The Human Cost of Specialty Drugs

My mom’s battle with breast cancer and the experience she had with her insurance company’s PBM is what motivated me to start House Rx. Learn more about my mom’s story and how we’re changing the specialty pharmacy experience for patients and their caregivers.

Tesh Khullar, Co-Founder & President
March 11, 2022
3 min read

In cancer care, there's been increased attention to the "financial toxicity", or financial burden, of a cancer diagnosis. But I didn't realize how little attention was paid to the "emotional toxicity" of navigating treatment until my mom was diagnosed with breast cancer in 2007.

At first, everything was going great. The quality of care she was getting from her local community oncology practice combined with the compassion of her care team allowed my mom to focus on getting better. But things drastically changed when her red blood cell count dropped, and she needed Procrit to spur red blood cell growth. Taking supportive care medications are a common occurrence for cancer patients who are receiving chemotherapy. It certainly wasn’t something we thought would be an issue. We were wrong.

Like many patients before her, my mom was forced to use a specialty pharmacy owned by her insurance company. After 3 weeks of waiting and 10+ phone calls later, my mom was finally able to get her medication….in the mail. It arrived with a syringe and instructions for how to fill it up and inject it into the side of her stomach.

Like so many of us, she wasn’t able to inject a needle into herself,  and instead had to bring it to her community oncologist to administer the injection.

This arrangement is known as “brown bagging.” It’s an increasingly common tactic used by insurers, and their pharmacy benefit managers, to steer patients to specialty pharmacies that the PBM controls – no matter the burdens it places on patients.

Insurers are able to get away with this because there is a severe lack of transparency within our drug distribution system. Neither patients nor their physicians have much control over how, where, and when they can access the specialty medications they need. The care delays and logistical obstacles that prevent patients from receiving treatment in a timely manner are merely collateral damage in a system that exists to serve the financial interests of insurers and PBMs.

For a country that has access to some of the most advanced healthcare in the world, this is unacceptable.

Bringing transparency to the drug distribution and PBM landscape in order to help patients and their caregivers is the challenge my co-founder, Ogi Kavazovic, and I formed House Rx to tackle. You can read more about our mission and vision via Ogi’s recent post.

We’ve both worked closely with specialty practices, and know by partnering with physician practices and empowering them with pharmacist expertise and technology, we can radically change patients’ specialty medication experience.

To that end, we’ve built a platform that keeps patients with their care teams by empowering providers to offer medically integrated specialty drug dispensing. It’s an operation built to scale – allowing private practices of all sizes and specialties to set up a partnership between physicians and pharmacists to collaborate on patient care. But more importantly, these efforts will drive better patient outcomes and improve the care experience so that patients will never have to go through what my mom did.