Express Scripts Decides Cancer Patient’s Drug Isn’t Approved Yet, Shrugs

paperworkHealth insurance is supposed to make your life less stressful, not more. It’s supposed to help you treat illnesses, not keep you away from legitimate treatments. Yet mail-order pharmacy kept a life-extending treatment away from a terminal cancer patient, causing her extra stress and costing her time spent on the phone and not receiving treatment.

The drug, Afinitor, is relatively new. The Food and Drug Administration only approved it for cancers like hers a year ago. Naturally, this meant that her drug benefits provider, Express Scripts, insisted that the medicine hadn’t been approved for her diagnosis. Even though it was. Last year. We just said that a few sentences ago.

Her insurance company also insisted that Afinitor hasn’t been approved yet, and that they can’t pay for “unproven drugs or therapies.” You know, that experimental drug that her doctor prescribed and that the FDA approved. A year ago.

The patient reached out to heroic consumer reporter Kurtis Ming of CBS Sacramento, who contacted Express Scripts to see what they had to say. Coincidentally, they overnighted the drug to the customer right away.

A company spokesperson told CBS 13, “We worked with the patient, her physician and her insurer to make sure she received the required medication as quickly as possible.” Three weeks is their idea of quick?

Call Kurtis Investigates: Why Pharmacy Refused Drug For Terminal Cancer Patient [CBS Sacramento]