Misleading Formulary Information and Poor Communication – Bestmed Rhythm 2

I am extremely disappointed with the service and contradictory information received from Bestmed regarding medication cover on the Rhythm 2 option.

A member, Ms Marlyn Cass, was recently ill and was prescribed Ciprofloxacin by her doctor for an acute condition. At the pharmacy, the medication was declined as “not covered”, despite Ciprofloxacin appearing on the official Bestmed formulary list provided to us by Bestmed themselves.

When this discrepancy was queried, Bestmed responded by referring us to the chronic medication authorisation process, requesting ICD-10 codes and additional documentation. The problem is that this was never a chronic medication application to begin with. This was medication prescribed for an acute illness.

This raises serious concerns:

- Why is Ciprofloxacin listed on the formulary if it is rejected at pharmacy level? - Is the Rhythm 2 plan only intended to cover chronic conditions despite Bestmed stating that acute medication is covered? - Why are members being given conflicting information by different departments? - Why is a straightforward formulary medication claim being turned into a chronic application process?

Additionally, Stilpane was also rejected despite the circumstances requiring treatment and symptom management.

Members pay monthly contributions expecting transparency and consistency. It is unacceptable that a formulary medication can simply be rejected without proper explanation, while members are sent in circles between departments.

Bestmed needs to urgently clarify:

1. What medications on the Rhythm formulary are genuinely covered for acute conditions; 2. Why pharmacies reject medication that appears on the official formulary; 3. Why staff are providing contradictory explanations to members.

At present, this feels misleading and unnecessarily frustrating for members who are already dealing with illness and medical expenses.