Unauthorized changes to prescriptions by the pharmacy consistently puts patients' care in danger.
A community oncology and hematology clinic in Pennsylvania was being forced to use a specific PBM specialty pharmacy for their patients’ oral chemo prescriptions, despite the practice having its own in-office dispensary. They had actually applied to the PBM two years earlier for the right to dispense drugs; however, approval was still “pending.”
Frank was one of the clinic’s patients battling rectal cancer. His oncologist prescribed an appropriate medication and submitted it to the PBM specialty pharmacy for filling. Soon after, the PBM called the clinic and announced that approval was denied for the submitted diagnosis, however if the oncologist were to change the diagnosis to one of several other cancers, they would then approve it. The clinic responded by noting that this would be a fraudulent change, that they refused to comply with it, and would be reporting it to the State of Pennsylvania. Within ten minutes of that call, Frank’s medication was approved without any changes.
A pharmacy is forbidden to change prescription instructions without the approval of the prescribing physician.
Edward was another of the clinic’s patients, also battling rectal cancer. He had been prescribed the same drug, with a specific dosage, to be taken twice daily, seven days a week, for five weeks. However, when the medicine arrived, the PBM specialty pharmacy had changed the dosage and instructions. This was done despite the fact that a pharmacy is forbidden to change prescription instructions without the approval of the prescribing physician. To make matters even worse, the quantities sent to Edward were incorrect, even for the adjusted regimen.
Chris was another patient at the practice battling with rectal cancer and prescribed the same medication with the same dosage. He too found that his prescription had been changed by the PBM specialty pharmacy—from seven days per week to five days per week. When the PBM specialty pharmacy called Chris to schedule shipment he refused because the instructions were different from those he’d been given at the doctor’s office. At this point, the PBM specialty pharmacy called the patient’s physician, who had to reinstate the original prescription.
Because of the constant, unauthorized changes to the details of prescriptions made by oncologists, this practice worries that patients’ care is in danger. And these changes are not isolated to just this PBM or practice—specialty pharmacies seem to be playing it fast and loose with the oncologists’ directed treatment plans. Details, such as number of dosages and their size, are crucial life-and-death matters, and PBMs and their specialty pharmacies should not be changing them.