The case of a Louisville woman who was denied life-saving cancer medication was featured during testimony before the U.S. House Ways and Means Committee on Thursday.
Several top health care insurance executives faced questioning from lawmakers over rising prescription costs and access to necessary treatments.
The situation centers on Pharmacy Benefit Managers (PBMs), middlemen in the prescription drug supply chain who manage drug plan benefits for insurers.
Andrea Kelley told lawmakers that being denied her medication puts her at risk of cancer returning.
“Despite being stable on the medication for a year, United Healthcare is now denying Andrea her Lupron injection and Vioza medication, according to her doctor,” said Rep. Buddy Carter, R-Georgia. “These denials are actively increasing Andrea’s chance of cancer recurrence. This isn’t about convenience or cost, this is about whether her cancer comes back.”
Lawmakers said Kelley’s case reflects a broader pattern of PBM denials that endanger patients’ health.
Currently, a bipartisan spending bill includes provisions aimed at reforming PBM practices, though it still faces significant hurdles before it can become law.
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