Why Pharmacy Refused Drug For Terminal Cancer Patient

CBS Sacramento

A Shingle Springs woman says the mail order pharmacy refused to fulfill a prescription to help battle her terminal cancer.

When three weeks went by and she says the cancer spread, she called Kurtis.

This medicine was prescribed to try and contain the cancer.

But while going weeks without it, cancer popped up in other areas of her body.

So why won’t the pharmacy fulfill her doctor’s prescription?

“It has been the biggest nightmare, I just didn’t think I would have to fight for my life for the drugs that I needed,” said Nancy Greenlee-Gowdy, Shingle Springs resident.

Already fighting for her life battling breast and stomach cancer, Nancy can’t believe how hard she’s had to fight for her cancer medication.

“Just begging them, give me my medication, this is my life,” said Nancy.

Her doctor prescribed the drug back on May 14th but Nancy’s mail order pharmacy, Express Scripts, denied the prescription, saying the medication isn’t for this type of diagnosis.

But the FDA approved the drug Afinitor for her condition last July.

Nancy’s doctor faxed Express Scripts this letter the day after the denial but the pharmacy still didn’t fill her prescription.

“There was no reason it shouldn’t be authorized, there’s absolutely no reason,” said Nancy.

Nancy’s turned to her own insurance company for help.

But Carpenters Health Welfare Trust Fund for California instead said “no benefits will be provided for unproven drugs or therapies.”

“It’s not experimental treatment. It’s FDA approved,” said Nancy.

For three weeks, Nancy says she called her insurance company and the pharmacy almost every day and during that time, her cancer grew.

“My tumor markers are going up, this can’t wait anymore,” said Nancy.

“Three weeks is a damn long time to somebody who is looking down on a terminal diagnosis,” said Amy Bach, Executive Director, United Policyholders.

Consumer advocate Amy Bach says Nancy’s insurance company should’ve advocated for her.

“Her family paid premium for that protection and they deserve that protection,” said Bach.

Express Scripts, recently merged with Medco.

We found since 2004, the state pharmacy board fined the two companies 13 times, including this citation for not providing a patient her medication for 18 days, something Express Scripts is appealing.

“We don’t want patients to have to wait excessive amounts of time for drug therapy,” said Virginia Herold, Executive Officer, California State Board of Pharmacy.

Once we contacted Express Scripts, they overnighted Nancy’s much needed medication, telling us in an email:

“We worked with the patient, her physician and her insurer to make sure she received the required medication as quickly as possible. – Brian Henry, spokesperson

Nancy doesn’t think three weeks is quick. There’s no telling if the delay shortened her life.

Her fight continues and she is now focusing on her son’s wedding this fall.

“We’re all excited about that, will be my first trip to Maui, my first trip to Hawaii. Cross that one off my bucket list,” said Nancy.

We reached out to her insurance company too which says it did advocate for her.

They say they didn’t realize the drug was approved for her condition for two and a half weeks after she first tried to get the prescription filled.

The information presented in this publication is for general informational purposes and is not a substitute for legal advice. If you have a specific legal issue or problem, United Policyholders recommends that you consult with an attorney. Guidance on hiring professional help can be found in the “Find Help” section of www.uphelp.org. United Policyholders does not sell insurance or certify, endorse or warrant any of the insurance products, vendors, or professionals identified on our website.

Source: https://uphelp.org/why-pharmacy-refused-drug-for-terminal-cancer-patient/
Date: July 24, 2024