Caremark PHC, LLC

May 21, 2015 Revdex.com290 Donald Lynch Boulevard, Suite 102Marlborough, MA 01752-4705Complaint ID: [redacted]/ [redacted]  To whom it may concern: CVS/ caremark administers the prescription benefits portion of the health plan for the City of [redacted] of which Ms. [redacted]...

[redacted] is a member. This letter is in response to the correspondence we received from your office on May 11, 2015. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID [redacted].  Upon review of this concern, we confirmed that one of the medications in question would not be authorized by Ms. [redacted]’s prescribing physician until she was seen by the physician. It was also confirmed that the second medication was never received by CVS/caremark mail order pharmacy.   I contacted Ms. [redacted] via telephone on April 12, 2015 to advise what had transprired and informed her I would reach out to her physician’s offices to assist in trying to obtain the required prescriptions.  Our records reflect that the two medications were received and shipped to Ms. [redacted] on May 12, 2015 and May 13, 2015.  Additionally, upon review of Ms. [redacted]’s 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 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 ###-###-####. Sincerely,  [redacted]Member Advocate

September 29, 2016
 
Revdex.com
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
 
Complainant ID: [redacted] / [redacted]
 
To Whom It May Concern:
 
This letter is in response to the correspondence we received from your office on...

September 19, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns regarding the payment of $98.22 that was processed on September 18, 2016.
 
On September 18, 2016, Ms. [redacted]’s most recent order of medication was shipped; the total cost for this order was $4.37. Prior to this order, Ms. [redacted] had a balance on her account of $93.85. The $93.85 balance was from orders placed on March 28, 2016, June 17, 2016, and August 26, 2016.
 
As part of Ms. [redacted]’s plan design she is allowed to have orders of medication dispensed without a method of payment on file if the balance on her account is less than$ 100.00. This would explain why Ms. [redacted] was able to have her three previous orders dispensed without payment.  On September 18, 2016 Ms. [redacted] added a method of payment on file and the whole balance due of $98.85 was applied.  Ms. [redacted] has been advised that we will use the method of payment on file to pay for all future orders.
 
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 to contact me at [redacted].  My office hours are Monday thru Friday from 9:00 a.m. to 5:30 p.m. Central Time.
 
Sincerely,
 
 
[redacted]
Member Advocate

April 21, 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 April 19, 2016. 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 3 fills at an in-network pharmacy of their choice. After the 3 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, 2016. We regret that there is no exception to this rule. Any 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 plan. Any 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

October 30, 2017     Revdex.com of Eastern MA, ME, RI, & VT 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 [redacted] Group...

health plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on October 17, 2017. Thank you for the opportunity to address Ms. [redacted]’s concern as expressed in Complaint ID: [redacted].   We have researched Ms. [redacted]’s concerns regarding the increased cost of her medication. Effective October 1, 2017, Ms. [redacted]’s plan changed the category of her brand medication from preferred to non-formulary, which resulted in an increased copayment. Plan members affected by this change were mailed notification letters in advance of the change.   Ms. [redacted] was contacted and informed of her right to appeal as well as the process to initiate an appeal. Copayment information for the generic version of the medication was also provided. Ms. [redacted] stated she would contact her doctor to discuss the options. When we spoke again, Ms. [redacted] reported that she and her doctor had determined she would try the generic version of the medication. Assistance was provided in obtaining fills for the generics through her local pharmacy.   Lastly, opportunities to provide Ms. [redacted] a better customer service experience were identified as part of the research into this complaint. Additional training and coaching will be provided to the representatives 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 1[redacted].   Sincerely,     [redacted] Member Advocate

Revdex.com of Eastern MA, ME, RI, & VT 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 [redacted] health plan, of which Ms. [redacted] is a...

member. This letter is in response to the correspondence we received from your office on October 4, 2017. Thank you for the opportunity to address Ms. [redacted]’s concern as expressed in Complaint ID: [redacted].   We have researched Ms. [redacted]’s concerns regarding her request to fill specialty medications at a local pharmacy. Ms. [redacted]’s plan requires specialty medications to be filled through the CVS Specialty® pharmacy. Although the plan does not allow for exceptions under normal situations, on April 10, 2017, Ms. [redacted] was granted a one-time allowance to fill one specialty medication at a retail pharmacy. Ms. [redacted]’s request for another exception was denied as she must fill according to the plan provisions, regardless if she did not utilize the previous exception.   Ms. [redacted] was assigned a single point-of-contact within CVS Specialty pharmacy to assist her in making the best use of her plan benefits in conjunction with manufacturer and other discounts outside of her plan. Ms. [redacted] has determined she will only fill one medication through CVS Specialty pharmacy at this time. Ms. [redacted] has agreed to schedule a time to speak with her point of contact to make arrangements for delivery of that medication.   Lastly, opportunities to provide Ms. [redacted] a better customer service experience were identified as part of the research into this complaint. Additional training and coaching will be provided to the representatives 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 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]. .Dear [redacted]Thank you for your response.  I did receive an e-mail from [redacted] after, I believe you have communicated with them, and they stated that patients need to have a 30 day supply filled first before 90 day supply to be dispensed.Then, please help me understand the 2 concerns that I have asked from last correspondences.  Why CVS/Caremark does not call the provider or patient to see if the prescriptions still needed to be filled at the mail center, and of course, if the information on the prescription be correct?And, why CVS/Caremark charged 90 day supply from patients but just dispensed for 30 day?  Any consideration for the refund the difference from CVS/Caremark?I highly believe CVS/Caremark is a company that is "helping people on their path to better health."Please help me, as a patient and a customer, understand the two concerns that I have.Thanks.Regards,
[redacted]

June 10, 2016
 
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 member. This letter is in response to the correspondence we received from your office on May 16, 2016. Thank you for the opportunity to address Mrs. [redacted]’s concerns regarding her issue.Upon review, in January of 2016, Mrs. [redacted] had paid out of pocket for a medication. Mrs. [redacted] then proceeded with the appropriate process of filing a claim for reimbursement with CVS/caremark. Upon generating a reimbursement, an internal computer error occurred. This unfortunately led to the check never being issued to Mrs. [redacted]. At this time, Mrs. [redacted]’s reimbursement in the amount of $35.54 has been issued in the form of a paper check. Mrs. [redacted] can expect this check in the mail within 7-10 business days. The check will be mailed to the address we have on file for Mrs. [redacted].
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

June 29, 2015 
[redacted] 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] is a...

member. This letter is in response to the correspondence we received from your office on June 17, 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 due to Ms. [redacted]’s location, her refills need to be placed and shipped in advance to prevent any delay in therapy. We have confirmed that once her order is shipped, it takes 5 days for delivery. Caremark Specialty Pharmacy has made the necessary adjustments and accommodations to ensure that all future orders will be placed and shipped 10 days in advance to ensure they are delivered on time.  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]. Sincerely,  [redacted]Member Advocate

I have received my money from CVS Caremark.  Thank you!

Revdex.com of Eastern MA, ME, RI, & VT
[redacted]
Phone: [redacted] | Fax: [redacted]
 
Complaint # [redacted] / [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. Thank you for the opportunity to address Mrs. [redacted]'s concern as expressed in Complaint # [redacted].
 
Upon review of this concern we verified that the medication in question is not covered by the benefit plan and is considered a Non-Formulary Drug. An appeal request was received by our exception team on May 16, 2016 and it resulted in a denial. CVS/caremark administers the prescription drug benefits for the [redacted] a benefit plan. As a benefit plan administrator, we are required to administer the prescription portion of the benefit plan in accordance with the benefit features adopted by [redacted].
 
Additionally, 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.  Where necessary, Feedback has been provided to each member of the customer care team with whom Mrs. [redacted] interacted.
 
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

June 29, 2017
 
 
 
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
 
Complaint ID: [redacted] / Mr. [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 concern as expressed in Complaint ID: [redacted].
 
Upon review of Mr. [redacted]’s interaction with our customer care team, we have verified on June 8, 2017, he did request that six of his medications be refilled; one of the medications requested was [redacted]®.  All of Mr. [redacted]’s medications, with the exception of [redacted], were shipped on June 13, 2017.  The representative Mr. [redacted] spoke with, placed an order for [redacted] utilizing a prescription on file that expired on March 6, 2016.  The representative did overlook a valid prescription on file which would have allowed our pharmacist to fulfill Mr. [redacted]’s request.  Feedback and coaching has been provided to the customer care team member whom Mr. [redacted] interacted with. 
 
Mr. [redacted]’s final order for the medication [redacted] shipped on June 22, 2017.  I have been in contact with Mr. [redacted] to discuss his concern and he has confirmed his order was received.
 
We sincerely apologize for any frustration or inconvenience that Mr. [redacted] has 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 have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####.
Sincerely,
 
 
[redacted]
Member Advocate

Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
290 Donald Lynch...

Boulevard, Suite 102
Marlborough, MA 01752-4705
 
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.  Thank you for the opportunity to address Mrs. [redacted]’s concerns as expressed in Complaint # [redacted].
 
Upon review of Mrs. [redacted]’s concern, we were able to verify there was no error made when filling her prescription. Although Mrs. [redacted]’s prescriber wrote the prescription for a quantity less than what she expected for a 90-day supply, there was nothing wrong with the prescription. In the instance that there is an issue with a prescription, our pharmacy will contact the prescriber to verify information. When our pharmacy processed Mrs. [redacted] prescription there was no reason to verify how it was written. 
 
Additionally, the copayment that Mrs. [redacted] paid for her prescription was correct. The medication in question is a generic medication. The plan benefit copayment for generic medications is $8 at retail for up to a 30-day supply and $20 at mail order for up to 90-day supply. If the cost of the medication is less than the copayment amount, Mrs. [redacted] will be charged the lesser amount.   
 
Lastly, pursuant to the plan benefit, once Mrs. [redacted] has reached the plan benefit retail fill limitation for maintenance medications at a local in-network retail pharmacy; the options are to use either the CVS Caremark mail order service or the Maintenance Choice program.  The Maintenance Choice program provides participating plan members with the choice of receiving up to a 90-day supply of maintenance medication through a CVS or [redacted] pharmacy for the same copayment as mail order. Any maintenance medications that are filled outside of this plan benefit fill limitation will result in being responsible for 100% of the cost of the dispensed supply.
 
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 ###-###-####.
 
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 not true on the dates. In my complaint look at the dates and reasons why it took a month to get my medication. They are just trying to save face and lie about everything. I was told I had to contact my doctor to get a new prescription which indicates to me CVS was not going to make any effort to do so. Since the CVS pharmacist do not have to contact doctors it appears there will be more patients out there not getting their medication. [redacted] needs to go back to school for advocacy  training she is not doing anything to make the employees better in what they are doing. My health rights to medication in a timely manner was violated and everyone knows it. It is sad  that their answer to this problem is to tell me to pay for my medication if I want it. I do not accept their phoney aplology which is not coming from a good place it is just something to say.    I have very good insurance that pays them in full for my medication.   I am expecting my refill in a timely manner.  
Regards,
[redacted]

March 29, 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. This letter is in response to the correspondence we received from your office on March 16, 2016. 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 have confirmed that effective January 1, 2016 The [redacted] prescription drug plan would no longer cover any brand or generic proton pump inhibitor medication. We verified that letters were mailed to members prior to this change taking effect allowing them time to discuss alternative options with their physician.  If members of the plan are unable to take the alternative medications due to a diagnosis of Barrett’s esophagus or Zollinger-Ellison syndrome an exception request can be submitted by contacting CVS/caremark at [redacted]. At this time we have not received the necessary information needed from Mr. [redacted]’s physician to complete the exceptions process.
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].
Sincerely,
[redacted]
Member Advocate

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

Instruments, 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 account and order history we confirmed that there was an order placed on August 5, 2015 which shipped on August 7, 2015. Per [redacted] tracking # [redacted], the order was delivered on August 11, 2015. On September 8, 2015 there was an order placed for another medication which shipped on September 9, 2015; per [redacted] tracking # [redacted] this order was delivered on September 17, 2015. There was a third order placed on September 30, 2015 which was shipped via [redacted] tracking number # [redacted] and delivered on October 5, 2015. Furthermore all three orders were shipped to [redacted], TX, [redacted]. If Mr. [redacted] needs assistance with further verifying any order status information he can contact me at 1-[redacted]. I am available from 7:00 am to 3:30 pm Central Time.  We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced. 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.” Again, should you or Mr. [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. 
 
Regards,
[redacted]

In order to properly investigate your concerns, we are in need of additional information.  Please provide us with the following information: Your childs first and last name along with the Date of Birth, and the medication in question.

July 5, 2016
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont[redacted]
[redacted]
Complaint # [redacted]/ [redacted]
 
To whom it may concern:
 
CVS / caremark administers the prescription benefits portion of the...

[redacted] plan, of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on June 20, 2016. Thank you for the opportunity to address Mr. [redacted] concerns regarding his issue.
Upon review of this concern, Mr. [redacted] has been prescribed [redacted], at this time the prescribed medication is not covered under Mr. [redacted] prescription benefit. In order to gain approval, this medication needs to go through CVS/caremarks appeals process. At this time, Mr. [redacted] has exhausted all levels of appeals administered through CVS/caremark. The only available option is to move forward with an External Review, which was initiated on June 25, 2016. This process can take up to 45 days to reach a decision. As a courtesy, we were able to approve an override for the [redacted] to be filled under Mr. [redacted] prescription benefit. The override is approved until September 1, 2016 while the External Review process is complete.
 
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. 
The order was for 145 packets and Caremark only provided 120 packets so Caremark's statement that they filled the order correctly is very clearly false to any reasonable observer.  Simply stating that Caremark may not provide a partial box is meaningless.  If this is due to statutory or regulatory restrictions, then Caremark needs to demonstrate this.  Caremark is simply declining to fulfill their obligations to provide the full ordered quantity, while at the same time charging me for the full order.Regardless of whether federal statutory or regulatory restrictions govern their decision to under-fill my order, it is illegal for Caremark to charge me for a product which they are not supplying.  Based on my consultations legal with a legal expert, at a minimum, Caremark must provide a pro rata refund.  In the absence of this refund, I will pursue this matter via litigation, as, over time, Caremark's intent to persistently under-fill my prescriptions will become very costly, and will amount to stealing hundreds and even thousands of dollars from me.
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 ask for the approval for vacation prrscription for 3 months.   Regards,
[redacted]