Caremark PHC, LLC

November 11, 2016
 
 
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].
 
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. As a onetime courtesy, on November 7, 2016, a credit for $7.26 has been placed on Mrs. [redacted]’s account.
 
We want to reiterate, 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]. Please add your rejection comments below. The response did address the fact that that cvs sent a fax to my doctor asking why I not filled my prescription in a timely manor. which in non of  there business. My doctor misinterpreted the fax as a request from cvs to have the order refilled. I had nothing to do with it. Also they did address the request to not fill any other orders not requested by me.                                      �...⇄  regards,
[redacted]

This is in response to your inquiry dated August 30, 2016 regarding the member’s mail order prescription.
 
I verified we received a prescription from the member’s physician on August 29, 2016. The member had purchased a 30 day supply at his local retail pharmacy on August 29, 2016. The mail...

service pharmacy is able to fill a prescription when a prescription has been filled at the retail pharmacy for a 30 day supply or less.
 
Anytime a physician provides the Mail Service Pharmacy with a new prescription by fax, telephone, electronically or the member mails in new prescriptions, the Mail Service Pharmacy automatically processes the order in good faith; unless the member requests otherwise. By law, once a prescription is dispensed and leaves our facility, it cannot be restocked or resold.
 
The prescription was filled and shipped in good faith; therefore, the member is responsible for the copayment.
 
In addition, at the time of the order, the [redacted] credit was set as default; however, the transaction was declined. As of September 1, 2016, [redacted] credit has been discontinued as an available payment method.

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]

March 1, 2018     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 Specialty® is the dispensing pharmacy for Mr. [redacted]'s specialty medications....

  This letter is in response to the correspondence we received from your office on February 9, 2018. Thank you for the opportunity to address Mr. [redacted]'s concern as expressed in Complaint ID: [redacted].   The specialty pharmacy received an order request on October 6, 2017 with a requested delivery date of October 10, 2017. The request could not be completed because there were not refills remaining on the prescription.  The specialty pharmacy’s attempts to obtain a prescription from the patient’s physician were not successful until October 11, 2017.   Another factor is that Mr. [redacted]’s insurance plan has a limit of two pills a day for the medication in question whereas his physician was prescribing three pills a day.  Approval was required from the insurance provider on a monthly basis to override that plan design feature.    On February 19, 2018, a Patient Advocate with our Specialty pharmacy advised that they were in contact with Mr. [redacted]’s prescriber and secured a new prescription for the medication in question which allowed for the additional refills.  In addition, Mr. [redacted]’s prescriber provided our pharmacy a prescription for a different strength of the medication, which is not subject to the same quantity plan design restrictions.    We value our members and we are confident that future service will better reflect our commitment to our purpose of, “helping people on their path to better health.” Should you or 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. 
I did NOT receive letters about being forced to use CVS. Prove that those letters were left in my mailbox. Do you seriously believe I would purposely leave my 8month old daughter and myself without the medicine we need? It is absolutely ridiculous that you do not freely offer a 30 day perscription professional courteously to people who are in a situation like mine. Your company have proven yourselves to be unprofessional and uncaring stuffed suits with no actual care for the people who pay you. I will make sure to post about this experience on social media and boycot CVS in the future. You are in ANYTHING but the caring profession. Shame on you!
[redacted]

CVS/Caremark administers the prescription benefits portion of the [redacted]. insurance Plan, of which Mr. [redacted] and Mrs. [redacted] are members. This letter is in response to the correspondence we received from your office on December 14, 2015. Thank you for the opportunity to...

address Mr. [redacted] concerns as expressed in the complaint. Mr. [redacted] submitted a complaint on behalf of [redacted] regarding a medication that did not ship within a timely manner. The order was originally placed on December 2, 2015 and void as of December 13, 2015. The order was flagged with payment concerns on December 5, 2015. We attempted to contact Mr. & Mrs. [redacted] on December 5 and 7, 2015 but when we did not receive a response the order was voided on December 13, 2015. Mr. [redacted] contacted customer care on January 6, 2016 to inquire on the status of the order not processing through the 2015 benefits. In an effort to accommodate Mr. [redacted] situation a request was made to allow an exception to honor 2015 benefits for the medication in question; the request was approved. While researching, Cvs/Caremark was able to determine there were no internal issues delaying the order. The only factor which delayed the order was a payment issue. When the cost of an order reaches a certain threshold our automated system calls the member for a secondary approval. If the member is unresponsive the order will be voided . In Ms. [redacted] case, the [redacted] benefit has a maximum balance allowed of 250.00 and the cost of the order in question exceeded 600.00. 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].

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,your outlook on this matter is not an apology but poor business and UN knowledgeable staff .Had to go this far to have this resolved.What does that say about your policies and this business.
[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].  
[redacted]           [redacted]            [redacted]
Regards,
[redacted]

CVS/Caremark administers the prescription benefits portion of the health plan for [redacted] & Company, of which Ms. [redacted]’s son is a member. This letter is in response to the correspondence we received from your office on April 8, 2015. Thank you for the opportunity to address Ms....

[redacted]’s concerns as expressed in complaint ID [redacted]. Upon review of Ms. [redacted]’s concern, we have confirmed there have been no privacy or HIPAA violations committed.  Our records reflect the phone number being used is a shared number between Ms. [redacted] and her son; therefore, she may receive phone calls or messages regarding her son’s prescriptions.  Representatives who make contact with our members are trained to obtain a combination of three to four primary and secondary authentication elements in order to ensure that CVS/caremark is in adherence with the Health Insurance Portability and Accountability Act (HIPAA).  Additionally CVS/caremark will not release any protected health information regarding Ms. [redacted]’s or her son’s account unless we have documentation providing authorization release information to a specified named individual. Should Ms. [redacted]’s son choose to no longer receive phone calls or messages on the shared phone number, he may contact our customer care team at ###-###-#### to make the appropriate changes to his account.   CVS/caremark is committed to protecting the PHI of individuals in compliance with the Health Insurance Portability and Accountability Act. We sincerely apologize for any frustration or inconvenience that Ms. [redacted] experienced. Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####.  Sincerely, [redacted]Member Advocate

Dear sir or madam,
Thank you for giving us the opportunity to address your concerns regarding the member’s mail order prescriptions handled by the CVS Caremark Mail Service Pharmacy. This is in response to your correspondence dated March 30, 2016. 
The drug [redacted] 20mg tablets is listed on...

the Formulary (list of covered drugs); however, the drug has a Step Therapy restriction. A utilization tool that requires the beneficiary to first try another drug to treat his medical condition before we will cover the requested drug. The beneficiary was required to first try atorvastatin, before we could cover [redacted].
On 03/03/2016, we received an order via phone for [redacted] 20mg tablets. The prescription was prescribed as 90 pills for a 90-day supply. In terms of the copay, [redacted] has a $90 copay at mail order because it is a Tier 4 drug.  Additionally, the beneficiary has a $125.00 deductible that applies to Tier 3, 4 and 5 drugs. On the call, the beneficiary was advised that the cost of the order was an estimated $215.00. The member agreed to the cost and the Customer Service Representative completed the order.
The order was processed as 30 pills for a 30-day supply as the [redacted] 20mg has a coverage restriction. A letter dated 03/03/2016, was sent to the beneficiary advising that we had filled a 30-day supply of this drug in order to avoid interruption of therapy; however, the beneficiary would need to request an exception to the coverage of the drug. The order shipped on 03/04/2016 and was delivered to the beneficiary’s residence on 03/08/2016.
The Plan has authorized an exception to allow the coverage of [redacted]. An override was placed on the account to allow the beneficiary to receive the remaining 60 pills without an additional charge. The order was shipped on 04/13/2016, and is currently in transit for delivery.
To find out which medicines are covered, the beneficiary can refer to his Formulary booklet or call CVS Caremark Customer Care.
Please feel free to contact me with additional questions regarding this response.
Sincerely,
*
[redacted]
Medicare Part D Regulatory Grievances
Phone [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].. 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 30 D supply to be filled first then followed by 90 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 30 D supply filled first in order to get the 90 D supply.  I can just send in the 90 D Supply Rx directly to get the 90 D supply.  Particularly, I spoke to your rep [redacted] on 12-30-15 2:50 pm ([redacted] to confirm that I don't need to have the 30 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 90 D supply instead of 30 D if there is a change?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. 
[If you are rejecting the business's response please enter your rejection comments here. I am not satisfied with CVS Caremark's response for the simple reason that why did they allow prescriptions to be filled for me on January 4th 2016 in the amount of $194.02 if I was carrying a balance from the previous year. They allowed them to be filled at that time, but not when requested earlier this month. Then for me to order them, then to have someone cancel the order. Thank god I checked the order status the next day while adding a prescription I forgot to add to the order to find out it had been cancelled! I would have waited for these medications to maintain my kidney from rejection. CVS Caremark also has to let me know what medications I can and can not get filled at my local [redacted] Pharmacy with who I would much rather do business with, because CVS has allowed certain medications get filled there, only to get denied the next I go there to get them filled. I do not want 90 day supplies also! With all the medication changes that my doctors make according to the blood lab work that have have drawn on a monthly basis, quantities change and it is to much of a hassle to inform a Mail Order service about said change and then have to wait 3- 5 days for medications to come in the mail. I will not be satisfied unless I can at least get my essential medications filled at a brick and mortar store location!! My transplanted kidney is not something I want to lose over a Mail order service! I am NOT happy with CVS Caremark's service, end of story!
Regards,
[redacted]

July 22, 2015 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 member. This letter is in response to the correspondence we received from your office on June 8, 2015. Thank you for the opportunity to address Mrs. [redacted]’s concerns as expressed in Complaint ID [redacted]. Upon review of this concern, it was determined that the medication in question required a prior authorization. This information was received, processed and approved as of July 17, 2015 and is good until July 17, 2018. A letter has been sent to Mrs. [redacted] informing her of the approval and time frame. A 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] experienced. We 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

[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]

Please add this to the current complaint. I just received another call from CVS/BCBS pharmacy. This is the fourth person calling me to tell me the Doctor should have written the prescription better. My complaint is simple, CVS should not be filling unclear prescriptions without contacting my doctor and myself. I informed the lady on the phone that if she had nothing else to say but it’s the Doctor’s fault then there was no need for this conversation. [redacted]

July 14, 2015        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], of which Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on July 2, 2015. Thank you for the opportunity to address Mr. [redacted]'s concerns as expressed in Complaint ID: [redacted]. Upon completion of our internal investigation and 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. We confirmed Mr. [redacted] did not want to attach a method of payment to the order that he was placing and preferred to be billed for the order.  Instead of the customer care representative explaining that this was not an option, they opened a [redacted]™ account to care for the copayment costs of the refill.  Mr. [redacted] did not give consent for the [redacted]™ account to be opened. Please be assured that the actions of the representative that caused this occurrence are not in line with any of CVS/caremark’s procedures nor are they customary of the service CVS/caremark strives to achieve. We have been able to successfully reverse the charges that were placed on the [redacted]™ account.  We regret that we are unable to close the [redacted]™ account. Only Mr. [redacted] can close the account due to it being a personal account even though our representative made the error of creating the account. Mr. [redacted] can contact [redacted]™ at [redacted] for further assistance and direction.  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 satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted]. Please add your rejection comments below. 
I did receive the notification letter and took it to my doctor in late January. He followed the instructions and submitted the request due to my diagnosis of Barrett's and I initially received an approval from Caremark on 1/28/2016 based on that request. After that, Caremark's records were corrupted and they claim I was rejected because I am over 17. That is not part of the exception requirement. I was told to have my doctor re-submit the request on appeal, which he has done, but nothing has changed. After MANY phone calls, CVS refuses to admit their error and assist me in resolving this issue.
Regards,
[redacted]

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. I appreciate the time that Mr. [redacted] spent with me on the phone discussing the issue. 
Regards,
[redacted]