While the PBM bureaucracy failed to remedy the situation, his cancer went untreated and continued to spread.
James was a patient in his late 50s, suffering from advanced renal cell carcinoma. On May 18th, his oncologist prescribed a particular medication, and they began a two-week wait for his insurance company to approve usage. Upon receiving approval, the doctor’s office sent the prescription over to James’ PBM-mandated pharmacy, with a request that it be handled ASAP, as the patient’s situation was dire.
One week after making the urgent request and having heard nothing, the practice followed up to ascertain the status of his prescription. A few days later, a response came back from the pharmacy that they had attempted to contact James twice, but had not succeeded to reach him. They asked the doctor’s office to have the patient call the pharmacy himself. The office asked the pharmacy if and when they had been planning to contact them, to notify them that there was an issue with delivering James’ medication. The pharmacy responded that their policy is to try phoning the patient three times, and then they either contact the prescribing doctor’s office or simply mail the prescription back to the patient.
James’ cancer continued to spread, untreated, leaving him no closer to receiving his medication than he had been three weeks earlier.
While the PBM bureaucracy failed to try to remedy the situation, James’ cancer continued to spread, untreated, leaving him no closer to receiving his medication than he had been three weeks earlier. As for the PBM pharmacy, they seemed completely unconcerned, despite the fact that the five-year survival rate for advanced renal cell carcinoma goes from 53% down to 8%, if it passes from Stage III to Stage IV.
Time and again, doctors reach out to PBM-mandated specialty pharmacies to enquire about the status of medication— only to discover that the process is stuck, and no one at the pharmacy feels any sense of urgency, despite the fact that the patient in question is being treated for a life-threatening condition in which time is of the absolute essence.