The problems began with an error on Bateman’s end. During the prior authorization for Lear’s Nerlynx, Bateman accidentally answered a question wrong—she thought the person on the phone was asking whether Lear had ever been on an antiemetic medicine rather than an antidiarrheal—and Express Scripts promptly denied approval for the drug. The very same day, Bateman appealed the denial and provided the correct information, but she had to wait nearly a month before the medication was finally approved, according to clinical notes she provided to The Atlantic.

Then there was a new complication. Bateman called Accredo, the specialty pharmacy, which agreed to set up the delivery of Lear’s medication, Bateman says. But after more than a week of phone tag, neither Bateman nor Lear had heard from the pharmacy. Bateman realized there might be an issue with Lear’s insurance, which had changed on January 1. Bateman called the new insurer, Optima Health, who said the prescription had been transferred to a different specialty pharmacy, Proprium—though according to Bateman, she had never been notified about this. An Optima representative gave Bateman a new number to pass on to Lear so that Lear could set up the delivery of the Nerlynx.

Bateman was a busy nurse at a busy practice just trying to get one tiny thing taken care of. At this point, in her clinical notes, Bateman spewed a frustrated, punctuation-free stream: “[Lear] called me back at 4:40 pm and stated that Proprium pharmacy stated to her that the medication needed a prior authorization ...” Bateman had already been told that a prior authorization would not be necessary, she says. When she called to clarify, Optima told her she was right, but there was yet another problem: The medication had a bank-breaking $1,367 co-pay.

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A spokesperson for Sentara, the parent company of Optima and Proprium, said in an email that Lear’s previous insurer appeared to be the “primary hold up” in this case, and that it was a “a highly unusual set of circumstances which resulted in an unfortunate delay.”

Bateman usually encounters some hurdles in getting cancer medications to her patients, but she told me this was one of the worst cases she’d ever had. At the end of her note on January 22, Bateman wrote that she had spent more than 16 hours on the phone attempting to get Lear her medication. And Lear still didn’t have it. The way Lear was ultimately able to secure it and avoid the high co-pay was by canceling her primary insurance, making her secondary plan her primary one, and filling the prescription with Accredo after all. On February 6, she was finally able to start taking Nerlynx.

Citing patient privacy, Express Scripts declined to comment on Lear’s specific case. In an emailed statement, a spokesperson told me that “sometimes patients have primary and a secondary benefit plans. The differences in those plans, and the timing of plan-year changes, can lead to confusing situations.” They said that in cases where Accredo is an in-network pharmacy, patients are generally able to get their medications.