Caremark PHC, LLC

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.
Dear Sir or Madam,I am requesting that complaint #*** be reopened.On 9/29/15, CVS/Caremark responded to my complaint with:I spoke with the member on September 23, and advised per his *** *** benefits, he does not have out of network benefitsI also advised him there is not an option for reconsideration as he is not being denied a benefit The member did advise this is the only pharmacy in the US that is able to fill the medicationI advised the member I would do some additional research for him and contact him back. I contacted *** *** ***, a preferred pharmacy, who advised they are able to order the ingredients and could compound the medication into a lozenge. I spoke with the member today and advised of this informationThe member stated he would contact *** *** *** and his physicianThe member did not require any further assistance at this time.It took more than days to confirm whether or not *** *** *** would be able to fill my prescription but I have since learned that are able to do so, leaving me back at square one; having coverage for a medically necessary medication but being denied any reimbursement because the only pharmacy in the US where it is available is out of network with no sort of appeal process.Thanks,*** ***

I have my health insurance through my company The provider is united health care Their prescription coverage is through cvs Caremark In my plan I have a deductible to meet an once that was done my prescription costs are to be 10% of the charge We met our deductible in May, yet Caremark continued to charge us the full price of the prescriptions We over paid out of pocket by we finally just got reimbursed took us many months Our next prescription cost showed that we met our deductible and I paid 10%However recently I picked up prescription and it showed that we had not met our deductibleI am out another We need our medications After many phone calls this issue is not resolved Our pharmacy is in disbelief about this situation This is staring to look like insurance fraud I see that cvs Caremark in were sued for this exact thing in a class action lawsuit Is this happening again? In the United health care system it shows that our deductible

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.
[I called and spoke with a representative before the prescriptions were mail ordered in and asked that my account be noted not to ever fill prescriptions with me calling in to orderHe assured me that it was noted and I had to call in to orderWe I called in on April 3rd, I again to the representative that I would call in when I was ready to order my prescriptionI told every representative that I have spoken with that I want to call in or go online to order my prescriptions. .]
Regards,
*** ***

CVS Caremark began working to fill prescription on a mail order basis several years agoTo the best of my knowledge with federal employees, retireesI’m retired as of 12/10/I purchased medication through *** Pharmacy to include above medications that was until the co-pay soared to untenable levels 9$$)Cvs has seems to demonstrate a complete total scorched earth business model by causing delays or denials and prescriptionsIt has added a burden to my family practice physician and a dire exasperation to me with the intent to discourage me from using CVS Caremark by asking me to jump through hoops for fireThen telling me after every day (I was dotted and T’s crosses), that they didn’t have an orderIt (the CVS Comp) were of good conscience, they would work with this patient, not against

Good Afternoon,
We are in receipt of your correspondenceIn order to properly investigate your concerns, we are in need of additional information. Please provide us with the following information:Member ID number, your husband’s full and Date of BirthWe apologize for any frustration and
inconvenience you may have experiencedIf you have any additional questions, please feel free to contact our toll-free at: *** ***

This is in response to your inquiry dated October 7, regarding mail order prescriptions and letter that were sent. 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. I spoke with the member and advised of this informationI advised him this is not done to inconvenience the member; however, the Member Quality Assurance Program is in place to ensure the FEP members are receiving quality patient care as it relates to prescription medicationThe program focuses on member safety, prescriber coordination and ensuring that benefits are being administered according to the terms of coverage outlined in the *** *** *** *** *** Service Benefit Plan Brochure. I also advised CVS Caremark Mail Service Pharmacy may contact his physician directly regarding medications if we are unable to fill them or if they may cause interactionsPer the member’s request, notes have been placed on file regarding his grandson to not contact the physician to change any medicationsIt also states, if we are unable to fill the medication for any reason, to send the original prescription back to the memberThe member was satisfied and did not require any further assistance at this time

August 12, 2015, Revdex.com*** *** *** *** *** *** ** ***Complaint ID: ***/ *** *** To whom it may concern: CVS/caremark administers the prescription benefits portion of the health plan for *** *** ** ***, of
which Ms*** *** is a member. This letter is in response to the correspondence we received from your office on July 29, 2015. Thank you for the opportunity to address Ms***'s concerns as expressed in Complaint ID ***. Upon review of Ms***’s concern, we confirmed that order # *** was received via electronic prescription request from the prescriber’s office on July 23, 2015. Ms*** was notified on July 24, that the order was processing and shipping within 3-days. On July 25, when Ms*** attempted to cancel order # *** online the order was too far along in process to be successfully canceled. Notification was sent to Ms*** advising that the order could not be cancelled as requested. Ms*** is stating that the notification prompted her to contact customer care to attempt to cancel the orderPer call monitors, Ms*** asked that another order (order#***) be canceled instead, and was successfully cancelled Upon review of the interaction between Ms*** and our customer care team there was no mention of order # ***Order # *** shipped on July 28, For this particular situation, CVS/caremark’s return policy does not allow for the return of medication. CVS/caremark cannot restock and/or resend medication after it has left our pharmacy facility, and all returned medication is destroyed. As a onetime courtesy, a mailer had been sent to Ms*** to retrieve the order for creditTo ensure that this does not occur in the future, Ms*** may want to communicate her concerns with her prescriber as these prescription requests were not initiated by CVS/caremark. She may also adjust her messaging alerts if there is a better method of contact. We sincerely apologize for any frustration or inconvenience that Ms*** experienced. We value Ms*** as a member and we remain fully committed to our purpose, "helping people on their path to better health". Should you or Ms*** have any additional questions or concerns, please do not hesitate to contact me at 1-***. Respectfully, *** ***-***Member Advocate here

I have my health insurance through my company The provider is united health care Their prescription coverage is through cvs Caremark In my plan I have a deductible to meet an once that was done my prescription costs are to be 10% of the charge We met our deductible in May, yet Caremark continued to charge us the full price of the prescriptions We over paid out of pocket by we finally just got reimbursed took us many months Our next prescription cost showed that we met our deductible and I paid 10%However recently I picked up prescription and it showed that we had not met our deductibleI am out another We need our medications After many phone calls this issue is not resolved Our pharmacy is in disbelief about this situation This is staring to look like insurance fraud I see that cvs Caremark in were sued for this exact thing in a class action lawsuit Is this happening again? In the United health care system it shows that our deductible

I m not able to utilize my CVS Caremark insurance for my secondary insurance for my dependentMy dependent has primary insurance through *** and secondary insurance through *** which both use CVS CaremarkI called CVS Caremark advise several times in the month of January that the *** is my secondary insurance which *** has listed as secondary and asked for them to update the second plan as secondary and they advise they cannot helpI am not able to utilize my secondary CVS Caremark insurance at the pharmacy due to both CVS Caremark plans showing as primary insurance*** has also contacted CVS Caremark 01/13/and they were unable to get assistance as well I am having to pay for prescriptions and force to pay for mailing postage for prescriptions to CVS Caremark for reimbursement

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

I am a *** customer of ***The customer service that I received from *** was terribleI was misinformed about the prescription gap coverage which increased my cost for my prescriptionsThe information that I received from *** was not correctI have discussed the problem with several ***’s representatives and supervisorsThese folks transfer my call to various departmentsThese departments tell me that they will get back with me in or hoursI had continue to call to talk with someoneThe *** did not take my case seriouslyI am waiting for an Executive from *** to call me to discuss an approach to fix the problemI am sure that I will have to call *** to initiate this phone call with an ExecutiveThis is terrible customer service which began with *** providing me with incorrect gap coverage information which resulted in a very high cost for my prescription

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 for ***, of which
Mrs*** *** is a memberThank you for the opportunity to address Mrs***'s concerns as expressed in Complaint ID: ***.In review of this concern we are not able to grant Mrs***'s request to fill the medication in question at a local retail pharmacy outside of plan guidelines. Per plan guidelines, once a member has reached their plan benefit retail fill limitation for medications at the local retail pharmacy, the medication needs to be filled by CVS/caremark mail order service. Any medications that are filled outside of this plan benefit fill limitation will result in Mrs*** being responsible for 100% of the cost of the dispensed supplyAny request for paper claims reimbursement for medications filled outside of the plan benefit limit will be denied. In review of Mrs*** account we verified that high priority instructions have been added to further reinforce and ensure that only the requested supply of the medication in question is processed and filledThese instructions include the specific manufacturer that is to be used as well as the National Drug Code (NDC) for the product that is to be dispensedThese instructions were in Mrs*** account before but due to human error they were overlookedWe regret that this is the second instance that this error has been madePlease be assured that the actions that caused this occurrence are not in line with any of CVS/caremark’s procedures nor are they customary of the service CVS/caremark strives to achieveThese actions have been reported and coaching has been provided to the individuals involved with this situationWe sincerely apologize for any frustration or inconvenience that Mrs*** experiencedWe 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 in contacting me at ***.Sincerely,*** * ***Member Advocate

CareMark CVS is a mail order prescription drug company that partners with our medical insurance, *** *** *** *** of SC
On May 23, 2017, CareMark filled two unauthorized prescriptionsBecause this company is SO difficult to deal with, we had a HOLD on our account preventing medications from being filled until we called, double-checked their understanding of the prescription, and released the holdWe never released the two prescriptions in question, and CareMark admitted that they filled it without our authorizationOur credit card was billed $on May 24,
Upon receipt of the medication, we immediately called CareMarkDespite admitting their error, they refused to refund our money and they refused to allow us to return the medicationThey admitted that they violated the HOLD and told us to have our doctor rewrite the prescription and they’d send an additional two months worth of medicine that would total the amount billedWe reluctantly agreed since it wa

On June 8, I called CVS CareMark at ###-###-#### to order refills for my meds already on file and submitted CVS CareMark handles medications for my health insurance with *** *** Spoke to a resolution specialist (i.eit was internally escalated on June 8) I ordered medications including *** *** aerosol for a total of $99.01, and was given Confirmation #*** As of June 14, 2017, CVS CareMark has reneged and refused to shipCVS CareMark may have intentionally dawdled til my prescription expired, and then said I needed a new script Also, I can't get a new script as I do not have a relationship anymore with my former doctor Furthermore, none of this was disclosed to me when I ordered on June Now CVS CareMark will not honor my order of June 8, CVS will not fulfill their duty, and I will not get my medication They just keep coming

August 10, 2015 Revdex.com*** *** *** *** *** ***
*** ** *** Complaint ID: ***/*** *** To whom it may concern: CVS/*** administers the prescription benefits portion of the health plan for the *** *** *** *** *** of which Mr*** is a memberThis letter is in response to the correspondence we received from your office on July 21, Thank you for the opportunity to address Mr***’s concerns as expressed in Complaint ID ***. The order in question was received via electronic prescription request from Mrs***’s prescriber’s officeThe order was not initiated by CVS/***. We have verified that there were no comments or direction from Mrand Mrs*** directing our pharmacy not to fill any order requests received from the prescriber’s officeAdditionally, after reviewing calls with our customer care team there was never a request to hold any orders when requested by the prescriber prior to the order shipping outAt this time comments have been added to Mrand Mrs***’s files to ensure that prescription order requests are placed on hold when received until Mrand Mrs*** authorize the order for processing. CVS/*** will not initiate a prescription request unless directed to do so by Mrand Mrs*** Furthermore, upon review of Mr***’s interaction with the customer care team; we recognize that there were opportunities for additional training and coaching for our staff. Where necessary, feedback has been provided to each member of the customer care team with whom Mr*** interactedLastly, we address issues in this office on behalf of the CEO, *** ***; it is not customary that he speak to members directly to resolve their concernsShould Mr*** have any additional questions or concerns regarding this experience and situation, he can contact me at ###-###-#### We sincerely apologize for any frustration or inconvenience that Mr*** experiencedWe 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 Mr*** have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####Sincerely, *** ***Member Advocate

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. Regards,
*** ***

I ordered four medications through mail order servicetotaling $It was shipped by *** MAIL INNOVATIONS*** says they transferred to Post OfficePost Office says they never received packageI need these medications before I run out of them at no extra costs to me

I have a chronic disease that requires me to be on *** From November of until June of my dosage had been consistent of mg a day, which CVS charged me a copay of $ In June my dosage was changed to mg a day, which CVS is charging me a copay of $ When I called to have it corrected, believing it was an error they told me that because my new dosage requires a mg and a mg pill for, they are charging me for two separate prescriptions The end result is I'm getting less medicine for twice the amount of money I spoke to three different "supervisors" who all told me that is their practice and refused to do anything even though it doesn't make any sense I don't understand how it's legal to do this? When I asked if I had my doctor specifically request all mg pills how much they would charge me and they said it would go back to $ Why should the patient be impacted by their practices? I would go somewhere else but they force me to us

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #***I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
*** ***

I am the primary care physician who was caring for *** *** She is under my care for obesity, borderline diabetes and hyperlipidemiaI tried to prescribe weight loss medication called *** for the patient This medication was declined by CVS Caremark but I was instructed by them to write a letter of medical necessity in order to get it coveredI wrote a letter of medical necessity and it was declined again with the instructions to try another medication from their formulary alternativesI prescribed one of the medications from their recommended formulary alternatives and it was deniedI was recommended to write another letter of medical necessity for the formulary alternativeThe letter was reviewed and the medication was deniedI spoke to a representative to ask why they recommended formulary alternatives and then denied itThe representative told me that the formulary alternatives were no longer covered but now methamphetamine was covered with a Copay of less tha