An NBC 10 I-Team investigation reveals that thousands ofsubscribers to Blue Cross & Blue Shield of Rhode Island, as well as hundreds ofmedical providers, are outraged over a new pharmacy benefits manager hired byBCBSRI.
The company, called Catamaran and located in Illinois, washired by BCBSRI in January to take over the management of most pharmacybenefits covered under the Rhode Island company's policies.
But many doctors areoutraged, because prescriptions are routinely denied when something called "priorauthorization" is requested.
"It's been a disaster," said Dr. Gary L'Europa, aneurologist in Warwick. "Prior authorization has always been a problem butsince January a number of patients had their medications denied for no apparentreasons."
An official of BCBSRI, Dr. Gus Mancchia, says the non-profitis well aware of the problems with Catamaran, but claims steps are being takento correct them.
"We've established a direct mail order phone and faxnumber for providers. Catamaran has added staff to work directly with BlueCross on prior authorization requests and the firm is simplifying the priorauthorization form," Mancchia said.
But the efforts of Blue Cross and Catamaran are notsatisfying patients and medical providers in Rhode Island.
"We wait weeks and weeks and weeks, you're advised whenyou call your request can take up to four weeks," said an officer managerfor a local doctor's office.
Doctors say many of their patients have had to go withouttheir medications, sometimes for weeks. But BCBSRI denies that. The companysays when a prior authorization is denied, BCBSRI makes sure the patient getsthe medications they need on a temporary basis.
Calls placed to Catamaran were not returned.