The Doctors delve into a troubling health concern which unfortunately affects far too many patients: vital medications not being covered by insurance.
We meet Norma, who tells us after being diagnosed with Stage 3 blood cancer, and the pharmacy stood in the way of her receiving her life-saving medications. Her pharmacy benefits manager (or PBM) denied the medications her doctor had prescribed due to their medication sequence protocol. She says as she waited for her meds to be approved, her health continued to deteriorate.
The Doctors question if our healthcare system's bureaucracy is putting patient's lives in danger.
Norma, her husband Rodney and her oncologist Dr. Ravi Rao join the panel, and Dr. Rao explains Norma's PBM insisted she take an additional drug before she received all of her prescribed meds. He says she was forced to wait 2 months during the ordeal. "I felt like my life was on the line. I didn't know if I was going to live to get the drug I needed," Norma recounts, explaining she spent more time in bed and used a walker during that time.
Dr. Rao says he felt it would not be prudent to wait and see if the drug the PBM wanted her to try would be effective or not and he believed starting the final drug in her regiment should occur as soon as possible. He says while they waited on the PBM, they lost ground on the advances they had made on her cancer. He even feared she might die due to the holdup.
So how can patients ensure they get the medications they need? Dr. Daniel Tomaszewski, assistant professor of pharmacy at Chapman University, shares how to advocate to get your needed prescriptions. He suggests:
- Know your preferred medications and your covered medications.
- Know your pharmacist, as they can be a great advocate and resource.
- Be open to generic and low-cost medications, Dr. Tomaszewski says he opts for these drugs when he needs to take medications.