Mansell, Engel & Cole
  • Home
  • About
    • Steven S. Mansell
    • Mark A. Engel
    • Kenneth G. Cole
    • Keith F. Givens
    • Adam Engel
    • Zachary K. Housel
  • Practice Areas
    • Denied Claims & Disputes
    • Types Of Insurance
  • Case Results
  • Blog
  • Contact
Select Page

A nemesis for some insureds: pharmacy benefits managers

On behalf of Mansell, Engel & Cole | Aug 13, 2019 | Denied Insurance Claims

It’s just “one more layer of bureaucracy,” says a disgruntled doctor.

That physician’s discontent – arguably, even rage – points straight toward a single participant in the health care system. Namely, that is the pharmacy benefits manager. So-called PBMs were largely nonexistent in the medical industry a few short years ago, but are now playing an increasingly key role as health insurance company adjuncts.

Their job: to weigh in on physicians’ prescriptions and make definitive judgment calls on whether they will be filled or rejected.

Understandably, that infuriates doctors. Those singularly trained professionals are the individuals who work most closely with patients. They have no doubt that their voice should reign supreme regarding needed regimens and drugs for the sick – and sometimes dying – people they treat. Legions of them say they are angered and stunned by the fact that far-removed and anonymous individuals who are not their peers can override their professional recommendations.

And yet that is precisely what PBMs do, with increasing frequency and often little accountability. A recent national media report on pharmacy benefits managers and their often unbridled powers terms them “elusive middlemen with the authority to deny doctors’ prescriptions based on company policies.”

To say that PBMs are deemed a flatly unwelcome addition in the health care realm by the nation’s physicians is a stark understatement. Doctors who comment on them criticize not just their intrusiveness into the patient-MD relationship, but the fatal consequences that can result from their ignorance and narrow focus on costs.

“They are hiding behind all these processes,” complains one practitioner, “and we are struggling here.”

  • Facebook
  • Twitter
  • LinkedIn

Recent Posts

  • Fighting a denied earthquake insurance claim
  • Overview of Oklahoma’s bad faith laws
  • Common reasons why health insurance denies claims
  • When a life insurance company denies a claim
  • The importance of additional documentation after a denied claim

Archives

  • January 2021
  • December 2020
  • November 2020
  • October 2020
  • September 2020
  • August 2020
  • July 2020
  • June 2020
  • May 2020
  • April 2020
  • March 2020
  • February 2020
  • January 2020
  • December 2019
  • November 2019
  • October 2019
  • September 2019
  • August 2019
  • July 2019
  • June 2019
  • May 2019
  • April 2019
  • March 2019
  • February 2019
  • January 2019
  • December 2018
  • November 2018
  • October 2018
  • September 2018
  • August 2018
  • July 2018
  • June 2018
  • May 2018
  • April 2018
  • March 2018
  • February 2018
  • January 2018
  • December 2017
  • November 2017
  • October 2017
  • September 2017
  • August 2017
  • July 2017
  • June 2017
  • May 2017
  • April 2017
  • March 2017
  • February 2017
  • January 2017
  • December 2016
  • November 2016
  • October 2016
  • September 2016

Categories

  • Blog
  • Denied Insurance Claims
  • Firm News
  • Insurance
  • Insurance Disputes

RSS Feed

Subscribe To This Blog’s Feed

Start Your
Free Insurance
Claim Review

Mansell, Engel & Cole The Insurance Attorneys

Office Address

204 N. Robinson Ave.
21st Floor
Oklahoma City, OK 73102

Map & Directions

Get In Touch

Phone: 405-212-5921
Fax: 405-232-4140

  • Follow
  • Follow
  • Follow
IBFTLA - Insurance Bad Faith Trial Lawyers Association
Member of The National Trial Lawyers - Top 100 Trial Lawyers
AV Preeminent Rated Lawyers
Review Us

© 2021 Mansell, Engel & Cole. All Rights Reserved.

Disclaimer | Site Map | Privacy Policy | Business Development Solutions by FindLaw, part of Thomson Reuters