Caremark PHC, LLC

CVS/caremark administers the prescription benefits portion of the [redacted]. Insurance plan, of which Mr. [redacted] and Mrs. [redacted] are members. This letter is in response to the rebuttal we received from your office on January 20, 2016. Thank you for the opportunity to address Mr. [redacted]'s concerns as expressed in Complaint ID [redacted]. The maximum allowed balance of 250 is not specific to one medication, the total is the sum of any standing balances on the account as well as the balance of the orders which are in process. The total cost of the order in question which included three medications was 695.68. The method of payment on file declined twice on December 5, 2015. 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. [redacted]'s had medication on hand, an override was entered to allow the medication to be purchased at the retail pharmacy, the next available refill date for CVS/caremark mail order is February 13, 2016. Since the order was voided, the prescriptions never returned to 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 pharmacy. in this instance, that would be the step that would be taken to restart the requested medications, Mr. and Mrs [redacted] can contact customer care at [redacted] to initiate the order. We sincerely apologize for any frustration or inconvenience that Mr.[redacted] experienced. We value Mr. [redacted] 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. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1-[redacted].

In order to properly investigate your concerns, we are in need of additional information.    Please provide us with the following information:   Patients name, patients date of birth, and the medication in question.

January  22, 2018     Revdex.com 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705   Complainant ID: [redacted] / [redacted] To Whom It May Concern:   CVS Caremark® administers the prescription benefits portion of the NTT Data Inc....

health plan, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on January 8, 2018.  Thank you for the opportunity to address Mr. [redacted]’s concerns regarding his prescriptions not showing up on the Caremark website.   As of January 12, 2018, Mr. [redacted]’s medications are now listed on the Caremark website for him to view.  Once Mr. [redacted] logs onto the website he will need to go to the view all prescriptions link. From the view all prescriptions, Mr. [redacted] will be able to see all of his prescriptions and when they are due for a refill.  Mr. [redacted] will also be able to see when these prescriptions were last filled.  Mr. [redacted] has the option of placing his orders for medication on the Caremark website or by calling customer care. If Mr. [redacted] has any questions regarding the website or needs to place an order, he can contact customer care at [redacted]. This phone number is also listed on the back of his prescription benefit card.   We value Mr. [redacted] as a member and remain committed to our purpose, “helping people on their path to better health.” Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate to contact me at 1-[redacted].  My office hours are Monday thru Friday from 9:00 a.m. to 5:30 p.m. Central Time.     Sincerely,     [redacted] Member Advocate

In order to properly investigate your concerns, we are in need of additional information.  Please provide us with the following information: Member ID number and your Date of Birth,

Complaint ID: [redacted] – [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the [redacted], of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on January 27, 2016. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID: [redacted]
Upon further review, we verified our initial delay in providing a refund for the returned medication was due to the return being unauthorized.  CVS/caremark’s return policy does not allow for the return of medication for credit or refunds.  If the recipient refuses the shipment or returns the medication outside of acceptable reasons for a return under our policy, the recipient is still responsible for the full copayment. After further consideration, an exception was made to allow a credit for the returned medication. Refunding the method of payment used to pay for this order would have been ideal; unfortunately the method of payment has been removed from our files. A request for a refund check was submitted on January 27, 2016; generally this process will take approximately 3 – 4 businesses days to complete. Once the refund check is mailed out, general mailing time frames will apply. 
Additionally, upon review of Mr. [redacted]’s interaction with the customer care team; we recognize that there were several 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. [redacted] interacted.
We sincerely apologize for the frustration and inconvenience that Mr. [redacted] experienced. We value Mr. [redacted] 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. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
Sincerely,
[redacted]
Member Advocate

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 #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

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 #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

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 # [redacted]. Please add your rejection comments below. 
Since I have never ordered any thing from CVS, and never will after this fiasco, why is prescription adherence any of there concern? That is between me and my doctor. The dates you entered don't make any since either. Since you sent the request out in March, why would my doctor wait until December to respond. She said they received a fax from you in December. Also you did not address my request to have my account flagged to not fill any prescription without my authorization.    
[redacted]

Dear Revdex.com:
I have reviewed the response submitted by CVS Caremark and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I appreciate to have read that they acknowledge further training and coaching is necessary for their customer care team and feedback was given to each customer care representative.  I have high hopes that the complaint/issue is a thing of the past.   I also appreciate the apology of frustration and inconvenience that this has caused my son as well as myself. Apology accepted.  I understand that by choosing to accept the business response that my complaint will be closed as resolved.  
Regards,
[redacted]

So I was charged $20.00's that one a day for 90-days May 25th, and Got another one July 7th for $15.26 for 2-a day.according to the one from May I believe I have paid all I owe.I wouldn't have this issue if I could get where I wanted at my local pharmacy![redacted]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 # [redacted].   Regards,
[redacted]

August 4, 2015 [redacted] Complaint ID: [redacted] To whom it may concern: CVS/Caremark administers the prescription benefits portion of the health plan for the [redacted] Children’s Hospital...

MC of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on July 28, 2015. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID [redacted]. Upon review of this concern, it was determined that Ms. [redacted] was enrolled in a [redacted] plan which is deemed inactive. We have verified that Ms. [redacted] is in fact enrolled in an active plan effective July 1, 2015 under [redacted] Children’s Hospital MC. We have also confirmed that as of July 29, 2015, her eligibility information has been updated to allow Ms. [redacted] to utilize her prescription benefits as needed.  We sincerely apologize for any frustration or inconvenience that Ms. [redacted] experienced. We value Ms. [redacted] as a member and we remain fully committed to our purpose of “helping people on their path to better health”. Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted]. Sincerely,  [redacted]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 # [redacted]. Please add your rejection comments below. 
Regards,
[redacted]

February 22, 2017
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont290 Donald Lynch Boulevard, Suite 102Marlborough, MA 01752-4705
 
Complaint #[redacted]
 
To Whom It May Concern:
 
CVS Caremark administers the prescription benefits...

portion of the [redacted] Insurance Companies health plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on February 6, 2017. Thank you for the opportunity to address Ms. [redacted]’s concerns with being unable to refill her prescription for [redacted].
 
After reviewing Ms. [redacted]’s concern, we have confirmed Ms. [redacted]’s plan prefers the generic alternative of [redacted]® to be dispensed; therefore we attempted to request the alternative from the prescriber. While awaiting for a response, Ms. [redacted] called to check the status of the order. Upon advising Ms. [redacted] of the pending request, she stated she didn’t want to change. Per her request, we notified the pharmacy and the order continued processing.  Mrs. [redacted]’s prescription shipped February 4, 2017 and was delivered on February 6, 2017.
 
Additionally, it has been determined that our customer care team failed to meet our level of expectations.  Upon review of Ms. [redacted] interaction with the customer care team; we recognize that there were several opportunities for additional training and coaching for our staff. 
 
We value Ms. [redacted] 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 Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
 
Sincerely,
 
[redacted]
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 # [redacted].
This is the exact same response I've received three times now.  I cancelled my auto-refills 16 days before shipment; CVS told me I had to cancel 11 days before not to be charged.   CVS NEVER disputed these facts - that I was in compliance with its cancellation policy but was charged for prescriptions anyway.  This is the second time CVS has shipped me prescriptions I didn't order.  CVS is using abusive business practices.  As I've now stated three times, CVS can arrange for pickup and shipping of the prescriptions that should have never been sent to me; I will leave them on the front porch.   I am not going to waste my time dealing with this when I followed CVS's policy and CVS did not.  
Regards,
[redacted]

Please provide the rebuttal response

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 # [redacted]. Please add your rejection comments below. 
I did not want this prescription filled by them. They tried to slide more than a $15 co-pay through [redacted].  In fact they tried to slide a $120 payment through.  $105.00 was suppose to be billed for another prescription.   The doctor's office canceled the prescription they sent Caremark by mistake.  I called Caremark after they sent me an email.  They told me they were filling the prescription anyway because they received it from the doctors and they did not see the cancelation. It wasn't my call to cancel the prescription.   Every prescription I get fill by Caremark is a hassle.  I have to get my Insulin and several other high dollar prescriptions filled by Caremark but since they want to throw away my business over a $15.00 prescription that is fine.  I am not going to do business with a cheesy business even if it puts my life at risk.
Regards,
[redacted]

February 5, 2018   Revdex.com 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705   Complainant ID: [redacted] / [redacted]   To Whom It May Concern:   CVS Caremark® administers the prescription benefits portion of the health plan for New York...

[redacted], of which Mrs. [redacted] is a member. This letter is in response to the correspondence we received from your office on January 16, 2018.  Thank you for the opportunity to address Mrs. [redacted]’s concerns regarding the delay her husband experienced receiving his medication.   On January 9, 2018, Mrs. [redacted] contacted CVS Specialty® to place an order for her husband’s [redacted] for delivery on January 11, 2018.  At the time the order was placed, the prescription on file for [redacted] was expired. Since this drug is a controlled medication a new prescription is needed every 30 days which caused the order to be delayed. When Mrs. [redacted] called CVS Specialty on January 12, 2018 to get the status of Mr. [redacted]’s order she was advised that a new prescription was needed. On January 16, 2018, Mrs. [redacted] called back and scheduled Mr. [redacted]’s order for [redacted] to be delivered on January 19, 2018.  Due to the filling pharmacy not having sufficient stock, Mr. [redacted]’s order was not delivered as scheduled. CVS Specialty Pharmacy in Monroeville was able to fill and ship Mr. [redacted]’s medication on January 19, 2018.   On January 22, 2018, [redacted], with the Specialty Cares Team, contacted Mrs. [redacted] to verify the medication order was delivered. Mrs. [redacted] confirmed the order was delivered on January 20, 2018. Mr. and Mrs.  [redacted] have been advised that since [redacted] is not a specialty medication it can be filled locally and a new prescription will be needed for his next fill. We have also assigned single point of contact, [redacted], to assist Mr. and Mrs. [redacted] with their future orders.  [redacted] can be reached at 1-[redacted], extension [redacted].   We value Mr. and Mrs. [redacted] as members and remain committed to our purpose, “helping people on their path to better health.” Should you or Mr. and Mrs. [redacted] have any additional questions or concerns, please do not hesitate to contact me at 1-[redacted].  My office hours are Monday thru Friday, 9:00 a.m. to 5:30 p.m. Central Time.     Sincerely,     [redacted] Member Advocate

In order to properly investigate your concerns, we are in need of additional information.  Please provide us with the following information: Member ID number and Date of Birth.

February 6, 2017
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont290 Donald Lynch Boulevard, Suite 102Marlborough, MA 01752-4705 
Complaint ID: [redacted]/ [redacted]
 
To Whom It May Concern,
 
CVS Caremark administers the prescription benefits...

portion of many health plans. This letter is in response to the correspondence we received from your office on January 23, 2017. Thank you for the opportunity to address Ms. [redacted]'s concerns as expressed in Complaint ID: [redacted].
 
After reviewing Ms. [redacted]’s concern, it was verified the two prescription benefit plans in question are both set as primary; we are not showing one as primary and the other as secondary. When Ms. [redacted] needs to fill a prescription, she should provide her insurance card for the benefit she wants to use at the retail pharmacy as primary. Due to Ms. [redacted]’s benefits both being primary, the retail pharmacy will not be able to process her prescriptions through her alternate benefit plan. If Ms. [redacted] seeks to obtain additional reimbursement through her alternate benefit she would need to submit a request for paper claims reimbursement; her plan benefit allows for paper claims reimbursement. CVS Caremark is unable to make changes to reflect what Ms. [redacted] is requesting. Ms. [redacted] would need to contact her benefits directly to change the status of her coverage from primary to secondary.
 
Lastly, upon review of Ms. [redacted]’s interaction with the customer care team; we recognize that there were several 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 Ms. [redacted] interacted.
 
We value Ms. [redacted] 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 Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
 
Sincerely,
 
 
[redacted]
Member Advocate

February 5, 2018   Revdex.com of Eastern MA, ME, RI, & VT 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705 Complaint ID: [redacted] / [redacted] M. [redacted]...

                                        ...⇄ To whom it may concern:   CVS Caremark® administers the prescription benefits portion of the [redacted] health plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on January 20, 2018. Thank you for the opportunity to address Ms. [redacted]’s concern as expressed in Complaint ID: [redacted].   Upon review of this inquiry and concern, we verified that Ms. [redacted]’s accumulations were satisfied in October 2017. We re-verified and confirmed that Ms. [redacted]’s deductible was completely satisfied on April 2017; then in October 2017 Ms. [redacted] satisfied her Maximum out of Pocket expense. Ms. [redacted]’s accumulations were checked multiple time to verify they were correct. We could not find any evidence of Ms. [redacted] being overcharged. At this time we conclude Ms. [redacted] is not owed any reimbursement for copayments assessed for her medications. If Ms. [redacted] can provide any documentation which reflects where she was overcharged we would be glad to further review this situation.        We value our members and we are confident that future service will better reflect our commitment to our purpose of, “helping people on their path to better health.” Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1-[redacted].   Sincerely,     [redacted] Member Advocate