Clearing out their inbox, the PBM was filling prescriptions and sending prior authorization notices for patients who had passed away.
A practice in California began receiving request after request from a particular PBM for prior authorization to initiate a refill—what was unusual was that they were for a variety of expired prescriptions. What was going on? None of the practice’s patients had been prescribed these drugs recently. In fact, some were for drugs that patients had stopped taking months earlier, while others were for patients who had died.
In fact, some were for drugs that patients had stopped taking months earlier, while others were for patients who had died.
The practice was puzzled at first, but then came to the following conclusion: “It seems they [the PBM] are just going through their files, and when a prior authorization expiration date pops up for prescriptions filled through their pharmacy at one time, they are automatically sending out prior auth requests.”
An amusing anecdote on the surface, stories such as this reveal the wholesale approach taken by the PBMs, in which patients are viewed not as individuals in need of medical care, but rather as a potential market of consumers. Spread across the entire health care system with drug benefits managed by PBMs for millions of patients, this scenario also potentially means millions, if not billions, of dollars of wasted costs in cancer medications.