Cancer patients are being denied drugs, even with doctor prescriptions and good insurance

Feb 2011
18,163
12,867
The formerly great golden state
#1
Cancer patients are being denied drugs, even with doctor prescriptions and good insurance

But that insurance didn’t ensure Smith would get the drugs she needed when facing CVS Specialty Pharmacy – the pharmacy their insurance required them to use. Cancer drugs prescribed by Smith’s oncologist were denied because they didn’t follow the standard protocol sequence of medications that Smith’s pharmacy benefit manager, CVS Caremark, had in their guidelines.

That means pharmacy benefit managers have the authority to trump a doctor’s medical judgment without seeing patients or knowing their full medical history, and without accountability for the consequences of what happens to sick people.
"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.
 

The Man

Former Staff
Jul 2011
47,044
34,495
Toronto
#2
Meanwhile:


People in Moscow can take free cancer screening tests, clinics are given grants for early cancer detection, and cutting-edge life-saving treatments are covered by mandatory health insurance. Read this mos.ru piece for more details on cancer treatment and prevention in Moscow.
More: Prevent and cure: How Moscow fights cancer

Also: Russian scientists developed a new drug for cancer diagnostics and treatment

And: Cuba to Receive Anti-cancer Medicine from Russia for First Time

Etc. Yep, even Russia is ahead of America on this one, sadly...

Ironically, it is, in part, because of their dictatorship. They don't have a powerful "Big Pharma" over there, telling the government what to do. It's other way around. The pharma oligarchs fear Putin, not he them ;)

And he doesn't let them actually abuse the people too much either, at least, to go so far that would cause public discontent and unrest :)

So, there are positive aspects to that system... Though, many more negative ones also, to balance it out...
 
Mar 2012
57,883
39,438
New Hampshire
#3
Cancer patients are being denied drugs, even with doctor prescriptions and good insurance



"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.
They do this with diabetics as well. First drug typically prescribed is Metformin. If a doctor and patient decide to go another direction, the pharmacy will deny it and prescribe Metformin anyway.
 
Likes: The Man
Feb 2011
18,163
12,867
The formerly great golden state
#4
They do this with diabetics as well. First drug typically prescribed is Metformin. If a doctor and patient decide to go another direction, the pharmacy will deny it and prescribe Metformin anyway.

"Pharmacy benefit manager's" job seems to be to manage health care so as to maximize the pharmaceutical companies' bottom line.
 
Mar 2012
57,883
39,438
New Hampshire
#5
Likes: The Man
Sep 2016
19,808
13,968
My own world
#6
They do this with diabetics as well. First drug typically prescribed is Metformin. If a doctor and patient decide to go another direction, the pharmacy will deny it and prescribe Metformin anyway.
That's the dumbest thing I have ever heard. I understand if the pharmacist himself or herself calls the DR and says 'hey this drug you are prescribing will interfere with some medication the patient is on for something else.' The can suggest to the DR that he prescribe X instead of Y as the pharmacist knows more about drugs then the DR but for an insurance company or drug company or "pharmacy benefit manager" to refuse to give a drug for another reason if not related to the welfare of the patient is nuts.
 
Likes: The Man
Mar 2012
57,883
39,438
New Hampshire
#7
That's the dumbest thing I have ever heard. I understand if the pharmacist himself or herself calls the DR and says 'hey this drug you are prescribing will interfere with some medication the patient is on for something else.' The can suggest to the DR that he prescribe X instead of Y as the pharmacist knows more about drugs then the DR but for an insurance company or drug company or "pharmacy benefit manager" to refuse to give a drug for another reason if prescribed by a DR is nuts.
These new companies came about as a request from the insurers who felt it would overwhelm them to have so many people covered so they brought this in house. Now they all use these benefit managers, who by the way get to have access to your medical records. They follow your prescriptions and look for ways to save money. Its supposed to help the patient but all it does is get in the way. Our pharmacist told us these benefit managers are a pain but they cant do anything. They seem to get final say unless the patient wants to pay in cash.
 
Likes: The Man
Feb 2010
34,654
24,595
between Moon and NYC
#8
Cancer patients are being denied drugs, even with doctor prescriptions and good insurance



"Pharmacy benefit managers," not doctors, get to decide on which drugs a patient can have. While they decide, and appeals are made, cancer patients get sicker and sicker.

Cancer drugs are very expensive, into the hundreds of thousands of dollars. That's one part of the problem. The other part is managing care for the benefit of the pharmacy, rather than the benefit of the patient.

Yep. Complex problem. Definitely two sides to the issue.

The insurance industry has had guidelines and restrictions in place for many years. And the current increasing (breathtaking) cost of some medical care is just making the issue worse.




..
 
Likes: The Man
Feb 2011
18,163
12,867
The formerly great golden state
#9
Yep. Complex problem. Definitely two sides to the issue.

The insurance industry has had guidelines and restrictions in place for many years. And the current increasing (breathtaking) cost of some medical care is just making the issue worse.




..
many sides to a complex issue, yes. The core of the problem is that a course of chemotherapy can easily cost into the high seven digits just for the medication.
 
Likes: The Man