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4.23.2010

Discover Health Advocacy: Life-saving drug not covered

We built our company, Health Advocate, Inc., to help people navigate the complex healthcare system and to provide them answers when they need them the most. Here is an example of how we have helped a member with a healthcare solution.

Problem: Life-saving drug not covered

Frank, a diabetic, had a costly mix-up in his insulin prescription. He expected the prescription to be the newer, pen-based pre-filled cartridge injection system, on which his physician instructed him during his office visit. However, the physician had not specified cartridges and the pharmacy benefit management service (PBM) sent Frank traditional, more costly insulin vials, which he unsuccessfully tried to exchange.

Solution:Health Advocate provided documentation from the patient’s physician that he wanted pre-filled cartridges and the PBM agreed to the exchange, saving both Frank and his self-funded employer money.