MedImpact Healthcare Systems

I have type 2 diabetes and initially tried various forms of metformin but had very severe abdominal cramps and uncontrollable diarrhea to the point of total embarrassment and disgust. Medimpact approved a tier exception for two years for Jardiance which has been very successful for my diabetes treatment. When I applied for another year of tier exception this year I was denied with no explanation other than Medimpact said they could do it. They would not even acknowledge that they had approved the exception two years prior. Medimpact seems to sit on its principled high horse to represent a patient’s interest but ultimately they are simply in bed with the health organization whose drug plan they manage.

Medimpact will not cover Wegovy until May 1st even though the FDA Approved its use for cardiovascular heart conditions on March 8, 2024. Once again, a pharmacy management company is overriding the physician, FDA and company who is paying them for services. Should something happen between now and May 1st my spouse will have this to document them playing doctor. They say 24/7 customer service not true.

My doctor prescribed Wegovy two weeks ago. I awaited prior authorization, it was approved. I get to CVS and they say I owe the full price. I was on the phone for one hour and 45 minutes and no one could tell me why I would get authorized and still have to pay 100%. Doesn’t that mean I’m denied? And no one could offer a substitute, alternative or even a reasonable explanation. They also denied my prescription for Contrave. I can’t imagine how a company could willfully take your premiums month after month and offer such mediocre service. I’m grateful this isn’t life or death for me. I can’t imagine being ill and having to fight for medications. How these people sleep at night is beyond me. If you don’t cover a drug, there should be a reasonable substitute, not just a deny and continue to take my money without providing a service.

Not only did MedImpact fail to send me the benefit card at the beginning of the year, but also did they decline to cover generic antibiotic prescribed after a dental procedure after us having to pay out of pocket for it. Furthermore, the claim submission is unavailable on their website and apparently, per discussion with customer service, one has search for it using search engine as it can’t be done via their portal. To top it off, the benefit denial letter arrived but there is still no card despite my request. Would not recommend using this provider for prescription coverage.
Such behavior is clearly targeted at saving money at any cost by directly harming vulnerable people.

My parents are sick so I can't deal with it now but I will be filing an ADA complaint against this company. They are ruining my life.

They change formulary mid year don’t cover brand name drugs they used to cover anything to save a dollar and pocket it..it’s obvious they don’t care about patient well being and are primarily focused on how much money they are making..totally disappointed with the coverage

MedImpact Healthcare Systems, Incis in receipt of the complaint and has confirmed with the consumer's health plan that they will be directly resolving the complaint with the consumer

MedImpact Healthcare Systems, Incis in receipt of the complaint and successfully resolved the complaint directly with the consumer

MedImpact Healthcare Systems, Incis in receipt of the complaint and successfully resolved the complaint directly with the member

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me I will wait for the business to perform this action and, if it does, will consider this complaint resolved Regards, [redacted]

MedImpact Healthcare Systems, Inc(MedImpact) received and researched this complaint Research yielded that standard process was appropriately administered In this instance, MedImpact is contracted with the consumer’s health plan to perform pharmacy benefit management services The health plan provides custom Prior Authorization Guidelines to MedImpact to utilize for prior authorization of drugs In each instance that the consumer requested the drug [redacted] , it was denied based on the fact that the requests did not meet the criteria as outlined by the health plan The consumer has the option for a second level appeal before exhausting MedImpact’s internal process This option would provide the consumer another opportunity to request the drug MedImpact appreciates the opportunity to address Revdex.com consumer complaints If additional information is required, you can contact me directly at [redacted] or [redacted] Thank you, [redacted] Regulatory Compliance Administrator II MedImpact Healthcare Systems, Inc