Valley Voices

CVS response to Bee story did not deal with key problems in getting cancer drugs

Fresno oncologist Ravi Rao, left, with patient Norma Smith and her husband Rod, voices his frustration in working with pharmacy benefit managers in treating his patients.
Fresno oncologist Ravi Rao, left, with patient Norma Smith and her husband Rod, voices his frustration in working with pharmacy benefit managers in treating his patients. Fresno Bee file

It is with great interest that I read the response from Dr. Brennan of CVS Health (Aug. 25, The Bee) to the article date and the editorial from several weeks ago. Unfortunately, his response neatly side steps the main issues brought up by the prior Fresno Bee article from Aug. 8 and the subsequent editorial.

Would you ever agree to undergo surgery if the anesthesiologist was told by the insurance company that they would only allow him/her to use only two out of the three anesthetics you actually need during surgery?

While treating patients with cancer, we often use combinations so as to take advantage of a concept called synergy. Because each drug attacks the cancer cells in a different manner, the benefit of the combination is much more than what we get by just adding up the benefits of each single drug. By doing so, we add 1+1+1, and get 5, in a manner of speaking. Using only one drug to treat a cancer when the best treatment is to use a combination of three drugs is just not adequate. CVS made us do just that.

As a result of the delays in obtaining the correct combination on time, my patient was left with inadequate therapy, and her health deteriorated on a daily basis. The system of “appeals” to correct the situation is slow, cumbersome and bureaucratic. At no point in time was I or my staff able to speak to someone who actually made a decision to convince them to change their pace of decision making.

Dr. Brennan also did not address the question of why the patient, her family, my staff or I had to spend hours on the phone to get this issue resolved. Over time, while waiting, listening to the music while on hold on the phone with CVS, I began to realize that the delays were deliberate. The intent seemed to be to make us fatigued and give up. Dr. Brennan did not explain in his response why it was so time consuming and painful for us to talk to anyone who could change their decision(s). He also does not explain who in their system was overriding my medical decisions, and changing the chemotherapy protocols I had ordered.

This constant fight with medical insurance companies and now, with PBMs, is draining our energy as medical professionals. The obstacles we are facing can be best described as low-degree harassment. This harassment is taking its toll on the morale of the medical profession, and is having a wide-ranging impact on our behavior. One can imagine that of all the physicians who deal with these kinds of situations on a daily basis, at least some would decide to not fight any more. It is definitely easiest to follow the path of least resistance. These providers will then end up doing exactly what the insurance company/PBM conglomerate wants them to do — chose the easiest-to-get therapy (i.e., the drug on which the insurance/PBM company makes the most profit).

Even worse, this is contributing to a rapid increase in physician burn out. As an example, in August of 2019, I know of two experienced doctors in Fresno have decided to retire early — both have quoted the stress of dealing with insurance companies as one of the factors that made them retire early.

As a society we need to decide what kind of a health system we want — one run by physicians who sit face to face with patients and make decisions, or by someone like Dr. Brennan who is employed by a for-profit entity which seems to have lost its way.

Dr. Ravi D. Rao is a Fresno oncologist.