I-Team: New complaints about Blue Cross prescription coverage

The NBC 10 I-Team has received dozens of complaints about prescription coverage in the two weeks since our report on a new prescription benefit manager for Blue Cross & Blue Shield of Rhode Island.

On Jan. 1, BCBSRI contracted with the Catamaran company of Illinois to manage the nonprofit's prescription coverage. About a year ago, BCBSRI contracted with CVS Caremark to handle all specialty prescription drugs.

Dawn Souza, of North Kingstown, has two sons who suffer with a severe suppressed immune system disease. Since birth, they have been taking a drug called IVIG. It must be taken intravenously. Until last year, Souza was using the Coram Infusion company to not only administer the drug, but also provide a nurse for her younger son. Her Blue Cross insurance covered the total cost of the drug and the nurse.

But sometime last year, Souza said she was told by BCBSRI that she had to drop Coram and start using CVS Caremark for both her medication and a new nurse.

"Blue Cross is telling us we have to get our medications from CVS Caremark. Now we have to pay a 20 percent co-pay, something we really can't afford," Souza said.

Souza registered numerous complaints with Blue Cross and eventually got some satisfaction. But Souza herself has a serious reflux problem. In January, she was told she had to get "prior authorization" for her prescriptions, even though she had been taking them for years.

"I had to deal with the Catamaran company. They denied me the prescriptions," Souza said.

When the mother of two called the Catamaran company, she was both surprised and disappointed at what she found out.

"I asked to speak to a doctor. I figured there must be a doctor there because the company was making decisions that affected my health. But I was told, there was not doctor to talk to," Souza said.

BCBSRI said it realizes there are "limited" complaints about the company's new prescription benefit manager. But a representative for the company said it is working with patients and providers in an effort to improve the quality of service.