Caremark PHC, LLC

This is in response to your inquiry dated June 14, for the member regarding his mail order balance
We are unable to research the medication ordered in January as we do not have a drug nameThe member’s mail order balance is $due to a credit card chargeback on February 29, 2016.
When a medication is lost in transit and a reship is completed, the member is charged for the original order; however, they are not charged for the reshipmentTherefore, the member would be responsible for the copayment for one of the shipments

I have been a managed Type I diabetic for yearsMore recently, my regimen consisted of *** fast acting insulin with meals and *** for basal insulin which I took twice daily, at breakfast and dinnerOver time, I began experiencing concerning side effects with this regimen, including but not limited to unconsciousness during low blood sugar episodes during the night requiring emergent ambulance care on multiple occasions, as well as a transient ischemic attack suffered in or about during which time I lost all control of my upper and lower limbs for a period of nearly minutesIt is my understanding this a precursor to CVAAt that time, I discussed with my doctor my short-comings with the *** regimen, and asked if there was an alternative treatment to better manage my sugarsAt that time I began using *** once daily for control of my sugars throughout the dayImmediately on starting ***, I began to notice complete resolution of these side effects of the prior reg

My physicians office placed an order for my prescription and I was told CVS Caremark would have to fill the prescription and they would call to schedule delivery This was the first week of April 2016/ My appointment was for the 15thI never rec'd a call so I ended up calling the 12th to ensure my prescription would be delivered on time for my dr apptWhen speaking with the rep they told me the delivery date would be the 14th so I would make my Friday (15th) appointmentCome Friday the prescription never arrived I called and was placed on hold at least times for over ten minutes each time and the reps did not come back on the lineFinally a rep did not put me on hold and told me that there were not any notes as to why they did not ship the medication it just simply didn't shipAlso, that it was noted to ship that morning and I would have SaturdaySo I completely missed my appointment and there was no reason as to whyI took off the morning for this specifically and had bee

January 26,
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
*** *** *** *** *** ***
*** ** ***
Complaint ID: ***/ *** *** on behalf of *** ***
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the *** *** ***Insurance Plan, of which Mr*** *** and Mrs*** *** are membersThis letter is in response to the rebuttal we received from your office on January 20, Thank you for the opportunity to address Mr***’ concerns as expressed in Complaint ID: ***
The maximum allowed balance of $is not specific to one medication, the total is the sum of any standing balances on the account as well as the balance of orders which are in process The total cost of the order in question which included three medications was $The method of payment on file declined twice on December 5, When an order is voided due to payment issues, the member would need to request the order to be placed again
In an effort to ensure Mrs*** had medication on hand, an override was entered to allow the medication to be purchased at a retail pharmacyWith the purchases completed at the local retail pharmacy, the next available refill date for CVS/caremark mail order is February 13, Since the order was voided, the prescriptions never returned to the refill screen, this is also the reason the status of the order is “in process”Internally, CVS/caremark representatives have the ability to manually place a refill request by sending notification to the dispensing pharmacyIn this instance, that would be the step that would be taken to restart the requested medications; Mrand Mrs*** can contact customer care at *** to initiate the order
We sincerely apologize for any frustration or inconvenience that Mr*** experiencedWe value Mr*** as a member and we are confident that future service will consistently reflect our commitment to our purpose, "helping people on their path to better health"Should you or Mr*** have any additional questions or concerns, please do not hesitate in contacting me at 1-***
Sincerely,
*** ***
Member Advocate

This is the second time this company, has given me the run around about a prescriptionFirst of all, they sent my eye doctor an authorization form in which my eye doctor faxed to them times, and they keep complaining they haven’t gotten the formThen without any reason, they have denied me by *** eye drops that I need, because I have been diagnosed with severe eye drynessI have been using *** for over years, and CVS Health who have never met me or anything is denying me of a prescription I seriously needThis is the worst company I have ever had the misfortune of using, I would not recommend this company to my worst enemyThis company is horribleI need my *** and they have no legitimate reason denying me this prescription

My Ophthalmologist Sent a Prescription for *** * One Drop in Right Eye at Bed Time Dispense Bottles for a a month Supply - I was sent only boxes with my most recent order (which is a month supply) and CVS Caremark has charged me my Day copay!
When I called CVS Caremark to try and resolve this issue the Pharmacist told me my eye doctor only Ordered bottles and not the I requested a copy of the Original Prescription and when I reviewed it my Ophthalmologist had actually ordered that bottles be dispensed! The Pharmacist LIED to me!
I Expect an apology and Resolution of this issue because the CVS Caremark Contract with my Health Insurance is for a month/day supply of medication for the copay I am charged

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***Please add your rejection comments below.
This is not a resolutionMy doctor submitted an authorization in January It took them until December to approve the medicationTo say we have to go through that month process again every months is ridiculousIf there is a new medication that does better than *** does, I have full confidence my doctor will be on top of that and discuss changing my medication regimen with meI don't object to trying something new when it's not forced down my throat like CVS has done and continues to do with this proposed "resolution"I do object to my employer's prescription drug carrier arbitrarily refusing to cover medications that have worked and been covered for years to try to further their own corporate agenda of trying to force the makers of *** to reduce their costsThat does nothing to benefit the patients you are contracted to cover
Regards,
*** ***

Company stated I paid for my cancer medicine on June 22, I paid the bill in question with a personal check on April 12, The company stated on the explanation of benefits that I paid the bill on June 22,I would like for CVS Specialty to send me a letter stating that I did pay my April bill in April and the June 22nd date is incorrect because of something on their endI have addressed this issue with CVS Specialty in April, May and JuneOn July 2, I attempted to resolve this issue; three hours and many runarounds later, they will not provide me with the telephone number/law firm that I need to speak toThey have not sent this to a collection agency ythey do their information is not correct and I want it correctedI want this corrected with the above mentioned letter

October, 5,
Revdex.com
Donald Lynch Boulevard, Suite
Marlborough, MA 01752-
Complainant ID: *** / *** ***
To Whom It May Concern:
This letter is in response to the correspondence we received from your office on September
14, Thank you for the opportunity to address Mrs*** concerns regarding three claims totaling $that were not applied towards her deductable accumulations
Upon review of Mrs*** concerns I was able to confirm the balance came from three claims in the amounts of $664.65, $50.00, and $Mrs*** was incorrectly placed in the wrong prescription plan by her employer’s benefits officeMrs*** should have been placed in the High Deductable HSA plan and instead was placed in the No Deductable PPO plan in errorThis was due to a misunderstanding by Mrs***’ benefits office that sends the eligibility files to CVS CaremarkOn August 11, Mrs*** was sent a letter to let her know that she was undercharged for some of her prescription medications between January 1, and March 8, 2016.
The letter is not indicative of her plan benefit or CVS Caremark penalizing Mrs*** for what became an underpayingThe intention of the letter was to inform Mrs*** corrections were being made to the amount she owed based on the fact that the deductible had not been met at the time of the claimsFurthermore, the undercharges could affect Mrs*** high deductible health plan status and could result in tax penalties for Mrs***We are obligated to notify Mrs*** of these potential tax penalties, and seek to help her in avoiding such through the correctionMrs*** is not obligated to pay this money back, although is required to report the undercharge on her taxes at the end of the year
We value Mrs*** as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mrs*** have any additional questions or concerns, please do not hesitate to contact me at ###-###-####. My office hours are Monday thru Friday from 9:a.mto 5:p.mCentral Time
Sincerely,
*** ***
Member Advocate

September 21,
Revdex.com
*** *** *** *** *** ***
*** ** ***
Complaint ID: ***/ *** ***
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the health plan for ***
*** ***, of which Mr*** *** is a memberThis letter is in response to the correspondence we received from your office on September 12, Thank you for the opportunity to address Mr***’s concerns as expressed in Complaint ID: ***
As stated in Complaint ID: ***, Mr***’s order from August 29, was never delivered to himThe Mail Innovations tracking information indicated his order was delivered; however Mr*** could not confirm the order was delivered to himOur mail order pharmacy processed a replacement order on September 13, and per *** tracking information the order was delivered on September 14, I spoke with Mr*** on September 15, and he confirmed receiving his medications
We value Mr*** as a member and we remain fully committed to our purpose, “helping people on their path to better health”Should you or Mr*** have any additional questions or concerns, please do not hesitate in contacting me at ***
Sincerely,
*** ***
Member Advocate

In Mid February an order was placed by my physician for a Rx CVS created an order - Rx# ***
I have repeated told CVS that:
I have not received the Rx
They have FAILED to call me on a line that indicates CVSAs an Identity Theft Victim three times over, I do NOT answer un-identified inbound calls
I have repleted the above to them now in over email/messages
Finally late last week a *** from the Service Recovery team left a voicemail message while calling from an un-identified telephone number I returned this call this morning He repeated the same old retorect that they had delivered.the Rx to my mailbox yet they fail to show proof of same
I will is necessary submit to the *** Postal Inspector an affidavit of said facts in this case for possible criminal investigation by either a postal service worker or a criminal sorting thru my mail box
This Rx is necessary and ordered from my doctor who is concerned with my prostate health and further d

This is in response to your inquiry dated September 30, regarding mail order prescriptions. We verified letters were sent to the member and his physicians regarding prescription utilization and/or coordination of care concernsWe realize that our member’s often have multiple health
issues and may receive medications from more than one healthcare practitioner; however it can be a problem if the practitioners are not aware of others prescribing similar medications. The request for information falls under HIPAA’s definition of “Health Care Operations” which permits sharing of patient identifiable health related information, also known as “Protected Health Information,” between a practitioner and the health plan or the health plan’s Business Associate that act on their behalf Therefore, members are not required to sign an authorization or consent form in order for the practitioner to share the requested information with the stated parties. We verified a letter was mailed to the member on August 26, advising the prescription he requested to refill could not be filled as it was filled on August 25, We verified a refill was ordered on July 23, 2015; however, it was too soon to be filled so it was placed in future fill until the fill date of August 25, The prescription was processed and shipped on August 25, The member has multiple prescriptions on file for the same medication; therefore, when he is on the website, the information he sees is pertaining to each prescription number It may state one prescription number is ready for refill; however, a refill was already requested under a different prescription number. We also verified we had two prescriptions on file for different medications in the same drug classA fax was sent to the member’s physician on July 27, inquiring to see if he were to take both medications togetherHis physician advised us not to ship one of the medications and a letter was sent to the member on July 29, advising of this information. We also verified the member has an outstanding balance of $for an order that was received and shipped on September 30, 2015. We attempted to contact the member; however, we were unsuccessfulA letter was sent to the member. Thank you in advance,*** ***

I am a pregnant women who has been diagnosed with gestational diabetes My doctor has prescribed me insulin and CVS Caremark denies my meds My doctor and my pharmacist can't even begin to believe they are denying my meds I would like CVS Caremark to dispense the meds so that I can get control of my gestational diabetes

In two sentences, for over weeks CVS/Caremark refuses to mail my prescriptionsAfter speaking with almost different persons they still refuse when they acknowledge that it was an IT problem in their ranks
CVS/Caremark (CVSC) received my and my wife’s order on July 24, I set up another profile on their website for my wife and myself since we were under another insurance planThis process required two profiles for myself and my wifeWe waited a period of days before reaching out to them to find out why the orders were delayedStarting on August 2, I found out that the problem was the same for the both of us
The doctor’s office stated that they resolved the problem and that I should callCVSC then advised that the problem was with my insurance, no coverageI called my insurance and they confirmed coverage for both the doctor and the prescription programAfter calling again, the case was escalated to *** *** *** was unsure of our information an

I have an internal yeast infection, also known as candida It hurts to a great extent I went to my doctor, and he prescribed on oral treatment as well as an internal treatment (I have extreme discomfort in the groan area, internally as well He prescribed *** which is the only treatment (as far as I know) for an internal yeast infection CVS/Caremark which works with *** *** *** of IL as their pharma provider denied it They then asked for a pre-authorization from my doctor, which he sent in, and they denied it again I called several times to *** of IL to determine why CVS/Caremark refused to cover it I spoke with an agent, and she looked and read the reasons For some reason, under ***, yeast infection/candida was not listed Again, *** is the primary, and only treatment for internal yeast infections as indicated by the National Institute of Health:
OVERVIEW
***
Background
*** (floo kon' a zole) is a fungicidal a

On 11/1/I called in response to a letter I rec’d from CVS/Caremark telling me I HAD to order my prescription for *** once a month pill directly through CVS or mail order Service person *** took my info and told me we could do ALL of my prescriptions that way, that I could just go on-line and re-order them as needed He told me he’d contact my doctors and previous pharmacy and get all the info, took my credit card and we were done
A week later I began receiving packages, bottles of a nasal spray supplement and a package of *** I NEVER REQUESTED THESEWhen I called spoke to “***” who tried to tell me that my doctor requested these First of all, Drs*** and *** would have NO KNOWLEDGE of CVS/Caremark unless CVS CALLED THEM, which they didThe doctors ordered nothingI asked for a supervisor as *** was no help (kept telling me to call my doctors!) *** was somewhat helpful but told me “we need to listen to the original phone call to proces

April 7,
Revdex.com
*** *** *** *** *** ***
*** ** ***
Complaint ID: ***/ *** ***
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the health plan for *** *** ***, of which Mr*** *** is a memberThis letter is in response to the correspondence we received from your office on March 16, Thank you for the opportunity to address Mr***'s concerns as expressed in Complaint ID ***
Upon re-evaluation of the concern, our records reflect that at this time we have not received the necessary information needed from Mr***’s physician to complete the exceptions processShould Mr***’s prescribing physician wish to submit this request they can do so by contacting CVS/caremark at ***. Unfortunately, without the required information we are still unable to resolve this in a favorable matter for Mr***
We sincerely apologize for any frustration or inconvenience that Mr*** experiencedWe value Mr*** as a member and we remain fully committed to our purpose of "helping people on their path to better health"Should you or Mr*** have any additional questions or concerns, please do not hesitate in contacting me at ***
Sincerely,
*** ***
Member Advocate

Received RX insurance coverage for CVS Caremark a few weeks prior Filled my prescription on August 30th and was told to pay the full $deductible on this purchase, only to find out a later date that the 30th was the final day of coverage for the year and that the deductible had reset when going to fill prescription once again in early October Any reasonable prudent person who knew the deductible would be reset the day after would have waited hours to fill that prescription unless it was life or death
Have contacted customer service and they have refused to work with me to refund this

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ***Please add your rejection comments below.
As I said in my original complaint I have gotten different answers from Caremark. This seems to be yet another response. If they want to resolve it, they should sent me original plan documentation that shows what they say is actually in the plan. When I pull up the plan on-line, I do not find the word "powder" anywhere in the file. To further discredit their claim about powders in use in prescriptions is the fact that they have been covering my on prescription that has an oil soluble powder in it
Regards,
*** ***

Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont*** *** *** *** *** ***
*** ** *** Complaint ID: *** / *** *** To whom it may concern: CVS/caremark administers the prescription benefits portion of the *** *** health
plan, of which Mrs*** *** is a memberThank you for the opportunity to address Mrs***’s concerns regarding the order she states she attempted to cancel with our specialty pharmacy. Upon review of Mrs***’s interaction with our Pharmacy Service Representative and Pharmacist we could not verify that she requested her order in question as described in her complaint to be canceledMrs*** contacted our Specialty Pharmacy on June 8, stating that she had received correspondence from the Specialty Pharmacy concerning an order which was pending for her Mrs*** spoke with a Pharmacy Service Representative and scheduled the delivery of the medication in questionMrs*** indicated that she would be out of the country from June 10, until July 1, 2015. The Pharmacy Service Representative suggested that we ship on July 6, for arrival on July 7, to avoid any issue with potential plan or flight delays and Mrs*** agreedMrs*** asked what to do if she wanted to cancel the order and the representative advised her that we need at least hours notice in order to cancel. Mrs*** did not admit to or say anything to alert the Pharmacy Service Representative that she felt uncomfortable with scheduling, ordering or receiving the medication in question Additionally, Mrs*** asked to speak with a pharmacist to inquire what to do if a dose was missed. She was transferred to a pharmacist who counseled her on the importance of compliance Mrs*** also asked additional questions about the medication’s stability, side effects and efficacyMrs*** did not express concern or advise that she wanted to hold or cancel the order We regret for this particular situation, CVS/caremark’s return policy would not allow for the return of the medication for credit. CVS/caremark cannot restock and/or resend the medication after it has left our pharmacy facility, and all returned medication is destroyed. Even if a recipient refuses the shipment or returns the medication, if under our policy the medication cannot be returned, the recipient is still responsible for the full copayment. We value our members and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mrs*** have any additional questions, please do not hesitate in contacting me at 1-***. Sincerely, *** * ***Member Advocate