Sarah's Story: Pregnant Mother Had To Go Without Eating Due to a Delay In Medications After Being Steered to Mail-order Pharmacy

Sarah, a pregnant woman whose life and the life of her baby, relies on insulin was forced to #mailorderpharmacy. She has been using her trusted pharmacy for as long as she could remember. The local pharmacy knows several of her family members. A couple of weeks before being forced, she received a letter. The letter was from CVS Caremark and read that she could save money by using mail-order. Sarah had no clue that this letter actually meant that she would either have to use mail-order or pay an unreasonable amount of 50%, $386 for the insulin that her and her baby's life depends on. PBMs prefer the word steering when they set copays higher to use a pharmacy outside of the PBM owned pharmacy. To most patients, having to pay 50-100% in order to receive medications from their trusted pharmacists is forcing them to mail-order.

Most cannot afford to pay 50-100% PBMs such as CVS Caremark, Optum RX, and Express Scripts oversee our insurance's pharmacy benefits. They are the gatekeepers to our pharmaceutical care and handle the prior authorization process, decide which pharmacy we can access, and determine and process reimbursements to pharmacies. Although it should be illegal, PBMs ofter decide patients can only use the PBM affiliated or owned mail order pharmacy.

After being forced to mail-order pharmacy, Sarah she was left unable to eat after her medications did not arrive on time. Sarah states, "It's not just my life that I worry about." When she attempted to order at her local pharmacy, she had 5 days left. After learning of the high copay to use her local pharmacy, she called CVS Caremark, a PBM owned by CVS. CVS mail-order pharmacy promised Sarah an overnight delivery. The first day, the medication didn't arrive. Second day, the medication didn't arrive. Third day, Sarah is out of medications and unable to eat. I asked, "Does the medication even show that it is on the way?" Sarah stated that there is no indication yet that she has seen that shows the package has been shipped.

She has mentioned that running out of insulin could cause harm to her or her baby. There are additional risks of developmental disabilities and complications during delivery if she doesn't have the insulin. After running out of insulin, Sarah called CVS Caremark. She asked if she could receive the insulin pen just one more time at her local pharmacy. She was told no because that wasn't the plan that she selected. As a prior health insurance agent, I can attest that due to an oligopoly in the PBM market, the ability for patients and employers to select a plan that isn't engaging in this unethical practice is almost nonexistent.

Frustrated and saddened, she was told instead of driving just a couple of minutes away to her usual pharmacy that processes her medications in 15-30 minutes, she would have to make a 45-minute drive to the next CVS retail pharmacy. Sarah, a school teacher, states that she is fortunate to be off school for the summer. She worries about those who may not be able to miss work or who may not have a reliable vehicle to make the long distance drive. By sharing her story, she hopes to raise awareness of the impacts that PBMs unethical business practices are having on patients' lives and our trusted pharmacists.

We appreciate Sarah for sharing her story and for those who will share this to ensure that others are made aware of the issues that patients are having. We believe mail-order pharmacy could be an option, but the forcing of mail-order must stop. Patients' lives depend on choice. Please sign the petition: The best way that you can help is by speaking or writing your legislators about this issue. You may also help by making a tax-deductible donation to our nonprofit, Unite for Safe Medications. Follow us on Twitter: @BoesingLoretta Facebook: Issues with Mail Order Pharmacy Facebook Page