From the way the Walgreens system is described, it should be harder to fail a patient than help them: When a pharmacist or tech receives a notice of insurance denial due to a need for pre-authorization, they need only click a mouse button to automatically send a fax to the doctor’s office to secure sign-off. It seems no one did that for Yarushka Rivera, who depended on epilepsy medication to control the seizures that eventually killed her. Now the Massachusetts Supreme Judicial Court has decided her family can sue Walgreens for that failure.
Rivera’s family visited the pharmacy five times between her 19th birthday, when her insurer began requiring preauthorization, and her death four months later. Each time, they say, the pharmacy said they would notify the doctor. The court noted that the paperwork was just two pages long and would take less than 10 minutes to fill out.
It is, in fact, rarer for a patient to request pre-authorization directly than for a pharmacy to do so, according to Rivera’s doctor. Neither the patient and her family nor the pharmacy ever notified the doctor’s office of the need for pre-authorization in this case, her physician testified.
Three years after Rivera’s death, in 2012, her family filed suit: They claim that Walgreens had led them to think—five times—that the medication would be approved any day. Had they not, the family would have tried another pharmacy. Instead, they stuck with the pharmacy their doctor says never contacted them, presumably also believing that trying another pharmacy could confuse the process or start it all over again.
Since then, Walgreens has fought to quash the case on the grounds that it had no legal obligation to contact the physician. The lower court and appellate court agreed; the Supreme Court just decided they’re wrong. It’s standard procedure for the pharmacist to reach out to the doctor for authorization. Moreover, the court noted, the pharmacy and pharmacists have obvious roles beyond dispensing pills furthering patients’ well-being.
The result? Nearly ten years after her death and six years after filing suit, Rivera’s family finally gets to pursue justice for Yarushka.