Another eleven days passed — nearly one month from the initial prescription — and he continued to wait, though his cancer did not.
Bertrand was diagnosed with renal cell carcinoma and prescribed a specific oral medication by his doctor. The oncology clinic sent out his prescription to the PBM- mandated specialty pharmacy on February 4th. Four days later, the clinic called the pharmacy to follow up, and was told that the pharmacy was waiting for additional information from Bertrand. Ten days later, they called again to see where things stood, and were told that while the pharmacy had tried to call the patient and schedule delivery, they had been unsuccessful in reaching him. The patient’s clinic asked why the pharmacy had not tried to call the patient’s doctor; were they not aware that Bertrand was suffering from renal cell carcinoma, and that it was quickly progressing without medication?
Nearly forty days since being prescribed the medication, Bertrand had still not received it.
Another eleven days passed—nearly one month from the initial prescription—and Bertrand informed the clinic that the medication had still not arrived. The clinic once again called the pharmacy and were told that the pharmacy had closed the patient’s account there, having been unable to reach him and verify his information in order to schedule shipment. The clinic then called Bertrand and asked him to contact the pharmacy in order to re-open his account and immediately schedule delivery.
Nearly forty days since being prescribed the medication, Bertrand had still not received it. The oncology clinic ultimately filed a formal complaint with the insurance company and is waiting for a resolution. Meanwhile, Bertrand continued to wait, though his cancer did not; in fact, between Stage I and Stage IV of renal cell carcinoma, five-year survival rates go from 90% down to 10%.
Time and again, patients wait for medication from PBMs that will never arrive—because of a small detail missing in the documentation, or a situation that requires the specialty pharmacy worker to take some proactive measure. These workers, with their passive attitude towards patient care, unfortunately, do not see themselves as partners to the process, nor do they see it as their responsibility to shorten the time needed to deliver patients’ medication.