After multiple delays and ruined medications, this community oncology clinic began documenting numerous cases of PBM abuses.
A community oncology clinic became so fed up with the problems and delays their patients faced in dealing with a PBM specialty pharmacy that they opened a dedicated file to document each case. Michelle, a patient at a Florida community oncology practice, had arranged for the PBM specialty pharmacy to ship her medication to one of their local branches, for easy pickup. However, when Michelle arrived at the store, she discovered that they had thrown away her prescription. She now had to request a new prescription from her doctor, get a new prior authorization from her insurance carrier, and then have the medication shipped again—all of which resulted in a two-week delay of treatment.
Exposed to the Florida heat and rain, the drugs were ruined and had to be reordered— subjecting him to another round of authorizations, delay of his life-saving treatment, and unnecessary cost for the health care system.
Diane, another patient at the clinic, had her prescription faxed to the same PBM specialty pharmacy. The pharmacy confirmed it had received the prescription. However, 50 days later, the medication had still not arrived. Clinic staff called the pharmacy, who then claimed they had never received the prescription. By the time it was all sorted out, Diane had been left two months behind in treatment.
The following month, another patient of theirs, Juan, came home to find that his medication had been delivered and left in the middle of the road. Exposed to the Florida heat and rain, the drugs were ruined and had to be reordered— subjecting him to another round of authorizations, delay of his life-saving treatment, and unnecessary cost for the health care system.
No system is perfect. But when a PBM specific pharmacy is repeatedly documented making life-threatening mistakes with no accountability, and cancer patients are forced to remain with them, unable to choose another pharmacy, it would seem that something needs to change.