July 20, 2020 Ashley Struble

Helping To Remove Barriers To Care

From a Specialty Pharmacy Liaison - This week I received a phone call from one of our Pedi-Endo patients' mothers, whose daughter is on injection therapy. While our hospital partner's specialty pharmacy is generally limited to helping patients with oral medications, I assist our patients in any way possible. The mother told me her daughter had an appointment to receive her next injection very soon but that she received a letter from the insurance provider saying the therapy was not covered. The mother immediately called the insurance provider but kept getting the run-around.

After a week of conflicting answers from the insurance provider, the mother was frantic. Her daughter's next injection was scheduled for the following day, and she didn't want anything to interfere with her daughter's treatment. That's when the mother called me.

She felt comfortable calling because we established a good rapport over the last few years. I started looking into her insurance coverage and quickly found out that her daughter, for some reason, had two different insurance ID numbers. The mother kept saying how nervous she was that the injection was possibly going to be delayed. I told her that since we spoke last week about filling the medication, she did not need to worry because their insurance already processed the medication, and there was a $0 copay.

I told her I would call her back shortly after looking into it further. I then went to our pharmacy’s Prior Authorization experts. They verified the policy was active, and everything would be fine for the appointment.

I called the mother back to explain that her daughter was good to go for the appointment as far as the clinic is concerned. After I took the time to explain everything, the mother told me, "You are such a blessing and a pleasure to work with regarding my daughter's medication." She also explained how she is very protective of her daughter and does not rely on too many people regarding her care. But she knows I am always here to help or remove any barriers to care.