Caremark PHC, LLC

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 [redacted] which is the only treatment (as far as I know) for an internal yeast infection CVS/Caremark which works with [redacted] 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 [redacted] 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 [redacted] , yeast infection/candida was not listed Again, [redacted] is the primary, and only treatment for internal yeast infections as indicated by the National Institute of Health: OVERVIEW [redacted] Background [redacted] (floo kon' a zole) is a fungicidal a

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] ***member id isw [redacted] Date of birth is 02/02/

I contacted Caremark at the recommendation of Dilley Allergy, San Antonio TX to set up medical treatment for allergies CAremark (CVS) clearly stated they required me to make the appointment in advance with my doctor for these allergy shotsThey needed proof of the appointment to ship the medicineHowever, my doctor's office said they could not make the appointment until they had the allergy shots This was contradictoryI was not sure what to do, and told CVS and my doctor I was not able to solve this as their requirements conflictedI became very busy at work and was not able to pursue the matter any further I did not authorize CVS to ship the medicationI did not make an appointmentI did not apply for the [redacted] insurance or fill out any paperwork that would imply I was moving forward with this treatmentA month or two later, CVS left a message that they had cancelled my request due to lack of responseThat was fineI thought it was done A few months later I

Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont Donald Lynch Boulevard, Suite Marlborough, MA 01752- Complaint # [redacted] To whom it may concern: CVS/caremark administers the prescription benefits portion of the health plan for the [redacted] , of which [redacted] is a memberThank you for the opportunity to address [redacted] ***'s concerns as expressed in Complaint # [redacted] The [redacted] plan requires members to fill a 30-day supply of a new medication/prescription before processing of a 90-day supplyCopayments and benefit information provided on caremark.com are only quotes and not a guarantee of coverageOur filling pharmacy will automatically reduce a prescription to abide by the member’s plan benefit rules and guidelinesWhen a prescription is reduced to abide by the coverage and plan design a letter is sent out to the member advising of the reason for the changeNo contact is made with the prescriber An exception cannot be made concerning the copayment [redacted] was responsible for with this order since the plan is working as intendedIf [redacted] wants an exception he will need to contact [redacted] CVS/caremark administers the prescription drug benefits for the [redacted] health planAs the administrator of the [redacted] health plan, we are required to administer the prescription portion of the benefit plan in accordance with the benefit features adopted by [redacted] We value [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 [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1- [redacted] Sincerely, [redacted] Member Advocate

Back in June 2016, I decided to use CVS/Caremark to get my prescriptions through mail order since it was cheaper than the local pharmacyMy health insurance is through [redacted] Federal governmentMy first bad experience with CVS/Caremark is when I called in June to check to see if they had my prescriptions from the doctor to fill, I was told yes and I said hold off because I just filled one at the local pharmacy because I needed it right away, they said they wouldAfter that when I did call back, I was told I needed a prior approval because my previous one expired in May (note I called in June and no said anything)After that it was downhill, every time I spoke to someone I got a different answer but one agent I talked to filled of my three prescriptions and asked how I wanted to be billed, I said invoice which he did; however when I called about the third medicine because I had received an email that it was cancelled, I was told that they could only invoice for

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] Hi,Thanks for your response I have searched through all the [redacted] Websites and your CVS Websites regarding the prescription benefits, I don't see the pre-requisite D supply to be filled first then followed by D Please see the attached.I have called [redacted] Rep and you CVS rep to confirm your statement They both stated that I don't need to have the D supply filled first in order to get the D supply I can just send in the D Supply Rx directly to get the D supply Particularly, I spoke to your rep [redacted] on 12-30-2:pm ( [redacted] to confirm that I don't need to have the D supply filled first.Please follow up and provide evidence Thank you.Also, please address the issue that if CVS desires to change the prescription order, why the patient nor the physician be contacted first?And if so, why still charged for cost of D supply instead of D if there is a change?Regards, [redacted] ***

CVS Pharmacy along with CVS Caremark and CVS Specialty have a relentless, unwanted, contact policyI have spent countless hours requesting that I not be contacted by phone, by text, by email to have my prescriptions refilledThey continued to promise to remove my number and continue to call meCVS Caremark has twice filled prescriptions that were never ordered then insist I pay the copay for a drug I did not order I have contacted them by phone, by email, in person, via [redacted] and [redacted] , but the contacts keep comingIt is beyond the point of harassmentWhile I do understand that there are other companies who provide this service, my insurance requires I do business hereThe contacts must stop!!!!!

Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont [redacted] Complaint ID: [redacted] / [redacted] To whom it may concern: CVS/caremark administers the prescription benefits portion of the [redacted] Health Plan, of which Mr [redacted] is a memberThank you for the opportunity to address Mr***'s concerns as expressed in Complaint ID: [redacted] Upon review of this concern, we verified that Mr [redacted] had a prior authorization which had expired in July of The fills of the medication in question prior to the prior authorization being expired all consisted of a $copaymentOn December 28, our filling pharmacy received a request to refill the medication in question, due to no active prior authorization in place the order processed for units at the $copaymentThe plan benefit covers the medication in question at 50%, Mr [redacted] was charged $and his plan benefit paid $The reason the medication in question was filled as units for a day supply was because the plan allows the medication in question to be covered without a Prior Authorization with a limit of units every days or units every days A new request for prior authorization was received on January 5, and approved through January 5, Additionally the $which reflected as owed on Mr***’s account has been absolvedAs of June 2, Mr***’s account is at a $balance 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 The response is unacceptable CVS told me to go buy it somewhere else because they did not have the medication Had CVS had the medication, my insurance would have paid the total cost and I would not have had to pay anything CVS needs to reimburse me 100% of my cost Regards, [redacted] ***

April 21, Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont [redacted] Complaint # [redacted] / Mrs [redacted] To whom it may concern: CVS / caremark administers the prescription benefits portion of the [redacted] health plan, of which Mrs [redacted] is a memberThis letter is in response to the correspondence we received from your office on April 19, Thank you for the opportunity to address Mrs [redacted] 's concerns as expressed in Complaint # [redacted] Upon review of this concern, it was verified the [redacted] health plan utilizes Mandatory Maintenance Choice, where in which the plan member can have fills at an in-network pharmacy of their choiceAfter the fills have processed, plan members must use CVS or [redacted] pharmacies or CVS Mail order pharmacy for all prescription medicine fills [redacted] has implemented this into their plan guidelines as of April 1, We regret that there is no exception to this ruleAny prescription medications filled outside of this plan benefit fill limitation will result in plan members being responsible for 100% of the cost of the dispensed supply as filling prescription medications outside of these options is not covered by the benefit planAny request for paper claims reimbursement for prescription medications filled outside of the plan benefit limit will be denied.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 [redacted] Sincerely, [redacted] Member Advocate

I am writing to you as I do not know what other option to take hoping that you can assist me A few months ago I tried to use my benefits at CVS to buy some speciality medications and it was just too expensive for me to affordI found another pharmacy that could fill the prescription at half the cost which would save me about dollars I went ahead and requested for an override which was offered to me but due to finances not being enough I went ahead and put that on holdI have tried to call again to get the override activated and I have now been advised that I can no longer utilize that money unless I wanted to just go ahead and pay out of pocket My questions were not really answered because from what I understand my benefits have not changed so I should be able to utilize the overrideMust I also mention that it is such a pain to be on calls for hours during the naïf stressful time for a patient trying to get medications instead of this being a painless process

February 23, Revdex.com [redacted] Complainant ID: [redacted] / [redacted] To Whom It May Concern: This letter is in response to the correspondence we received from your office on February 10, Thank you for the opportunity to address Mr [redacted] ’s concerns on behalf of his spouse Mrs [redacted] as expressed in Complainant ID: [redacted] On October 14, Mrs [redacted] filled her prescription and paid $out of pocketMr [redacted] was informed that they would need to send in a request via paper claim to receive reimbursement for this out of pocket expenseOn February 10, Mrs [redacted] was reimbursed $which was the contracted rate of the medication, $65.57, minus the $copayment Due to the confusion, and misunderstanding regarding the claims reimbursement process, an exception was made to reimburse at the full amount submittedAn additional reimbursement of $has been processedContact has been made with Mr [redacted] to provide this outcome to his concern 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 Mr [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted] My office hours are Monday thru Friday from 9:a.mto 5:p.mCentral Standard Time Sincerely, [redacted] Member Advocate

[A default letter is provided here which indicates your acceptance of the business's response 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] ***

My husband has liver damage and takes a medication called lactulose [redacted] has issues covering this so we need to open a TAR to get it approvedEvery month there is a delay between the pharmacy, [redacted] and the Dr office so we end up having to pay out of pocket for a portion of the prescription and we are promised that we will get reimbursed once the prescription gets approvedThe prescription always goes through but we never have gotten a refund because every time I go in and ask (with my receipt) they say that they cannot do itSo not only do I pay a portion out of pocket but then CVS bills [redacted] for the full amount so essentially they get paid twice for a portion of the prescription

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 themThey tried to slide more than a $co-pay through [redacted] In fact they tried to slide a $payment through $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 cancelationIt 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 $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]

Complainant ID: [redacted] / [redacted] To Whom It May Concern: This letter is in response to the correspondence we received from your office on May 17, Thank you for the opportunity to address Mr [redacted] ***’s concerns regarding receiving an unauthorized order of medication On April 1, Mr***’s doctor’s office sent in a new prescription to be filled via mail order in errorOnce a new prescription is received, if there aren’t any errors it will automatically go into processingIf there aren’t any rejections or concerns with the received prescription the order will be shipped shortly after processingOn April 5, Mr***’s order was shipped and, he was charged $Mr [redacted] never received the order due to it being mailed to his old addressDue to the frustration and inconvenience this issue has caused, Mr [redacted] has been credited $as of June 1, 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 to contact me at [redacted] My office hours are Monday thru Friday from 9:a.mto 5:p.mCentral Standard Time Sincerely, [redacted] Member Advocate

June 16, Revdex.com [redacted] Complainant ID: [redacted] / [redacted] To Whom It May Concern: This letter is in response to the correspondence we received from your office on June 9, Thank you for the opportunity to address Mr [redacted] concerns regarding receiving an unauthorized order of medication Upon review of this concern, CVS/caremark mail order received a prescription from Dr [redacted] office for processingThe prescription was received electronically and was filled automatically per our processThe prescription request was not initiated by CVS/caremark and there were no instructions dictating to hold the prescription on fileMr [redacted] ’s order was processed and shipped on June 4, At the time this order was shipped, Mr [redacted] was unaware that the medication in question was being filled via mail orderDue to the inconvenience, as a one-time courtesy, packaging has been sent to Mr [redacted] to retrieve the order for a reimbursementOnce the medication is returned Mr [redacted] will be credited $ 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 to contact me at [redacted] My office hours are Monday thru Friday from 9:a.mto 5:p.mCentral Time Sincerely, [redacted] Member Advocate

April 15, Revdex.com [redacted] Complainant ID: [redacted] / [redacted] To Whom It May Concern: This letter is in response to the correspondence we received from your office on April 4, Thank you for the opportunity to address Mrs [redacted] ***’s concerns regarding being charged for diabetic supplies Mrs***’s plan benefit includes a diabetic kit or diabetic bundling ruleAs long as supplies are filled within the same hour window as the insulin, the bundling will applyInsulin must process before the suppliesInsulin is charged a standard copayment and the remaining items are charged a $copayment including a second insulinIf Mrs [redacted] orders supply items without insulin, she will be charged a copayment for each diabetic supply item On August 23, Mrs [redacted] was charged $for insulin and lancetsThe test strips were processed before the insulin therefore the diabetic bundling rule did not apply On November 14, Mrs [redacted] was charged $for her order of insulin and lancetsMr [redacted] was charged $for the insulin and $for lancetsThe Lancets were processed before the insulin therefore the diabetic bundling rule once again did not apply In an effort to resolve this issue in Mrs***’s favor we have reimbursed her $as a courtesyAs of April 7, Mrs [redacted] was reimbursed $for her August 23, order of test strips and $for her November 14, order for Lancets 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 to contact me at [redacted] My office hours are Monday thru Friday from 9:a.mto 5:p.mCentral Standard Time Sincerely, [redacted] Member Advocate

July 22, Revdex.com [redacted] Complaint ID: [redacted] *** To whom it may concern: CVS/Caremark administers the prescription benefits portion of the health plan for the [redacted] which Mrs [redacted] is a memberThis letter is in response to the correspondence we received from your office on June 8, Thank you for the opportunity to address Mrs***’s concerns as expressed in Complaint ID [redacted] Upon review of this concern, it was determined that the medication in question required a prior authorizationThis information was received, processed and approved as of July 17, and is good until July 17, A letter has been sent to Mrs [redacted] informing her of the approval and time frameA message has also been left for Mrs [redacted] to inform her of our findings We sincerely apologize for any frustration or inconvenience that Mrs [redacted] experiencedWe value Mrs [redacted] as a member and we remain fully committed to our purpose of “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 [redacted] Sincerely, C [redacted] Member Advocate

1-12-placed order for day prescription from which my Doctor wrote for a day supply CVS Caremark erroneously charged me $for the day supply citing they were restricted from filling the whole prescription for days 1/14/2016, after several lengthy attempts to resolve this matter with Call Center reps; ***, [redacted] and continuously placed on unreasonably extended hold and finally forwarded to: "***" (Senior Clinic Advisor), and supervisors, "***," "***" (terrible disposition), and "***" who informed me because of the discrepancy, [redacted] would be given a one time bulk up credit for $dollars and to keep the day prescription These supervisors informed me I would not be billed for the prescription 1/15/16, [redacted] l left a voice mail stating what these supervisors told me earlier about the bulk of credit which I saved on my cell for documentation to support my voice records, date & time I did not receive a day s