Decision Report 201706645

Summary

Mr C complained that the board had unreasonably failed to reimburse the costs of his Clomiphene medication (medication to increase levels of the hormone testosterone) which had previously been prescribed outwith the UK. Mr C also complained that the board had refused to reimburse his costs for attending an endocrinilogist (a medical professional who specialises in hormones) outwith the UK. Mr C maintained that the medication and service provided by the endocrinologist improved his health.

We took independent advice on Mr C's complaint from a consultant endocrinologist. We found that, although Clomiphene is effective in raising testosterone levels, it has not yet replaced the currently used testosterone supplements in the management of hormone deficiency in men. The treatment is unlicensed in the UK and, whilst a clinician could prescribe it, it would be a discretionary matter to do so, and they would have to make a specific request. We found that the board's decision not to fund the medication or the consultation costs on the basis that it was not licensed, alternative appropriate medication was available, and the condition is commonly managed in the UK, was reasonable. We did not uphold the complaints.