In the more serene call center upstairs, dozens of patient representatives were on phone dealing verifying insurance coverage, coordinating authorizations, and arranging financial aid.
“We try to avoid scripted types of calls. We want patients to be comfortable,” says Mickey Law, a 25-year-industry-veteran who runs the facility.
Fewer Options
But when problems arise, patients locked into a single pharmacy find they have nowhere to go.
Jodi Ruehling, a school librarian in Massillon, Ohio, said her 6th-grade daughter suffered worsening hearing damage from a rare autoimmune disorder in 2016 after CVS’s specialty pharmacy was a week late in shipping a crucial anti-inflammatory medicine. Ruehling says she started calling CVS a month ahead of time to insure that all the authorizations were in place, but it didn’t help.
“It was always a runaround,” she said. “They kept telling me it was the doctor’s fault and the doctor hadn’t sent the prescription in.”
CVS’s takes “incredibly seriously” the importance of getting patients their medicines on schedule every time, said Alan Lotvin, CVS executive vice president for specialty pharmacy. When a problem occurs, “we do everything possible to make it right” and make sure it doesn’t happen again, he said.
In Ruehling’s case, CVS in late 2016 appointed a single point person to handle her calls and the service improved, she said.
Lawsuits
Some pharmacists have sued to get better access to the PBM networks.
In Arkansas, UnitedHealth’s PBM refused for 16 months to allow AllCare Specialty Pharmacy into the specialty pharmacy network it operated for a local insurer, according to a lawsuit AllCare filed against the PBM in 2016 accusing it of “deceptive and unconscionable” tactics.
Even though AllCare was already accredited, the PBM made AllCare get a second certification, which took nine months, the company said in the lawsuit. Then came new demands: it had to develop a program to monitor hepatitis C patients. AllCare submitted documents proving it had such a program, but was still turned down until it hired a lawyer to press its claim.