When a clinic staffer finally made it through the busy signals, the PBM told her they would't discuss the prescription because she wasn't on the "preferred" contact list for the patient.
PBM specialty pharmacies require patients to schedule delivery of their medications by phone, which seems, on the surface, a simple enough task. John, who was undergoing chemo for bone cancer, tried for an entire week to get through to his specialty pharmacy and schedule the next delivery of his medication, but no matter what time of day he called, the line was always busy.
“You are lucky you got through! ” she was told by the rep. “Our lines are so busy, we cannot make outbound calls because all of our lines are used up.”
Finally, one day before he was supposed to start a new chemo cycle, and with no medication left, John called the clinic in frustration, and asked if they could intervene in some way. Calling the specialty pharmacy, John’s clinic was able to speak with a representative. “You are lucky you got through! ” she was told by the rep. “Our lines are so busy, we cannot make outbound calls because all of our lines are used up.” Their luck ran out fairly quickly however; as the clinic staff member was not on John’s list of ‘approved’ contacts at the pharmacy, she was unable to speak on John’s behalf and schedule delivery of the medication. And with the lines tied up throughout the day, the specialty pharmacy rep was unable to call John to verify.
The clinic staff hung up, and had to call John back to tell him his only recourse was to continue trying to call in and hope that he will eventually reach someone— before it becomes too late to matter.
Another reason for delays in receiving medication from a PBM specialty pharmacy is the difficulty in adhering to their complex bureaucratic protocols. Pharmacies insist on speaking to the sick patient firsthand, hearing them name the drug, and confirming their shipping details before they will send the medication. However, patients often miss these calls, which are most often automated, and which stop after three missed attempts. In many cases, even when the patient answers the phone, they cannot confirm the name of the drug, causing another cycle of delay to begin.