Barbara, who was battling brain cancer, was prescribed two drugs: one a form of chemotherapy and the other an antiemetic that would alleviate the symptoms of nausea caused by the chemo. Both were to be taken in conjunction with the radiation treatments scheduled to begin six days later. At Barbara’s clinic, well aware of the urgency of the situation, the nurse on call faxed Barbara’s prescriptions over to her PBM-mandated specialty pharmacy, and at the same time, applied for prior authorization from Barbara’s PBM. Five days later the nurse called over to the pharmacy, asking for an update, since neither she nor Barbara had heard anything. The pharmacy worker informed the nurse that the prescriptions had indeed arrived and they were now about to enter them into their system to see if prior authorization was necessary. The nurse was nonplussed— why had the prescriptions not been entered five days earlier, when they were sent and received by fax? And what if the nurse had not called to follow up; how much longer would it have taken? Most importantly, how is it that the PBM-mandated pharmacy staff , who are dispensing medication aimed to keep people alive, do not see it as their duty to provide customers with the very best and fastest service possible? Barbara’s radiation treatments, scheduled to begin the next day and already delayed nearly a week, now had to be postponed until the medication could be received.
Multiple cases are reported in which doctors must reach out to PBM-mandated specialty pharmacies to enquire about the status of medication— only to find that while the pharmacy has received the patient’s prescription, it’s been just sitting on someone’s desk, untouched, with no concern for the person on the other end, who is being treated for a life-threatening condition.