Caremark PHC, LLC

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]

April 26, 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 [redacted], of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on April 18, 2017. Thank you for the opportunity to address Mr. [redacted]’s concern as expressed in Complaint ID: [redacted].
 
We have investigated Mr. [redacted]’s concern over the delay in processing his asthma medication. We found that Mr. [redacted]’s plan changed on January 1, 2017 and now requires him to fill a 90-day supply of maintenance medications at either CVS Caremark mail order or CVS retail pharmacies. If Mr. [redacted] wishes to continue filling a 30-day supply of his medications, he can call customer care to opt out of the program.
 
Mr. [redacted]’s prescription was received April 12, 2017, but rejected due to a retail claim for a 90 day supply paid April 3, 2017.  On April 17, 2017, Mr. [redacted] called our customer care team concerned that his order had not shipped. Mr. [redacted] was told about the retail claim and how it caused his order to initially reject.  Since Mr. [redacted] had not picked up the retail fill, the claim was reversed, and his mail order resumed processing.   The representative offered to stop the order and entered an override to allow the retail fill so Mr. [redacted] could have his medication without further delay. Mr. [redacted] picked-up his medication on April 18, 2017. 
 
Lastly, 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. Feedback has been provided to each member of the customer care team with whom Mr. [redacted] interacted. 
 
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

July 12, 2016
 
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont[redacted]
[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 member. This letter is in response to the correspondence we received from your office on July 5, 2016. Thank you for the opportunity to address Mrs. [redacted]'s concerns regarding her issue.
 
Upon review of this concern we verified via tracking information, the order in question was deliveredto Mrs. [redacted]’s home address on May 26, 2016. Due to Mrs. [redacted] stating she had not received said order, a courtesy reshipment of the order was mailed out on June 16, 2016 with a confirmed delivery date of June 18, 2016. Voicemails were left at the phone number on file for Mrs. [redacted]; we did not receive any return calls from Mrs. [redacted] to confirm delivery of this reshipment. On July 12, 2016, due to no confirmation from Mrs. [redacted] that she had received the reshipment, we mailed out a second reshipment as a courtesy via overnight delivery waiving the copayment of $7.99. This is the third order that was sent to Mrs. [redacted], any additional reshipments or orders will be at Mrs. [redacted]’s expense.
 
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

Complaint ID: [redacted] / [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of the United Airlines health plan, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on March 14,...

2016. Thank you for the opportunity to address Mr. [redacted]’s concern as expressed in Complaint ID: [redacted].
Upon review of the prescription order in question, we verified the order was shipped on February 13, 2016. Per [redacted] tracking information the prescription order was delivered on February 17, 2016. Typically, when there is proof of delivery of an order the mail order pharmacy will only reship at the member’s cost. In an effort to resolve this issue in Mr. [redacted]’s favor, an exception was made and an override was placed on file to allow Mr. [redacted] to receive a replacement order at no additional charge. A new prescription order was processed and shipped via [redacted] on March 17, 2016. Per [redacted] tracking information the order was delivered on March 18, 2016 and signed for by Mr. [redacted].
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. 
I did receive my medication as stated in their response. It is nice to know at least one person working for CVS is not completely incompetent. As far as their apology, I do not accept it. I'm in the service industry and if this were to happen in my buissness I would received a lot more than a cold I'm sorry form letter. But this is the day of major corporate pharmacy. They know I'm over a barrel and I have to use their substandard service, which I'm sure I will have to go through next time all over again. I just think I should not have to  dread calling for my prescriptions....
Regards,
[redacted]

.
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 health plan for the [redacted]...

[redacted], of which [redacted] is a member. Thank you for the opportunity to address [redacted] concerns as expressed Complaint # [redacted].
Upon review of [redacted]’s concern we verified that the two prescriptions in question were written by the prescriber for a 90-day supply. The [redacted] plan requires a member to fill a 30-day supply of a new medication/prescription before processing of a 90-day supply. Because of this plan benefit rule, members should not send new prescriptions to Mail Order for processing. The prescriptions in questions were reduced and processed correctly as a 30-day supply in accordance with the plan benefit.
CVS/caremark administers the prescription drug benefits for the [redacted] health plan. As 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

December 13, 2016
 
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 Community Heath Systems, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on November 22, 2016. Thank you for the opportunity to address Mr. [redacted]’s concern as expressed in Complaint ID: [redacted].
 
Upon review of Mr. [redacted]’ complaint we have confirmed the medication in question requires additional authorization in order to consider coverage. I have contacted the prescriber’s office in an effort to have another prior authorization completed. I was advised that they will not do additional prior authorization requests due to pervious requests being denied. I have contacted the prescriber’s office to initiate the appeals process. As of December 13, 2016 we are currently reviewing an appeal for the medication in question.
 
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

May 21, 2015
 
 
 
Complaint ID: [redacted] / [redacted]
 
To Whom It May Concern:
 
CVS/caremark administers the prescription benefits portion of the Community Health SystemsBenefit Plan, of which Mrs. [redacted] is a member. This...

letter is in response to the correspondence received from your office on April 28, 2015, referring to Complaint ID [redacted]. Thank you for the opportunity to address Mrs. [redacted].
 
As the administrator of the Community Health Systems Benefit Plan, we are required to administer the prescription portion of the benefit plan in accordance with the benefit features adopted by Community Health System.  Upon reviewing Mrs. [redacted]’s concern, it was determined that her benefit plan requires that Prior Authorization be obtained for the medication in question as of January 1, 2015.  Our records reflect that a prior authorization was submitted by Mrs. [redacted]’s physician on April 28, 2015 and was approved that same day; this authorization is effective through April 28, 2016.
 
Additionally, upon completion of our internal investigation; it has been determined that our customer care team failed to meet our level of expectations.  Upon review of Mrs. [redacted]’s interaction with the 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 Mrs. [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 Mrs. [redacted] has experienced. We value her 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 regarding this matter, please do not hesitate to contact our office at ###-###-####.
 
Sincerely,
 
 
[redacted]
Member Advocate

CVS/caremark administers the prescription benefits portion of the State of Illinois Insurance Plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on February 28, 2016. Thank you for the opportunity to address Ms. [redacted]'s concerns expressed in Complaint ID [redacted].  Upon review of Ms. [redacted]'s concern regarding delays with mail order, it was determined there were no delays with teh processing the order in questions. Ms. [redacted] called CVS/caremark's customer care several times to verify order status but was advised no prescription had been received. Although there was no specific issues verified with receiving prescription request, customer care could have provided Ms. [redacted] more options in an effort to bypass any pending delays. CVS/caremark accepts prescriptions in a variety of ways, for example: mail, fax, phone, and through electronic prescribing devices. Customer care agents also have the ability to generate an electronic fax, which is a fax sent to the doctor's office as a prescription request. Once the prescription was received, CVS/caremark processed and shipped the order overnight which was confirmed delivered. Additionally, calls will be reviewed and feedback and coaching will be provided to each member of the customer care team with whom Ms. [redacted] interacted. 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 [redacted].

June 11, 2015
 
 
[redacted]
[redacted]
[redacted]
 
Complaint ID: [redacted] [redacted]
 
To whom it may concern:
 
CVS /caremark...

administers the prescription benefits portion of many health plans as well as offers services through our Specialty Pharmacies.  This letter is in response to the correspondence we received from your office on May 20, 2015. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID [redacted].
 
Upon review of Mr. [redacted]’s concern, it was confirmed our specialty pharmacy received a request on April 24, 2015 from Mr. [redacted] requesting we transfer six of his medications from his local pharmacy to our specialty pharmacy and fill upon receipt.  During this process there were delays experienced since not all of the prescriptions were available to be transferred due to there were no refills available and renewals were needing to be obtained. On May 18, 2015, our specialty pharmacy contacted Mr. [redacted] informing him of the status of his prescription order;  it was at this time which he expressed dissatisfaction regarding our pharmacy being unable to fill all of his prescriptions at the same time.  Mr. [redacted] was informed he was out of refills and several attempts to contact his physician for renewals went unanswered.  
 
On May 21, 2015 we received new prescriptions for all of Mr. [redacted] medications via electronic prescription from his physician.  Mr. [redacted] was contacted by our specialty pharmacy and arrangements were made to have all 6 of his medications delivered on May 23, 2015 to his local CVS.
 
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 ###-###-####.
 
Sincerely,
 
 
[redacted]
Member Advocate

May 3, 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 Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on April 21, 2016. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID [redacted].
Upon reevaluation of Mr. [redacted]’s concern, we have confirmed that a balance must be paid within 90 days from the shipping date of the order to avoid any delays with processing. We also verified that Mr. [redacted]’s plan parameters allow him or his covered dependents to receive one fill of maintenance medications at any retail pharmacy; however, after that fill Mr. [redacted] or his covered dependents are required to obtain up to a 90 day supply of the maintenance medication thru CVS/caremark mail order or retail CVS/pharmacy. If the medication is obtained outside of the plan benefit guidelines the plan member would be responsible for the full cost. As the administrator of the prescription benefit portion of Mr. [redacted]’s health plan, we must adhere to the plan benefit structure set forth by our client, [redacted].
We value Mr. [redacted] as a member and we remain fully committed to our purpose of "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. 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. 
 I would like to reopen this complaint please.  I didn’t realize the subject of the complaint had responded, and you needed my feedback. Basically, they seem to have ignored the fact that prior to having my physician write the prescription, I preemptively called CVS Caremark to ask exactly how it should be written to avoid this exact scenario.  I had the Physician write the prescription exactly as I was told to by the CVS Caremark representative so that I could get what amounts to 3 items for essentially the same price as they charged me for one.  A lack of knowledge or training on their part, should not cost me 2 months’ worth of mediation. In addition to this complaint I will be contacting the representative for my company that owns the relationship between UPS and CVSCaremark and making sure they are aware of how poorly they handle customer service.  In the meantime, and credit for the single product that was filled, where it should have been 3, would be an acceptable, or a refund for the difference between what one costs at the bulk rate, as opposed to the single fill rate.
Regards,
[redacted]

February 23, 2016
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, 2016. 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, 2015 Mrs. [redacted] filled her prescription and paid $98.69 out of pocket. Mr. [redacted] was informed that they would need to send in a request via paper claim to receive reimbursement for this out of pocket expense. On February 10, 2016 Mrs. [redacted] was reimbursed $55.57 which was the contracted rate of the medication, $65.57, minus the $10.00 copayment.  Due to the confusion, and misunderstanding regarding the claims reimbursement process, an exception was made to reimburse at the full amount submitted. An additional reimbursement of $33.12 has been processed. Contact 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 9:00 a.m. to 5:30 p.m. Central Standard Time.
Sincerely,
[redacted]
Member Advocate

May 3, 2016
Revdex.com[redacted]
Complaint ID: [redacted]
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the health plan for [redacted], of which Mr. [redacted] is a...

member. Thank you for the opportunity to address Mr. [redacted]'s concerns as expressed in Complaint ID [redacted].
Upon review of Mr. [redacted]'s concern, we confirmed [redacted] requires all high dollar cold packaged medication orders to be placed on a hold and a phone call placed to the recipient. These calls are made to both gain approval to release the order as well as to make the recipient aware of the shipping of the order. Furthermore, a signature is required for delivery. This process is part of the plan benefit and went into effect January 1, 2016.
To assist with resolving Mr. [redacted]’s concern, as of April 1, 2016, comments have been added to Mr. [redacted]’s account pertaining to the medication in question. The comments state that the medication can be shipped without a phone call and no signature will be required. Furthermore, Mr. [redacted] will be responsible for these orders.
Lastly, 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 Mr. [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 Mr. [redacted] experienced. We value Mr. [redacted] as a member and we remain fully committed to our purpose of "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] my business hours are from 9:00 a.m. to 5:30 p.m. Central Time, Monday thru Friday.
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. Response from the business is requesting information and does not fit the criteria to reject/accept response.    ]
Regards,
[redacted]

This is in response to your inquiry dated August 8, 2016 regarding a mail order prescription.
We attempted to contact the member; however, we were unsuccessful. We are unable to research the request as we do not have a drug name. The member must provide the drug name in order for us to research...

further.

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, 2016. Thank you for the opportunity to address Mr. [redacted]’s concerns regarding receiving an unauthorized order of medication.
On...

April 1, 2016 Mr. [redacted]’s doctor’s office sent in a new prescription to be filled via mail order in error. Once a new prescription is received, if there aren’t any errors it will automatically go into processing. If there aren’t any rejections or concerns with the received prescription the order will be shipped shortly after processing. On April 5, 2016 Mr. [redacted]’s order was shipped and, he was charged $78.53. Mr. [redacted] never received the order due to it being mailed to his old address. Due to the frustration and inconvenience this issue has caused, Mr. [redacted] has been credited $78.53 as of June 1, 2016.
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 9:00 a.m. to 5:30 p.m. Central Standard Time.
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. thank you for the response. I fully understand how my policy works, including the fact that I have MRA dollars that pay out of pocket expenses until the MRA funds run out. At the end of the day, the MRA funds are still my dollars. My employer puts some funds into the account and I complete other activities to earn dollars. My purpose in filing this claim was not that I had to pay out of pocket for the $200 prescription, it was that CVS's prescription estimator is misleading to consumers and when I enter the information for the exact prescription that was ordered and it tells me the cost is $0, it is unacceptable that I am charged $200. It shouldn't matter if the dollars come out of pocket or my MRA, those are still my dollars to be used as I see fit. If I would have known the Rx was $200, I never would have ordered it. I would have declined to order the perscription and save those MRA dollars for a more important use. I want the MRA dollars to last as long as possible before I start paying out of pocket to meet my deductible. That is why I took the time to run the Rx cost estimator. Does that make sense? I want the $200 that was taken from my MRA and the money put back in my MRA account. I feel like CVS's website is deceptive and misleading to consumers. Again, I never would have ordered the Rx of I knew it would cost $200 (regardless of if it was coming out of my MRA or out of pocket)- it was CVS' responsibility to let me know an estimated $200 would be taken out of my MRA if I went ahead and ordered the Rx. Doesn't cvs need to take responsibility to misleading website information? If they estimate that an RX will be $0 and don't share any info to the consumer that money will be taken out of the MRA, isn't that totally misleading? I am very frustrated. I don't know what I could have done differently and don't feel like I should have to lose so much of my MRA funds towards this Rx I would have never filled if I known how expensive it was. CVS needs to take ownership of the lack of transparency of their cost estimator tool and refund money to my MRA account. Please help.
Regards,
[redacted]

January 18, 2016
Revdex.com
[redacted]
[redacted]
Complainant ID: [redacted] / [redacted]
To Whom It May Concern:
This letter is in response to the correspondence we received from your office on December 17, 2015. Thank you for the opportunity to address Mr. [redacted]’s concerns regarding receiving an unauthorized order of medication. 
Upon review of Mr. [redacted]’s concerns we were able to confirm that the prescription received was not filled in error.  Mr. [redacted]’s doctor’s office was sent a Non Adherence Advisory letter. The letter was not a request for a new prescription. The letter was sent to Mr. [redacted]’s doctor’s office to insure safety and proper usage. On October 2, 2015 we received a new prescription, and shipped the order on October 5, 2015.  There was no error committed by CVS/caremark as no new prescription was requested. Once a prescription is received by our mail order pharmacy, if there are no errors with the way the prescription is written or questions regarding the prescription, it will be filled as normal.  CVS/caremark’s return policy does not allow for the return of medication for credit for non CVS/caremark errors.
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 9:00 a.m. to 5:30 p.m. Central Standard Time.
Sincerely,
[redacted]
Member Advocate