KeyHealth Medical Scheme Plans Appeal over Ultomiris Ruling

In Short

KeyHealth Medical Scheme has told the Council for Medical Schemes that it intends to appeal a ruling linked to prescribed Ravulizumab, also known as Ultomiris.

What Happened: KeyHealth Medical Scheme And The Appeals Process

KeyHealth Medical Scheme informed the Council for Medical Schemes (CMS) that it intends to appeal a ruling of the Appeals Committee in a matter concerning prescribed Ravulizumab (Ultomiris).

CMS said it respects the outcome of the Appeals Committee decision in the KeyHealth Medical Scheme matter.

CMS also pointed to section 50(3) of the Medical Schemes Act 103 of 1998. Under this section, a party that is aggrieved by a decision of the Council may appeal to the Appeal Board. CMS said the appeal to the Appeal Board must be lodged within 60 days of receiving a ruling.

Because the ruling is now the subject of an appeal, CMS said it will be unable to comment on the implications of the ruling.

Why It Matters

An appeal means the decision is moving to the next step in the formal review process, which can delay clarity on what the ruling means in practice.

It also signals that disputes over prescribed treatments can extend beyond the Appeals Committee and into the Appeal Board process, with timelines set out in the Medical Schemes Act.