Samantha, a 30-year-old Wisconsin woman with severe psoriasis, was prescribed a new, but expensive drug to control her autoimmune disease, only to be denied coverage. Instead, she and her doctor were told to try less expensive steroid creams. She endured years of unnecessary pain and was left with ongoing scarring before she was able to get the more effective medication.
How could this happen? All too many patients are denied drugs they need because of “utilization management” practices—a euphemism if there ever was one—by one of the lesser known players in America's tangled health-care system—pharmacy benefit managers (PBMs).
