Caremark PHC, LLC

September 10, 2015 Revdex.com[redacted] Complaint ID: [redacted]  To whom it may concern: CVS/Caremark administers the prescription benefits portion of the health plan for SW Minneapolis of which Ms....

[redacted] is a member. This letter is in response to the correspondence we received from your office on September 2, 2015. Thank you for the opportunity to address Ms. [redacted]k’s concerns as expressed in Complaint ID [redacted]. Upon review of Ms. [redacted]k’s concern, it has been confirmed that CVS/caremark received a new prescription request on August 26, 2015. Due to a CVS/caremark system issue, the prescription received was not processed. It has also been confirmed that new prescriptions were also sent to Ms. [redacted]k’s local CVS Pharmacy on September 2, 2015 and were filled the same day. For this reason, Caremark was not able to fill the new prescriptions received on August 26, 2015 at mail order; however, the prescription is scheduled to process on September 17, 2015.   We sincerely apologize for any frustration or inconvenience that Ms. [redacted]k experienced. We value Ms. [redacted]k 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]k have any additional questions or concerns, please do not hesitate in contacting me at [redacted]. Sincerely,  
[redacted]Member Advocate

January 4, 2018     Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA 01752-4705   Complaint # [redacted]   Dear Sir/Madam,   CVS Caremark administers the prescription benefits for 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 December 27, 2017. Thank you for the opportunity to address Mrs. [redacted]’ concerns.   As previously stated, the [redacted] benefit implements a retail fill limitation for medications at local retail pharmacies.  Mrs. [redacted] is required to use mail order or her local CVS & [redacted] Pharmacies to fill maintenance medication once the plan implemented retail fill limitation has been reached. Currently, the plan does not have the option to opt out or override this benefit plan restriction.   Lastly, upon review of the interaction Mrs. [redacted] had with our customer care representatives we could not find any phone conversations where Mrs. [redacted] was advised she could always fill 30–day supplies at the local pharmacies. We regret that we are unable to resolve this situation in Mrs. [redacted]’ favor.   Should you or Mrs. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at 1-[redacted].   Sincerely,     [redacted] Member Advocate

Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
290 Donald Lynch Boulevard, Suite 102
Marlborough, MA 01752-4705
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 member. Thank 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 supply. Copayments and benefit information provided on caremark.com are only quotes and not a guarantee of coverage. Our filling pharmacy will automatically reduce a prescription to abide by the member’s plan benefit rules and guidelines. When 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 change. No 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 intended. If [redacted] wants an exception he will need to contact [redacted]. 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

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.  This company has all pertinent information regarding personable identifiable identifyers regarding [redacted] on the complaint form itself (order  # [redacted]).  Any additional information forwarded may place my privacy and security at risk  by the unknown individual conducting the investigation and  leave  me with no recourse in legal action.    [redacted] initiated this complaint due to company's failure to maintain proper record keeping and documentation in their database.  Voice recording is available for [redacted]     egards,
[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]. 
Thanks for the response.I do need the CVS Caremark Member Advocate to look at the case carefully.  Please do not recommend anything like to get copayment waiver as stated in the last reply from the Member Advocate.I have mentioned from my previous correspondences that CVS has charged for 3 month supply cost for a 1 month supply to patient.  CVS Caremark charged $50 instead of $25 and they only shipped out 1 month supply.  So $25 overcharge would need to be refunded.  Please let me know If I am wrong.Again thanks for the help, and appreciate "helping people on their path to better health."
Regards,
[redacted]

May 9, 2016
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont [redacted]
Complaint ID: [redacted] – Dr. [redacted]
On behalf of [redacted]
To whom it may concern:
CVS/caremark administers the prescription...

benefits portion of the [redacted] insurance plan, of which Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on April 26, 2016. Thank you for the opportunity to address Dr. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Although Dr. [redacted] expressed dissatisfaction with the Prior Authorization process, her main concern was a misquoted amount for an alternative medication she had prescribed. Dr. [redacted] was unsuccessful in obtaining coverage for [redacted]® and another possible alternative because the prescribed drug class is excluded from Ms. [redacted]’s plan formulary. After the denials of two possible medications, it was advised the prescription insurance covers [redacted]. At this point Dr. [redacted] and her staff called on multiple occasions and received conflicting information pertaining to the cost of [redacted]. One quote given was $150 because the medication would be prescribed at 3 tablets daily at a total of 270 tablets per 90 days which was the correct price. When calling again, a misquoted amount was given because the representative did not account for the prescribed quantity and performed a price estimate of 30 tablets per 30 days at $54. Due to this error, CVS/caremark will process a one-time correction by mailing Ms. [redacted] $96 which she will receive in 4-6 weeks.
We sincerely apologize for any frustration or inconvenience that both Dr. [redacted] and 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, Ms. [redacted] or Dr. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
Sincerely,
[redacted]
Member Advocate

December 23, 2015
Revdex.com serving Eastern Massachusetts, Maine, Rhode Island and Vermont
[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 December 6, 2015. Thank you for the opportunity to address Ms. [redacted] concerns as expressed in Complaint ID: [redacted].
Upon review of Ms. [redacted]’s concern, it was determined our specialty department did initially bill the medication in question to the incorrect benefit plan.  Once the correct benefit information was obtained by Ms. [redacted], our specialty pharmacy has attempted to resubmit the prescription claim to her correct benefit plan multiple occasions however has been unsuccessful.  Our specialty pharmacy is currently working directly with [redacted] in trying to resolve this issue. 
Ms. [redacted]’s account will continue to be monitored by our specialty team to ensure that all concerns expressed are addressed and resolved to her satisfaction.  A representative with our specialty pharmacy contacted Ms. [redacted] to provide her the latest update on her request and will continue to keep her informed.  Additionally, Ms. [redacted] has been refunded the amount of her order while we continue to try to resolve her concern.
We sincerely apologize for any frustration or inconvenience that Ms. [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." Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
Sincerely,
[redacted]
Member Advocate

This is in response to your rebuttal dated November 3, 2015 regarding a mail order prescription.We previously verified with a pharmacist, the member’s prescription was written for 4 bottles; however, per the directions provided by the physician, 3 bottles would last 90 days. The plan allows prescriptions to be filled for up to a 90 day supply; therefore, we are unable to fill a quantity that would take the member over a 90 day supply. We are unable to credit the member the monies for this prescription as it was filled in good faith per the directions provided by the physician.We spoke with the member and advised of this information. The member stated he would file another complaint as he does not agree with the outcome. The member did not require any further assistance at this time.

This is in response to your inquiry dated September 15, 2015 regarding [redacted], a non preferred pharmacy. I spoke with the member on September 23, 2015 and advised per his [redacted] benefits, he does not have out of network benefits. I also advised him there is not an...

option for reconsideration as he is not being denied a benefit.  The member did advise this is the only pharmacy in the US that is able to fill the medication. I advised the member I would do some additional research for him and contact him back.  I contacted [redacted], a preferred pharmacy, who advised they are able to order the ingredients and could compound the medication into a lozenge.  I spoke with the member today and advised of this information. The member stated he would contact [redacted] and his physician. The member did not require any further assistance at this time.

December 2, 2015Revdex.com [redacted]
[redacted]Complaint ID:  [redacted]/ [redacted] To whom it may concern,CVS/caremark administers the prescription benefit portion of the health plan for [redacted], of which Mr. [redacted]...

[redacted] is a member. Thank you for the opportunity to address Mr. [redacted]’ concerns as expressed in Complaint ID [redacted].Upon completion of our investigation, it was confirmed that the order in question was translated and filled correctly by CVS/caremark pharmacy. A review of the prescription reflects that it was submitted electronically by Mr. [redacted]’ prescribing physician's office on October 19, 2015. The prescription also reveals that the prescribing physician requested a 90 day supply; however it did not specify a specific quantity.  In order to fill the medication with the quantity requested by Mr. [redacted] a new prescription is required and the member would be responsible for the applicable copayment. Unfortunately we are unable to resolve this in a favorable matter for Mr. [redacted]. We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced. We value him as a customer and 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 additional questions or concerns, I may be reached at [redacted]. Sincerely,[redacted]Member Advocate

In order to properly investigate your concerns, we are in need of additional information.  Please provide us with the following information: Member ID number and your date of birth

Respondent states:" Per [redacted] tracking information the order was delivered on March 18, 2016 and signed for by Mr. [redacted].Revdex.com:"This is a flat out lie.  I did NOT sign for anything from [redacted].  I did however get the medication.  Lies like this from a major billion dollar corporation should be criminal.Let the record be clear that CVS cannot prove that statement of fiction.This company needs to be placed on notice of it's business practices and lies.Further lies and mis-deliveries from CVS WILL result in my filing a lawsuit.They have the ability to have this medicine delivered to me at any of there thousands of stores yet REFUSE to offer that option.They are in clear violation of my company's healthcare plan.
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. 
 
Respondent states:" Per [redacted] tracking information the order was delivered on March 18, 2016 and signed for by Mr. [redacted].Revdex.com:"This is a flat out lie.  I did NOT sign for anything from [redacted].  I did however get the medication.  Lies like this from a major billion dollar corporation should be criminal.Let the record be clear that CVS cannot prove that statement of fiction.This company needs to be placed on notice of it's business practices and lies.Further lies and mis-deliveries from CVS WILL result in my filing a lawsuit.They have the ability to have this medicine delivered to me at any of there thousands of stores yet REFUSE to offer that option.They are in clear violation of my company's healthcare plan.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. 
When a quote is made, it should be honored.  Also, if a charge is made that is more than the quote, the client should be notified.  Any increase beyond what was quoted should be considered credit card fraud1
Regards,
[redacted]
 %3

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. 
We will only accept a credit for the full amount.  [redacted] said they could not do it retroactively, only SilverScripts could.  I was in a hospital (Doctors at Renaissance in [redacted]) and believe someone on the staff there may have fraudulently enrolled me with the assistance of a SilverScripts representative.  I currently have and have had creditable insurance ([redacted] and [redacted])  for over 40 years.  I pay virtually nothing for prescriptions.  Interestingly, I've learned SilverScripts is owned by CVS.  CVS is the preferred pharmacy for MHBP and CVS processed a number of prescriptions during this period for me and billed these two insurances.  It is not hard for them to verify that I have insurance.  Research reveals that this is a common approach for SilverScripts.  Perhaps it's time I look for a new pharmacy.Regards,
[redacted]

February 10, 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 Ms. [redacted]...

is a member. This letter is in response to the correspondence we received from your office on February 3, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID [redacted].
Per the request of Ms. [redacted] we have removed her telephone number from our outbound calling programs. 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 [redacted]
Sincerely,
[redacted]
Member Advocate

August 29, 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 Ms. [redacted] is a member. This letter is in response to the correspondence we received from your office on August 18, 2016. Thank you for the opportunity to address Ms. [redacted]’s concerns as expressed in Complaint ID: [redacted].
Upon review of this concern, we verified that Ms. [redacted] was filling her [redacted] 500 mg tablets, 120 tablets for 30-day supplies which totaled 2000 mg daily at a copayment of $4.66.  On June 6, 2016, her physician reduced her dosage to 1750 mg and her medication was then filled for a 90-day supply with [redacted] 500 mg tablets (270 tablets) and [redacted] 250 mg capsules (90 capsules) as prescribed by her physician. Both medications were filled and Ms. [redacted]’s copayment for each medication was $14.00, totaling $28.00. Had Ms. [redacted]’s physician prescribed only [redacted] 250 mg capsules, she would have only had one $14.00 copayment. Ms. [redacted] was contacted by our specialty pharmacy and given this information. A courtesy credit of $14.00 has been requested. An offer to contact her physician to change her prescription to [redacted] 250 mg capsules - 7 times daily for a total of 1750mg was declined by Ms. [redacted].
 
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, “helping people on their path to better health”. Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted].
 
Sincerely,
 
 
[redacted]
Member Advocate

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # [redacted].
 
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. 
They said they have tried to reach me but they have never called my phone number [redacted] The prescription is for [redacted] 40 mg. I have been billed a total of $210.00 for two prescriptions which were suppose to be generic and free.. I have received a total of three (3) ninety day prescriptions in less than two months. 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] 
What is being done to address the complaint? - It was shipped but did not arrive until much, much, later than projected or needed.How will late deliveries be avoided from repeating the next time??
Regards,
[redacted]

This is in response to your inquiry dated August 19, 2016 regarding the member’s mail order prescriptions.
 
We verified the member’s current balance on file is $144. This balance is for a previous order which included two medications.  The card was charged in error as a Customer Care Representative selected the incorrect button to charge the credit card when placing the order for another order. The Customer Care Representative has been coached appropriately. The charge occurred on a different order than the order in which the balance is due for. There are no monies due for the order the complaint refers to as the member cancelled the order prior to the order shipping.
 
We spoke with the member on August 11, 2016. During this call, we apologized several times for the inconvenience this had caused her.  We also attempted to provide her with a point of contact when ordering medications through mail order so the order could be watched while it processed; however, the member declined.