After warning that his patients were waiting weeks and sometimes months for oral cancer drugs, Dr. Samuel Friedman has told The Guam Daily Post that a resident he was treating died on the same day her prescription arrived on island.
"That's really, really something," said Friedman, an oncologist. "The patient had chronic myelogenous leukemia, which is a treatable – if not curable – disease. Under the proper medication, the person can have a relatively normal lifespan. If she had the medication on time, she would be alive today."
Friedman began the approval process for the patient in February with her insurance provider, StayWell, he said. One factor contributing to the length of time to handle the request was a specialized test to prove that the sought-after drug would be effective on the patient. It's a step Friedman says was unnecessary, and was made worse when a local vendor performing the test transcribed the oncologist's directions incorrectly over the course of two attempts. Because the samples had to be shipped off island, each mistake cost the patient at least one week of treatment, Friedman said.
"For God's sake, she's going to die and she doesn't need this test," Friedman said. "I got emails (from StayWell) saying this is terrible, and if there's a problem just call us. Well, who the hell do you think I've been calling for the past two months?"
While Friedman can dispense many medications, currently health insurance companies won't pay his clinic for oral chemotherapy drugs. Instead, patients get these prescriptions approved through their insurance provider, and pick them up at a local specialty pharmacy. Depending on the provider, this process can take days or weeks – or in the case of the deceased patient, months.
"StayWell's (off-island partners), they're just the worst of the bunch," Friedman said. "They put so many roadblocks in your way that it takes forever to get things approved. Despite what StayWell says, 'Oh, it should be approved in a day or two.' No. It takes weeks. About three weeks ago I wrote them a medical certification saying that this patient is going to die unless she gets put on these drugs immediately, and they still didn't do anything about it."
The Post was able to speak with three insurance companies previously on this issue. SelectCare, NetCare, and TakeCare all said their subscribers are not experiencing long delays for these types of drugs. SelectCare and NetCare additionally said they retain overriding authority in oral chemotherapy medication requests, which can help secure the needed treatment even if it's denied by a pharmacy benefits manager. StayWell did not seem to have this same option, according to Friedman.