Dr. Rao and his patient Norma shared their experience battling pharmacy benefit managers over proper cancer treatment
Norma Smith was diagnosed with stage-three cancer in December. However, she and her husband did not only battle the disease, but also pharmacy benefit managers (PBMs). Despite having her cancer medication prescribed by Dr. Ravi Rao, CVS Caremark’s PBMs denied and delayed Norma’s chemotherapy treatments several times over the past seven months.
According to the pharmacy benefit managers, cancer drugs prescribed by Dr. Rao were denied because they did not follow the standard protocol sequence of medications in their guidelines. Dr. Rao, on the other hand, thinks that monetary reasons may have caused these delays.
“That’s because if the PBM pharmacist or who is in charge says no, well guess what? They’ll save money there,” Dr. Rao said. “The money comes out from a different pot. So the patient goes and gets surgery done, it comes out from a different part of the insurance.”