Unnecessary treatment denials put this patient's safety at risk and undermined his doctor's expertise.

George, a patient with multiple myeloma, was prescribed two specific medications that work in conjunction with each other. It was thus a great surprise when the specialty pharmacy refused to send his medication, saying that they wanted to discuss with his oncologist the drug interaction between the two medicines. His oncologist was also perplexed; it was common knowledge that these two drugs are always prescribed together, as the second medicine provides a key part of the maintenance for the first drug, a fact that was not only clinically known but actually spelled out clearly on the manufacturer’s website. George had also been on the medication combination for nearly 18 months at that point without problems.

George’s fiasco wasn’t over. The specialty pharmacy then caused further delay, as they insisted upon speaking again to the doctor.

After over a month of delays, the oncologist and PBM finally got this sorted out, but George’s fiasco wasn’t over. The specialty pharmacy then caused further delay, as they insisted upon speaking again to the doctor, this time to ascertain how many refills were needed. The irony of this was that this particular medication cannot be refilled, so it was simply additional time wasted, while George’s treatment cycle was again delayed.

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PBM specialty pharmacies have a long list of complex bureaucratic protocols. While they may be designed to prevent mistakes and ensure patient safety, the result is just as often unnecessary, time-consuming delays that in fact endanger the patients they are trying to protect.