Sara is a bubbly 51-year old that enjoys her job at a local financial services company. She was referred to Dr. Steven Baak at the Arthritis Center after complaining to her primary care doctor about joint pain and stiffness. Sara knew she was in the right place after meeting Dr. Baak, his office team, and their therapy dog Bunny, in the clinic! After an assessment, and frank conversation with Sara about her needs, Dr. Baak recommended both oral and infusion medication taken by IV to help with her arthritis. For Sara, who has a 9–5 job, this is a great option because she only has come to Dr. Baak’s office six times a year for a 30-minute treatment.
To get Sara the medication Dr. Baak had prescribed, his staff had to initiate a process called “prior authorization” with Sara’s healthcare plan – meaning they have to inform the plan about the medication Sara is going to receive and why. All was well until the Pharmacy Benefit Manager that oversees Sara’s healthcare plan got into the middle. The PBM disagreed with Sara’s choice of treatment, so they informed her they wouldn’t fulfil the order for the medication she and Dr. Baak had decided would work best to alleviate her symptoms. When Sara protested the result, the PBM directed her to take the issue up somewhere else, this wasn’t their problem. “What on Earth!?” said Sara, “I trust my doctor’s confidence in the treatment I have been prescribed – I am not changing doctors because a PBM says so!”
Sara is infuriated that she can’t get the medicine prescribed to her, when she needs it most, from the doctor she trusts. Because there isn’t any other recourse, Sara and her team are taking their case online, and with social media, to hope more public attention on the issue will create enough pressure to change the PBM system that has failed her!
