College students who came of age during the COVID-19 pandemic and the Supreme Court’s decision to overturn Roe v. Wade know two very big things. First, access to quality healthcare is not taken for granted, and second, geography matters. Unfortunately, these are the lessons I learned from childhood when I was infected with parvo, a seemingly harmless virus that triggered an immune response that led to juvenile arthritis, causing this condition in less than 1 percent of patients. . As a result, while most 20-somethings worry about access to reproductive health services and medicines, I am concerned about the unintended consequences of policies and politics clashing with the health care system, and how they can exacerbate those consequences. It also addresses the role played by pharmacy benefits managers. A prescription benefits administrator determines which drugs are covered by health insurance plans and how much a patient pays for prescription drugs.
For example, hydroxychloroquine, a drug I’ve been taking for years, has been in short supply since people started using it as an off-label and erroneous COVID-19 treatment, costing $45 out-of-pocket. to $100. $600 for 90 days. Or methotrexate, an inexpensive chemotherapy that has been around for decades and is often used in combination with other drugs to control arthritis symptoms. It is also prescribed to terminate a pregnancy. After the row is flipped, Access was restricted in certain states with restrictive abortion policies.
One would think that in a global medical center like Boston, such drugs would be readily available to patients with serious but treatable chronic or acute health problems. But you could be wrong, thanks to bureaucratic giants like Express Scripts, Accredo, and CVS Specialty, and the cost-conscious employers and insurance companies that outsource critical services to them.of Profit model of the PBM industry And it’s an industry that encourages delays and refusals to apply prescriptions without patient accountability or redress.
For months this winter, PBM kept making excuse after excuse for not filling my arthritis prescription. In the end, after hours of phone calls, unnecessary pain, and dangerous interruptions in my care, there was an error in the computer system interfacing with the PBM of Blue Cross, Illinois, Blue Shield, Inc., causing delays. It turned out to be the cause. However, even though my premium was paid to the Massachusetts Blue Cross Blue Shield, PBM does not, under Massachusetts law, give me or the Massachusetts Blue Cross Blue Shield this money. I wasn’t obligated to tell you. To make matters worse, there was no other way to secure the medicine.
There are no pharmacies or hospitals where I can pay for these drugs out of pocket, even if I want to. And no one asks for help. In the last two weeks alone, in order to secure a prescription, she has been on the phone with her PBM and phone calls at the doctor’s office and hospital benefits department, primarily through her insurance company, which the insurance company requires to be used to cover the prescription. I spent hours. . I have also spoken with the specialty pharmacy that PBM is claiming to use to dispense my medications and the drug copayment assistance program (run by the drug manufacturer).
Putting the responsibility on the PBM to ensure that the patient receives the medicines prescribed and that they actually receive the medicines they need to live a healthy life, which in my case is simply getting out of bed in the morning. there are no people
What’s the biggest irony?I one of the lucky ones. I have the best rheumatologist in the country and have the ability to pay for expensive insurance plans. I have a job that allows me to get away from my desk and spend an hour on her phone with an insurance company and a call center employee who works for her PBM. I have a devoted and politically connected parent, former Acting Governor Jane Swift, who has been with me in managing my care for 10 years. What about the vast majority, let alone all, of Massachusetts and US residents who have none of these privileges?
Our leaders have done a good job defending women’s right to choose in Massachusetts. But in a few years, Gen Z will have families of their own, care for aging parents, and think more about health care as they increase their own health needs. As Massachusetts policymakers consider the future of access to healthcare in the federal state, several PBM-related bills, including H1215, “The Pharmacy Benefits Administrators Act,” introduced by Rep. John J. Roan, Jr. submitted to parliament. Among other reforms, it would require state approval of PBM, restoring some power to consumers who depend on life-saving drugs. The time has come for my generation to have access to critical health services. we are watching.
Lauren Hunt will graduate from Northwestern University in 2023..
