like Stenlake compounding pharmacy made up thyroid meds without the Methocel.. phoned them and they told me to post me.. then told me ..they would test them out and I would have to pay full for replacement if their tests say they are OK..said they would pay to send back..then couldn't give me a free post address.. They told me just to stick in post box. I asked the post office and they said, I would be billed plus taxed extra if I did this, so I've bought them home again. They definitely are not gelling..and the hormone is running out too fast, before my next one is due. I found it difficult to stay on the road driving home yesterday..and was wiped with a headache past few days. This could have been the meds.

So now I'm wondering.. should I try and find someone else to send them to... or just send the bottle back to them and one somewhere else independent?

I did ask the TGA and they do not cover meds made up by compounding chemists either:-) They are exempt from being covered under the good manufacturers practise...or something similar..I part missed it. They advised trying a Pharmacy Guild or a State Dispensing? just in case Stenake say it tested with methocel in when It doesn't.. I have thougt of this.. but maybe its not worth the effort. I don't really like the idea of them doing the testing and me paying for the replacemeent meds based on what they say the results are though.. I think I would be fine if Stenlake had treated me in a friendlier manner, given me a free post return for the meds etc.

When I test them they don't gel as they should.. or gel in mouth etc.. If the mistake is really mine, I would be prepared to pay.. if they let me get a docs script etc first!..so if I do get a health fund I can part claim back. However I think I am right.. as rice flour.. the other ingredient acts exactly the same when water is added to it as the contents of the capsules., ie no expected gelling occurss, as I got with other meds with 30% Methocel and rice flour.

It is only the methocel. I'm sure the thryoid extract is in there as I'm holding out normal long term, so the actual drug is still in there in the correct amount
Anyway I just think..yet again:-), this is unfriendly.... to be told I'd have to pay if I'm in error according to their tests..which I assume are not independent(without any mention of discussing scripts etc and coverage with a health fund for the extra meds, so it would be pay in full), , seeing as I've been a customer there for 5 years.. and then not to be given a return freepost, I think that's what got to me as a last straw! LOL
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edited TO ADD 15/3/06
Re Stenlake..I did post in praise of them originally, but I posted later about the change of customer service friendliness to the worse. This is the first time they have got something wrong for me.. except for once adding colour to my caps (I'm allergic to some colours..and it's the sensiivities which are one of the main reason for people going the compounded route). That time they replaced the order friendly enough., although I had previously specified the no colour bit in writing.

Anway if you were planning on twice a day then all methocel or methocel 30 % to 50% and rest cellulose is fine.
IF you aren't allergic to Methocel (it gives me and a few others a mild asthma, which is one reason I try to minimize the amount I take).
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Love to hear from an fellow Aussies on this, especially if you have a health fund that does cover hormones, with a docs script of course!
I'm due for a health fund change!

On a more positive note
this url gives a few progesterone meds I didn't know where available in Oz
https://www.tgasime.health.gov.au/SIME/ARTG/ARTGPublicWeb.nsf/MEDpublic?SearchView&Query=progesterone&start=1&searchOrder=4&searchMax=1000&searchWV=0&searchFuzzy=0