Caremark PHC, LLC

In order to properly investigate your concerns, we are in need of additional information.    Please provide us with the following information: The medication in question

November 30, 2016
Revdex.com
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
Complaint ID: [redacted]
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the health plan for [redacted], of which Ms. [redacted]...

[redacted] is a member. This letter is in response to the correspondence we received from your office on November 17, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Upon review of this concern we verified our customer care team placed a refill order for Ms. [redacted] without her consent. Due to this miscommunication with our customer service team, Ms. [redacted] has been credited $72.18 for the medication in question. Ms. [redacted] has also been allowed to keep the medication in question.
Additionally, upon review of Ms. [redacted]’s interactions with our customer care team we recognize that there were several opportunities for additional training and coaching for our staff.. 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 remain fully committed 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 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]

On behalf of CVS/pharmacy, I would like to apologize to [redacted] for the problem she encountered with CVS mail order pharmacy.  At CVS, our goal is to be a trusted partner in our customers' health care.  When we find that we have disappointed a customer, we believe that it is...

important to understand what happened and to take the appropriate action.   It is our understanding that your orders were delayed from shipping due to policies and procedures that our pharmacy must abide by.  If we can be of further assistance we invite [redacted] to contact Customer Relations at 800-SHOP-CVS (800-746-7287).

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 had a feeling that your business would do nothing about your shady business practices. But at least the complaint and your unsatisfactory responses are now on file with the Revdex.com.
Regards,
[redacted]

July 8, 2017
 
Revdex.com of Eastern MA, ME, RI, & VT290 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 the health plan for Chicago Public Schools, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on June 27, 2017. Thank you for the opportunity to address Mr. [redacted]’s concern as expressed in his rebuttal on Complaint ID: [redacted].
 
Mr. [redacted]’s concerns pertaining to the rejected claim and denied prior authorizations for [redacted] have continued to be reviewed. Previously, we had identified that pursuant to the plan benefit, [redacted] is covered for specific conditions and that the information provided by Mr. [redacted]’s doctor did not meet the criteria for coverage. We had also outlined the steps taken to assist in resolution through the appeals process. Subsequent to our response, however, more information has become available that changes the outcome in Mr. [redacted]’s favor.
 
On June 27, 2017, we learned that all strengths of [redacted] tablets were to have been removed from the list of medications requiring prior authorization for the Chicago Public Schools plan. This change had not been fully implemented at the time Mr. [redacted]’s claim was submitted as intended.  Immediately after the issue was identified, voicemail messages were left for Mr. [redacted] on June 27, 2017 to inform him of the resolution (described below), provide the refund options, and offer to contact the pharmacy to request they process the claim. A second message was left to advise that the pharmacy had processed the claim and would issue the refund; he would only need to come into the store. Unfortunately, we are unable to oblige Mr. [redacted]’s request to email information to him as member communications are done by telephone for these matters.
To expedite the process of restoring Mr. [redacted]’s refund, an override was provided allowing his retail claim to process. Mr. [redacted]’s now has a paid claim for his earlier [redacted] fill. Mr. [redacted] can pick up the refund of the amount he originally paid less his $10.00 copayment at the pharmacy where he purchased the medication.
 
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 [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. As a company, CVS should take be responsible for their employee's actions. When I called the call center for the a certain medication's mailing address to be changed, I am assuming the "Customer care representative to know their company system and READ additional comments or notes.  THEY (so called customer care representatives) DO NOT READ NOTES OR ADDITIONAL COMMENTS. Here's another example of how they are not reading notes in the file!!On 09/21/16 a person named [redacted] left a message on my phone voicemail.  The message stated to return her call by calling [redacted] and "ask for extension [redacted]"  When I called that number, it was the call center and "customer care representative" stated she was not able to transfer me to extension [redacted]. I stated that I was returning [redacted]'s call from Caremark and I was given instruction to ask for extension [redacted]. Basically the customer care person told me that I was wrong and she does not transfer calls to another extension. When [redacted] called, I addressed above issue I had with the customer care representative.  [redacted] stated that the customer care rep made a mistake by not reading the comment or note not my file to transfer the call.  NOT READING THE NOTE AGAIN!!!   [redacted] stated "she should have read  the note"  YES!! the customer care person should have read the note  but she didn't.   The person I called on 08/23/16 to change the mailing address for a certain medication should have READ THE NOTE AS WELL!  IT DOES NOT SEEM LIKE ANYBODY IS READING ANY NOTES!  I CAN NOT TRUST THE COMPANY!I would like company to  mail future orders with express next day delivery with signature paid by the company  CVS is not taking responsibility for continued mistakes of the employees. Regards,
[redacted]

This is in response to your inquiry dated August 31, 2016 regarding the member’s mail order benefits.
I verified the member ordered the medication on August 23, 2016 and it was processed with the correct address on file; however, there were comments on file stating to ship it to a different...

address. The address was changed in the pharmacy and the medication was shipped to that address.  The notes on file have since been removed and the address on file is updated. I verified the member contacted the Customer Care Unit on August 29, 2016 and spoke with an Executive Recovery Representative. The Executive Recovery Representative placed a reship request for the medication on August 29, 2016.  The Executive Recovery Representative advised the member he would follow the order to ensure the address was not changed in the process. The address in the system had been imputed via the secure portal online by the member with a different city listed on August 23, 2016. The Executive Recovery Representative selected the correct address when placing the reship; however, it defaulted to the address the member provided online. The member received an email confirmation of the order and contacted the Customer Care Unit on August 29, 2016 as it was the incorrect city. The member spoke with a Senior Customer Care Representative who updated the city. The medication was shipped on September 1, 2016 and was delivered on September 2, 2016. The Executive Recovery Representative added notes to the member’s file per the member’s request to ship all packages UPS next day with signature required at the member’s expense. The Executive Recovery Representative contacted the member on September 1, 2016 to advise the medication had been shipped. The member did not require any further assistance at this time.
In addition, a request was sent to the dispensing pharmacy to submit a HIPAA disclosure form as the person at the incorrect address opened the package.

.  If you wish, you may update it before sending it.]
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]

December 14, 2015Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont[redacted]Complaint ID: [redacted] / [redacted] [redacted]To whom it may concern: CVS/caremark administers the prescription benefits portion of the [redacted]...

[redacted], of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on November 30, 2015. Thank you for the opportunity to address Mr. [redacted]’ concerns as expressed in Complaint ID [redacted].Upon review of the concern, we found that Mr. [redacted]’ request for reimbursement was denied in error by our claims department. Our claims department has been made aware of this and is working to reprocess the reimbursement request. In accordance with Mr. [redacted] plan guidelines he will be reimbursed based on the contracted rate and not the cash price he paid at the retail pharmacy.  Mr. [redacted] can expect to receive a reimbursement check within 30-days.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 [redacted].Sincerely,[redacted]Member Advocate

September 16, 2016
 
Revdex.com
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
 
Complaint ID: [redacted]/ [redacted]
 
To whom it may concern:
 
CVS Caremark administers the prescription benefits portion of the health plan for **...

[redacted] **., of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on September 7, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Upon review of this concern, we verified that the $200.00 refund requested is actually part of Ms. [redacted]’s Member Reimbursement Account (MRA), which is funded by her employer. This MRA account has been active since July 1, 2014.  With an MRA, the member will have funds stored in an account that can be spent on eligible medical and/or prescription expenses. The funds are tax-exempt and provided by the employer. Once the funds in the MRA have been exhausted, the member will be responsible for paying subsequent out of pocket costs. MRA’s can be maintained by CVS Caremark or by other companies, who would then send CVS Caremark files detailing the amounts contributed to and deducted from the account. In Ms. [redacted]'s case, the MRA is maintained by her medical benefit and CVS Caremark receives this information after the transaction has occurred. Upon processing Ms. [redacted]’s prescription through the benefit, her MRA would pay for the prescription through company dollars thus the CVS Caremark website would indicate a responsibility of $0.00. When checking drug cost on the CVS Caremark website the following disclaimer is provided: “Estimated usage, costs and savings are calculated through current plan year or the end of current calendar year. Actual savings may vary depending on plan structure, deductibles, previous payments, future claims and prior authorizations. Actual and projected costs may vary.” Ms. [redacted]’s web site concern has been reported to the CVS Caremark Web Team for review.
 
Additionally, Ms. [redacted] has the option to call her CVS Caremark customer service team at ###-###-#### to obtain copayment and financial responsibility information. The customer service representatives have access to financial information to verify the actual MRA cost when the member’s responsibility is $0.00. Regrettably, Ms. [redacted]’s request for a refund was reviewed and denied since the monies used were actually her company’s contribution.
 
We value Ms. [redacted] as a member and we remain fully committed 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 ###-###-####.
 
Sincerely,
 
 
[redacted]
Member Advocate

June 12, 2015 Revdex.com290 Donald Lynch Boulevard, Suite 102Marlborough, MA 01752-4705Complaint ID: [redacted]  To whom it may concern: CVS/ caremark administers the prescription benefits portion of the health plan for [redacted] of...

which [redacted] is a member. This letter is in response to the correspondence we received from your office on June 2, 2015. Thank you for the opportunity to address [redacted] concerns as expressed in Complaint ID [redacted]  Upon review of this concern, we confirmed that our mail order pharmacy did receive a 30 day prescription from [redacted] physician and the prescription was filled in accordance with his plan guidelines and the appropriate mail order copayment was applied. As a onetime courtesy, [redacted] was issued the $36.46 refund that he requested.  [redacted] credit card was refunded on June 3, 2015. This 30 day prescription has been discontinued to prevent it from being refilled through the mail order pharmacy. Additionally, upon review of [redacted] interaction with our customer care team; we recognize that there were several opportunities for additional training and coaching for our staff.  Feedback has been provided to each member of the customer care team with whom [redacted] interacted with.  Please note that our goal is to ensure that our valued customers receive only the highest level of customer care.    We sincerely apologize for any frustration or inconvenience that [redacted] experienced. We value [redacted] as a member and we remain fully committed to our purpose of “helping people on their path to better health”. Should you or [redacted] have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####. Sincerely,  [redacted]Member Advocate

Complaint: [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the health plan for [redacted] & Co., Inc., of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on...

February 16, 2016. Thank you for the opportunity to address Mr. [redacted] concern as expressed in Complaint ID: [redacted].
Upon review of Mr. [redacted] concerns regarding his deductible for his benefits we verified that the correct plan information was not attached to his account. Mr. [redacted] benefits office is responsible for submitting plan details to his Medical and Prescription providers. Mr. [redacted] has been updated in CVS/caremark’s System to reflect the appropriate plan information.
In researching Mr. [redacted] accumulation, all claims were reviewed and accounted for. Mr. [redacted] was provided incorrect information when we was advised that he would be receiving reimbursed for an over payment. The retail transaction in question went toward Mr. [redacted] deductible for the 2016 benefit year which has been met.
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

June 1, 2015  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 the...

[redacted] Insurance Plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on May 06, 2015. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID [redacted]. Upon review of this concern, Ms. [redacted] is requesting that we honor the copayment quote she was provided when inquiring about her medications. We were able to confirm that due to an incorrect quantity being entered by the representative, Ms. [redacted] was misquoted the cost of the medication. In accordance with Ms. [redacted]’s plan guidelines the copayment quote should have reflected a cost of $100.00 for the medication in question.   Test claims are performed to provide Retail, Mail Order or Paper Claim copayment prices and drug coverage information to our plan member. The copayment prices and drug coverage information provided is only a quote and not a guarantee of coverage. This disclaimer is always provided by CVS/caremark due to changes in price that may occur due to multiple factors within the market. Unfortunately, the quoted price will not be honored and we are unable to resolve this in a favorable matter for Ms. [redacted].  Lastly, upon review of Ms. [redacted] interaction with our customer care team; we recognize that there were several opportunities for additional training and coaching for our staff.  Feedback has been provided to each member of the customer care team with whom Ms. [redacted] interacted with.  Please note that our goal is to ensure that our valued customers receive only the highest level of customer care.    We sincerely apologize for any frustration or inconvenience that Ms. [redacted] experienced. 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 ###-###-####. Sincerely,  [redacted]Member Advocate

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 [redacted]. Mr. [redacted] had three fills of [redacted] between the months of June and August of 2015 at [redacted] Pharmacy on [redacted] [redacted]. The price of each fill matched the [redacted] plan design, showing a 90.00 co payment. According to the plan design Mr. [redacted] would be responsible for 20% coinsurance with a maximum of 90.00 at a retail pharmacy for an approved brand medication. [redacted] was contacted and confirmed a discount coupon was used to reduce the rate to 0. Once Mr. [redacted] switched to mail order, he was assessed the proper co payment of 225.00 which also matches his plan design. Mail order charges for a formulary brand medication would be 20% coinsurance with a maximum charge of 225.00 which also matches his plan design. Mail order charges for a formulary brand medication would be 20% coinsurance with a maximum charge of 225.00. Due to the member not being informed of the estimated cost when calling customer care to inquire about mail order, the return was allowed and credit was given on January 27, 2016. Mr. [redacted] will be receiving the credit balance in the form of a paper check because the credit card used for this order had been removed from the account. 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 [redacted]

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]

December 7, 2017     Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705   Complaint #[redacted]/ [redacted]   To Whom It May Concern,   CVS Caremark administers the prescription benefits...

portion of the Comcast health plan, of which Mrs. [redacted] is a member. This letter is in response to the correspondence we received from your office on November 24, 2017. Thank you for the opportunity to address Mrs. [redacted]’s concerns regarding an order she received which she did not need.   Upon review of this concern, we verified Mrs. [redacted] attempted to remove medications from the Auto Refill program. The Auto Refill and Renewal program allows members to receive prescription refills and renewals of maintenance drugs automatically. Mrs. [redacted] was sent an email advising her order # [redacted] was processing. Furthermore, the email advised if she needed to cancel or change the date of the order she would need to contact customer care or go on Caremark.com before November 20, 2017. Mrs. [redacted] contacted our customer care on November 22, 2017 when the order was in the process of being shipped. Customer care could not cancel the order at this time.   As a courtesy and in an effort to accommodate this situation, packaging has been sent to Mrs. [redacted] to return order # [redacted] for a full credit. If Mrs. [redacted] needs to remove any medications from the auto refill program she can call CVS Caremark customer care or go on Caremark.com to do so.   We value Mrs. [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 Mrs. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1-[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. 
I am not a medicare partipate nor have been. I use the ** entirely since I'm disabled.
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].
 
Regards,
[redacted]

February 16, 2016
Revdex.com
[redacted]
[redacted]
Complaint ID: [redacted]/ [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the health plan for ** [redacted], of which [redacted]...

[redacted] is a member. This letter is in response to the correspondence we received from your office on February 4, 2016. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID [redacted].
Upon review of this concern, we confirmed that there has been a billing issue with Mr. [redacted]’s file which caused a processing delay with his medication. This was due to his insurance information not being updated in November of 2015 when his last 90 day order was processed. Mr. [redacted]’s last 90 day prescription was processed on November 11, 2015. It was also confirmed that Mr. [redacted] filled a 30 day supply of this medication at his local pharmacy on February 4, 2016. Mr. [redacted] was also contacted by a representative from our specialty pharmacy to advise him that his insurance information had been updated and his billing issues have been resolved. The specialty representative also assisted Mr. [redacted] to set up his next 90 day delivery for the end of February. Due to the call volume during this time, there were delays in escalating Mr. [redacted] to a Senior Coordinator and his call was disconnected. The representative was unable to call Mr. [redacted] back as they received an incoming call when his was disconnected.
We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced. We value Mr. [redacted] as a member and we remain fully 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 in contacting me at [redacted].
Sincerely,
[redacted]
Member Advocate