We Overturned a Specialty Drug Denial (here's how) | Darci Roskelley, Direct Care Administrators

Imagine receiving a rapid cancer diagnosis, only to be told your critical specialty drug treatment isn't covered. In this episode of Care Beyond Code, we explore how one team turned a devastating denial into a fully covered path to recovery.

Darci Roskelley, Director of Operations at Direct Care Administrators, joins the show to share a high-stakes impact story about navigating the complex healthcare administration system. She explains how a simple misclassification between pharmacy benefits and medical benefits almost cost a patient everything, and how her team intervened. By leveraging international sourcing and removing the patient from the confusing middleman process, they secured the necessary care without the upfront costs.

What you’ll learn:

-- How miscommunication between PBMs and medical benefits causes denials

-- The steps to investigate and overturn a specialty drug denial

-- How international sourcing can significantly reduce medication costs

-- Why looking at the "whole picture" of a patient's health journey matters

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