An NBC 10 I-Team investigation reveals that thousands of
subscribers to Blue Cross & Blue Shield of Rhode Island, as well as hundreds of
medical providers, are outraged over a new pharmacy benefits manager hired by
BCBSRI.
The company, called Catamaran and located in Illinois, was
hired by BCBSRI in January to take over the management of most pharmacy
benefits covered under the Rhode Island company's policies.
But many doctors are
outraged, because prescriptions are routinely denied when something called "prior
authorization" is requested.
"It's been a disaster," said Dr. Gary L'Europa, a
neurologist in Warwick. "Prior authorization has always been a problem but
since January a number of patients had their medications denied for no apparent
reasons."
An official of BCBSRI, Dr. Gus Mancchia, says the non-profit
is well aware of the problems with Catamaran, but claims steps are being taken
to correct them.
"We've established a direct mail order phone and fax
number for providers. Catamaran has added staff to work directly with Blue
Cross on prior authorization requests and the firm is simplifying the prior
authorization form," Mancchia said.
But the efforts of Blue Cross and Catamaran are not
satisfying patients and medical providers in Rhode Island.
"We wait weeks and weeks and weeks, you're advised when
you call your request can take up to four weeks," said an officer manager
for a local doctor's office.
Doctors say many of their patients have had to go without
their medications, sometimes for weeks. But BCBSRI denies that. The company
says when a prior authorization is denied, BCBSRI makes sure the patient gets
the medications they need on a temporary basis.
Calls placed to Catamaran were not returned.
