NCPA's Blog - The Dose

The Dose

I became a pharmacist to help people. It's frustrating when I can't.

by Jayne Cannon | Mar 05, 2018

Oh, those PBM tales ...

Here's a story we received from a member in February. Has something like his happened to you?

Our member writes:

A father came into the pharmacy for a vital breathing medication for his son. He told us he'd already been to several pharmacies and everyone had told him the medication was unavailable. He wanted to know if we could help.

I checked and found out that the medication was out of stock from two of my wholesalers, but with some effort I found one that had it. But there was a catch, and it was big one — I was told that the acquisition price would be $1,756 above the reimbursement price! My guess is that no pharmacy would touch it at such an incredible loss.

So I attempted to try to speak to several departments and spent almost two hours on hold. One individual actually said there was a glitch with this drug and would need to speak to network operations. There was another hour hold with no answer. End result: I got nowhere.

The prescription was for two boxes of Cromolyn inhalant Solution for nebulization. This was a Medicaid Managed Care plan administered by one of the three largest PBMs.

The bottom line? There is no system in place to handle such acute situations. The patient's well-being is in danger, and there is no easy recourse.

I became a pharmacist to help people. It's frustrating when I can't.