Ask Aviva #17: Why didn’t the doctor tell me how to get the medicine?!

Dear Aviva,

My daughter is 9 years old and takes a special medication for her bipolar disorder. The psychiatrist recommended this medication and even checked that it was distributed in Israel. But when I went to the pharmacy with the prescription, they told me that they couldn’t sell it to me because I didn’t have permission! What’s the prescription then?

Sincerely,

Pill-less in Pardes Hana

 

Dear Pill-less

As a mother, it is extremely frustrating and debilitating to do all the hard work to get a new medicine for your child, which you obviously need, only to be rejected at the last step. You are encountering what I call, the 29 gimel conundrum. This means that there are some drugs that are only approved for certain diagnoses in the sal bruit or only in certain circumstances. But the kupah has a special committee called the “va’adat harigim”, or exceptions committee, which can approve that drug for the particular patient from within the kupah.

However, in order to do this, a kupah specialist (in the associated field), needs to complete a 29 gimel form, which defends the reason the patient needs this particular medication. That form, together with a copy of the prescription and a summary of the visit, needs to be submitted to the committee, and approximately 2 weeks later, an answer will be sent. This means that if you want to get this medication, you need to do it well ahead of the time you will actually need the prescription. And remember, this permission only lasts for six months, so you need to re-submit before the final date arrives. However, even if you managed to get the medicine privately (and paid a ton of money for it), you should still apply to the committee for the future, but you will not be retroactively reimbursed for what you have already paid.

Yours in health,

Aviva


Ask Aviva #16: Why won’t my doctor do an MRI for my back pain?

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