It’s not clear in this case whether the delay altered the course of the patient’s disease, said Michael Diaz, MD, a medical oncologist at Florida Cancer Specialists and Research Institute, St. Petersburg, who is president of the Community Oncology Alliance (COA).
At some point, the PBM for the patient’s insurance company decided that prefilled syringes were not covered but that vials — the use of which involved the patient’s drawing her own blood — would be covered.
Clearly, some oncologists prefer Medicare Part B’s fee-for-service approach to paying for prescription medications, which according to the Medicare Payment Advisory Commission (MedPAC) gives providers ‘incentives for use of higher-priced drugs when lower priced alternatives exist,’ ” Greg Lopes, a PCMA spokesman, told Medscape Medical News.
UnitedHealth Group owns OptumRx; CVS has merged with Aetna and already owns the PBM CVS/Caremark; Cigna owns Express Scripts; Anthem has developed its own PBM, IngenioRx; and Humana owns a PBM.