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ovarian cancer

CMScript 1 of 2022: Focus on Ovarian Cancer

Treatable ovarian cancer is a Prescribed Minimum Benefit (PMB) condition under Diagnosis and Treatment Pair (DTP) code 952M – Cancer of ovary – treatable. According to the PMB regulation, treatable cancers are defined as follows:

  1. they involve only the organ of origin and have not spread to adjacent organs;
  2. there is no evidence of distant metastatic spread;
  3. they have not, by means of compression, infarction, or other means, brought about irreversible and irreparable damage to the organ within which they originated (for example, brain stem compression caused by a cerebral tumour) or another vital organ;
  4. if points (i) to (iii) do not apply, there is a well-demonstrated five-year survival rate of greater than 10% for the given therapy for the condition concerned.

According to the PMB regulations, schemes must pay for the diagnosis, treatment and care costs of treatable ovarian cancer, irrespective of the medical scheme option a member belongs to. This would include consultations with doctors and other health professionals, surgery, radiology, pathology, chemotherapy and radiation therapy.

Council for Medical Schemes has published the PMB Definition Guidelines for ovarian cancer. These provide detailed information on the treatment options that are PMB level of care and those that are not.

Download the CMScript here.

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