I am rejecting this response because: I have waited since November of as that is when I sent the 1st Prescription Claim form requesting reimbursement for prescriptionsA month later I was sent a letter from PRIME THERAPEUTICS stating the pharmacy receipt was missing a letter code of sorts and I was advised to once again go to the pharmacy in order to get a different prescription receipt which I did and mailed to Prime by certified mailWhy you couldn't call the pharmacy yourself vsmaking me continue to wait on the monies owed to me was ridiculousSo no, nothing on your Parr has been taken care of in a timely manner I have been waiting now WEEKS to receive my refund!!! At the very least since you have no problem taking your sweet time you could have mailed a check to me that you state you mailed it on January 31st overnight mail! When I get a medical bill I pay it on time though Prime takes their sweet time and gets your monies to you whenever you feel like itOh and I had even sent emails to PRIME THERAPEUTICS and never received any response to my emails! I hope I don't deal with this company in the future! My complaints will be posted for the public to see on Revdex.com website so other patients will be aware of how this company could careless about refunding monies to individuals and do not respond to emails when reaching out for help! I had to get Revdex.com involved and I'm positive if I hadn't reached out to Revdex.com I would never had Prime send me the refunds that I am due! Thank gosh for the Revdex.com!
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me
Initial Business Response / [redacted] (1000, 6, 2015/10/02) */ Dear Ms***: You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns with Prime charging your credit card for the full amount of your co-pay for your medication, despite your request not to process the paymentYou have asked that Prime refund your co-pay in the amount of $because your credit card was charged against your wishes Our records show that you placed a call to Prime and spoke with a Member Service Agent (MSA) on September 10, 2015, requesting to refill a prescription for [redacted] You told the MSA that you wanted the cost of the medication to be split between two credit cards and asked to be contacted if this could not be doneOur records indicate that the MSA notated the order with your instructions During processing of your order, one of your credit cards was declinedThe next available form of payment on file, another of your credit cards, was used to complete the order according to Prime's standard processWe regret that the notation concerning your payment was inadvertently missedThis incident has been documented and reported to the correct supervisor for employee coaching Unfortunately Prime is unable to refund the $co-pay for your medication because it was correctly assessed in accordance to your pharmacy benefitsWe are willing work with you to cover any charges that you incurred as a resultPlease contact us for further information about this Prime regrets any inconvenience you may have experiencedWe evaluate all concerns regarding our members that are brought to our attention, and we will keep record of yours for future referenceIf you have further questions or concerns, please call Our member services are available hours a day days a week Initial Consumer Rebuttal / [redacted] (3000, 8, 2015/10/05) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do not agree with the results, however I feel there is nothing further I can do, so I am assuming this will be closedHowever I hope you will note I was a dissatisfied client with Prime Therapeutics
According to your account, there is a Utilization Management Program included in your current pharmacy benefits under your BCBSNJ planThis means that some medications need prior authorization (pre-approval) before they can be obtained using your pharmacy benefitsFor a list of medications in this program and other helpful information, please register at www.myprime.comAfter further review of your account, we found that your Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) Pharmacy benefits have changed as of October 1, According to your current pharmacy benefits [redacted] and **are a part of a Quantity Limits (QL) ProgramQL are applied to certain drugs based on the approved dosing limits established during the FDA approval processIf your doctor would like to prescribe an amount that would exceed this limit, he/she must submit a PA request to Horizon BCBSNJ for reviewThe information submitted should explain why you need to exceed the quantity limitOn October 5, 2017, Prime received a PA for **Based on information provided by your doctor, the request was denied because the information provided failed to meet pre-established criteriaThe decision was made by a panel of pharmacists who are trained to review all prior authorization requests based on your pharmacy benefitsIt was determined that your prescribed dose can be reached with a lower quantity of a higher strength that does not exceed the quantity limitPlease be advised that you have the right to appeal any services or coverage determination’sWhen you make an appeal, you are requesting the coverage determination to be reconsideredTypically, details about the appeal process are mailed with the coverage determination letterIf you have not received this information, please contact BCBSNJWe found no Prime errors during the process of your medication reviewOn October 25, 2017, [redacted] Pharmacy was able process your medication **
Initial Business Response / [redacted] (1000, 5, 2015/06/19) */ Dear Mr [redacted] , You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns about your prescription for [redacted] not being filled I have researched your account and found that you spoke with a Pharmacy Technician on June 11, The Pharmacy Technician explained that your prescription could not be filled because the quantity exceeded the allowable amount that can be filled via mail order, pursuant to your prescription benefits of your health insurance plan In order for your prescription to be filled at PrimeMail, your doctor must contact PrimeMail to clarify the prescription or complete the prior authorization form that was faxed to him on May 27, The prior authorization form explains why the medication is needed to treat your conditionThe form must be returned to [redacted] for review To date, we have not received any indication from [redacted] that they have received the completed prior authorization form from your doctorAlso, the prescription has not been clarifiedIt has been placed on holdPlease contact your doctor and follow up regarding this matter If you have further questions or concerns, please call PrimeMail(r), [redacted] Our member services are available hours a day, 7days a week Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/06/27) */ (The consumer indicated he/she DID NOT accept the response from the business.) The Pharmacy Technician said she would call Blue Shield to see what quantity they would approveShe asked me if I would accept the day quantity and I said I would and that I just wanted them to order it so I can get my prescriptionBrittney said she would immediately put in the order and I would receive an email confirming the order and that she would have it delivered overnightNo email was ever received and I kept checking the PrimeMail website to see if it was available on my personal site It was never ever mentioned to me that this prescription had to go back through my doctor like PrimeMail said in their response Being that PrimeMail cannot deliver a product like they promised and that they put in information in their response that was never mentioned to me I seem to have no other choice but to go elsewhere for all my prescriptions since they cannot be trusted Final Business Response / [redacted] (4000, 9, 2015/07/07) */ You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that your prescription [redacted] was not filled and shipped overnight as you anticipated I understand your concerns with not receiving your medication as expectedI have researched your account and found that on May 26, 2015, Prime received a prescription for ***Upon processing the prescription, Prime received a rejection from Blue Shield of California (BSC) stating that a Prior Authorization (PA) was required to fill the medication due to the quantity limits in place under your plan benefitsA letter was sent to you on May 27, with this information On June 11, 2015, you called and spoke with a Pharmacy Technician who advised you that your prescription was rejected and that a PA would be required in order for Prime to fill itShe advised you that Prime would reach out to your plan to verify how the prescription should be entered and that once the issue was resolved, the order would be processed and shipped to you Next Business DayOn June 12, 2015, Prime called BSC and was advised a PA would need to be completed by your doctor in order for the medication to be processed On June 30, and July 7, 2015, I contacted BSC and was told that to date, no PA has been receivedYour prescription has been placed on hold and can be processed once Prime has received the proper approvals from your health planPlease contact your doctor to follow up on this issue We regret any inconvenience this may have causedIf you have further questions or concerns, please call PrimeMail [redacted] Our member services are available hours a day days a week Final Consumer Response / [redacted] (3000, 11, 2015/07/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) Again PrimeMail has their facts incorrectI was told by the Pharmacy Technician that the problem was solved and that she would put in the order and have it shipped overnightYour answer that you keep relaying to the Revdex.com is different than what was told to me Being that you continue to get your facts wrong and refuse to follow through with what was promised I am going to gladly take my business elsewhereThere is no need to continue this complaint because PrimeaMail is NOT a company I want to do business
I am rejecting this response because: I understand the Revdex.com's role in this matter, and we are more than willing to accept an adequate resolution to our complaintI stated our desired resolution: a reversal of the termination of the contract The only ongoing matter is that after filing our appeal, we have not been notified by Prime Therapeutics of any advancement of the appeal or any changes we might make to advance the appeal ourselvesOur understanding of this situation is that the appeal process is a farce, probably a legal requirement meant to solidify the termination: i.e., They "gave us a chance" to appealHowever, since the only communication we have received from Prime Therapeutics is at the behest of the Revdex.com, we are not convinced that this appeal is being handled in a fair mannerThe Revdex.com can attest to the quality and informative value of the ONLY communication which we have received from Prime Therapeutics since formally filing this "appeal." A determination of the appeal is not sufficient, as we believe it to be a foregone conclusion based on our interaction (or lack thereof) with the contracting department at Prime Therapeutics, namely with Bill DevineThis may be a run of the mill business interaction for employees at Prime Therapeutics, but for employees of DrZ's Pharmacy, this is a decision that may impact their future as employeesWe also have patients of ours who are Prime members that would like this matter resolved so that they can know where they are to receive their next refillSo we have to take this matter a little more seriously and urgently than might be standard practice for Prime Therapeutics
After reviewing your account, we found there is a Utilization Management Program included in your current Horizon Blue Cross Blue Shield New Jersey (Horizon BCBSNJ) planThis means that some medications need prior authorization (pre-approval) before they can be obtained We understand the urgency to receive your medication when you need itWe have reviewed your concerns and found on October 5, 2017, we received an urgent PA request for ***, to be taken a twice dayYour plan benefit allows this medication to be dispensed with a maximum quantity of tablets in days On October 6, 2017, the PA was denied stating your requested dose can be reached with a lower quantity of a higher strength, which does not exceed the quantity limitFor example: you can obtain the [redacted] instead of the [redacted] twice a day that was requestedA letter of denial was mailed to you and a faxed copy was sent to your doctor On October 25, 2017, [redacted] was able process [redacted] for 30-day supply Prime is the pharmacy benefits manager (PBM) for BCBSNJ, which means we administer the prescription drug benefits of your health planPrime conducts all reviews of PA requests from physicians for members with BCBSNJ prescription drug coverage pursuant to the BCBSNJ health plan benefits, and in accordance with all applicable laws and regulations
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me
Initial Business Response /* (1000, 5, 2016/01/18) */
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that you received an order that you did not authorizeYou are
requesting a refund of $to be applied to the balance on your account
We understand your concern with receiving a medication you were not expectingAfter researching your account, we found that on January 5, 2016, Prime received an electronic prescription for ***Prime's process is to fill and ship any prescriptions received by a member or their doctor in good faith, unless Prime is notified otherwiseThere were no instructions accompanying the prescription advising not to fill it
As a one-time courtesy, your account has been credited in the amount of $to the balance on your accountTo guarantee that prescriptions are not filled, instructions must be sent with each prescription stating "Do Not Fill" or "Profile" on each prescription
We regret any inconvenience this may have causedIf you have further questions or concerns, please call ***Our member services department is available hours a day days a week
Initial Consumer Rebuttal /* (2000, 7, 2016/01/18) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I agree that they have righted the wrong that has occurred and going forward if I do have to use them for any prescriptions I will make it very clear to my doctor who is writing the prescription as to where it should be sent for fulfillmentI thank them for making this right
Dear Ms***,
You contacted the Revdex.com (Revdex.com) about your recent experience with Prime Therapeutics LLC (Prime)Specifically, you have concerns that your prior authorization (PA) requests for your medications have been deniedYou stated you want Prime to be absolved from
your medical insurance and would like all decisions regarding your medical coverage to be handled directly with Blue Cross Blue Shield of Illinois (BCBSIL)
After reviewing your account, we found there is a Utilization Management Program included in your current BCBSIL planThis means that some medications need prior authorization (pre-approval) before they can be obtainedOn May 20, 2016, Prime received a PA request for XXXX and on May 24, for XXXX, which were denied. On June 2, 2016, detailed letters informing you of the reason for the denials were mailed to you and faxed to your doctorThe letters also included the process for appealing the PA decision
Prime is the pharmacy benefits manager (PBM) for BCBSIL, which means we administer the prescription drug benefits of your employer’s health plan. Prime conducts all reviews of PA requests from physicians for members with BCBSIL prescription drug coverage pursuant to the BCBSIL health plan benefits and in accordance with all applicable laws and regulationsIf the specific criteria is met, the health plan benefits will be applied and if the criteria is not met, a member may choose to appeal the decision and ultimately may receive the medication at the full cost, without insurance benefits
We regret any inconvenience this may have causedIf you have further questions or concerns, please call ###-###-####Our member services department is available hours a day days a week
On February 1, 2018, you were provided with a response to your concerns through the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)You stated you are rejecting that response because you still have not received the reimbursement for the three prescriptions and you have been waiting for since November We understand your concerns about receiving your reimbursementPaper claim reimbursements typically takes up to to weeks to processIf additional information is needed, the process can take longerPrime cannot process paper claim requests without the proper prescription receipts On December 7, 2017, our records show a letter was mailed to you requesting detailed pharmacy receiptsOn January 9, 2018, we received all the proper information to process your paper claims As stated in the letter on February 1, 2018, the claim from November 14, 2017, was processed and the payment was mailed January 31, Our records show that payment has been cashed as of February 7, On January 29, 2018, the paper claim for November and were processed with a refund of $ The payment will be mailed on February 14, 2017, via next day delivery
I spoke with Mrs*** yesterday in reference to her billing concernMrs*** is expecting reimbursement for monies she paid towards her medication order in June At the time, the member was enrolled in co-pay assistanceHowever, she requested the pharmacy not use the program
assistance as the monies would not be applied to her accumulatorsThe pharmacy complied and reversed the claim to the co-pay assistance and charged her cc for the amount dueMrs*** spoke with a billing specialist at the pharmacy in Dec and was advised to submit for reimbursement from the co-pay assistance program directly by sending in the payment receipt from the pharmacy as well as the EOB she received from her primaryMrs*** explained to me yesterday that she did as the billing specialist advised and submitted the reimbursement request along with the documents to the co-pay assistance program on 12/19/On 12/20/in the AM she received a request for more documentation which she explained she immediately sent in to themHowever, she had not heard back from the co-pay assistance as of weeks agoI connected the member with the co-pay assistance program yesterday so that we can obtain a status on her reimbursement requestMrs*** was advised by the specialist at the co-pay assistance program that the request was forwarded to the manufacturer of the medication for review and consideration as the days for reimbursement from them had lapsed by the time they received all the information they needed from herThe specialist advised Mrs*** and myself that a decision is expected to be received from the manufacturer in about a weekMrs*** and I agreed to and scheduled a f/u with them next week Wed 2/Please advise if there is anything more needed at this time
Initial Business Response /* (1000, 5, 2016/02/05) */
Reference: Case ***
Dear Mr***,
You contacted the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)Specifically, you stated you're concerned about not receiving reimbursement for several
paper claims that you have submitted for review
We have had an opportunity to research your account and found that to date, we have not yet received any paper claim requests for reimbursementTo better assist you, you may fax paper claim requests to me directly at *** and I will be happy to forward them to the appropriate party or you can mail paper claims to the following address:
Prime Therapeutics (Commercial)
BCBSNC ***
Lehigh Valley, PA 18002-
We regret any inconvenience this delay may have causedPlease feel free to contact me directly if you have any questions or require additional informationOur member services are available hours a day days a week
Sincerely,
2/19/
Dear Mr***,
You recently contacted the Revdex.com about your experience with Prime Therapeutics Specialty Pharmacy LLC ("Prime Specialty Pharmacy")Specifically, you were concerned about inconsistent information provided about the delivery of your order
Thank you for bringing this to our attentionWe have researched your concern and found opportunities for improvementI've credited your account in the amount of $to reimburse you for the cost of the additional medicine
We regret that your experience with Prime Specialty Pharmacy did not meet your expectationsPrime Specialty Pharmacy strives to provide exceptional service while ensuring you receive the medicine you need to feel better and live wellPlease know that we are committed to exceeding your expectations with all future interactions
If you have further questions or concerns, please call Prime Specialty Pharmacy Our member services are available hours a day days a week
Thank you,
Al ***
Director Specialty Pharmacy Member Services
Prime Therapeutics Specialty Pharmacy LLC
I am rejecting this response because: there were instances prior to december 12th where errors were acknowledged by reps from prime this matter should have long been resolved and your firm has zero credibility given the incompetence and lies I have been fed on prior occasions I asked for tracking information or other proof that payment will be remitted, and for the payment to be expedited, neither of which has been offered I have zero interest in how you manage future cases, I want my case resolved at once and my requests met. have the payment sent by express courier and tracking information forwarded if these conditions cannot be met I will have no choice to pursue a combination of: a demand letter will be sent promptly to your legal address, followed by legal recourse, and additional complaints to state or federal government insurance and consumer related entities requesting a review of your licensing and order of approval as needed
Initial Business Response /* (1000, 5, 2015/10/26) */
Reference: Case# ***
Dear Ms***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that your credit
card was charged $for an order that you believe you did not authorize
We can understand your concern with being charged for a prescription order that you did not authorizeAfter researching your account, we found that Prime received a prescription for *** on September 17, The prescription is subject to prior authorization, pursuant to your health plan pharmacy benefitsPrime's agent worked with Blue Shield of California (BSC) to provide the prior authorization request form to your doctorOn September 30, 2015, you called and requested that Prime not fill the prescription because of the cost of the medicationAt your request, Prime's agent did not process the order for the medication
On October 1, 2015, Prime received a new prescription from your doctor's office for ***The order was processed and shipped the same dayPrime considers the receipt of a fax, telephone, or an electronic prescription from a doctor's office to be an initiation of a prescription drug order and we will process the order as such in good faith, unless instructed otherwise by the member or the doctor
On October 6, 2015, you called and stated that you did not authorize Prime to fill the medication and requested a refund of $A case was opened to research your concerns, and Prime determined the October order was for the same medication as the September order, which had been canceledAlthough the order was a brand new prescription and was processed in good faith pursuant to Prime's standard practices, the pharmacist you spoke with informed you that a return mailer would be sent to you to send the medication back to Prime, and that a refund would be applied to your credit card
The pharmacist should have informed you that the refund would be processed upon Prime's receipt of the medicationWe have provided this information to the appropriate supervisor for employee coaching and development
On October 12, 2015, you called and stated you had not received your refundThe agent you spoke with told you that a refund would be processed once Prime received the medicationShe indicated that after the medication is received, a credit would be applied to your card within hours, but it could take up to days to show on your bank accountYou requested to have a check mailed to you overnight instead of a credit card refundThe agent placed a request to the Accounting department and noted your requestPrime's Accounting department is only able to process a refund in the same manner the funds were receivedSince the payment was processed through a credit card, a refund can only be processed to your credit cardWe have provided this information to the appropriate supervisor for employee coaching and development
On October 14, 2015, Prime received the returned medicationA credit was applied to your credit card on October 15, Each bank has its own guidelines that determine when the credit is posted to a member's accountWe have been advised that the average time is business days, but may take up to days to post to your account
We regret any inconvenience this may have causedIf you have further questions or concerns, please call PrimeMail ***Our member services are available hours a day days a week
Initial Consumer Rebuttal /* (2000, 7, 2015/10/27) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I wouldn't say I'm totally satisfied as I feel their customer service practices need to be thoroughly reviewed but I did receive my refund days after it was issued, which was weeks after my initial conversationI will be sending this information to our provider for their review and sure hope they decide to change mail order pharmacies in the futureI never had issues until they switched to Prime
Initial Business Response /* (1000, 20, 2015/07/28) */
The member's designee contacted the Revdex.com on behalf of the member about her recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)In the complaint, the member's designee's concerns were
about the time it took Prime to process prescriptions and customer service issues
Prime provides pharmacy benefit management and mail order pharmacy services for this member's health planThe health plan provides Prime with coverage and eligibility information, which Prime uses when creating pharmacy profilesThe health plan provided Prime coverage and eligibility information for this member using a hyphenated last name so Prime created a pharmacy profile for the member with a hyphenated last name
Prime received prescriptions from three doctors between October and June Several prescriptions were written for the member with a non-hyphenated last name rather than the hyphenated last namePrime created a pharmacy profile for the non-hyphenated last nameThere was no coverage or eligibility information available for the non-hyphenated last namePrime staff reached out to the doctor, health plan, and member to address missing eligibility information and differences in the last nameUpon confirmation that this was the same person, Prime merged the profiles into a single profile using the member's hyphenated last name, the name on file with the health plan
Prime recommends the member work with her prescribers and health plan to make certain her last name is consistently noted to avoid this issue in the futurePlease note that if Prime receives another prescription written for the non-hyphenated last name, a profile without coverage information may be created and she may have a similar issue again
The complaint indicated Prime "lost" prescriptionsThere is no record of Prime losing any prescriptionsGiven the duplicate profiles and inconsistent use of the member's name, there was some confusion on calls with the member and her designees and Prime
Ultimately, the member did not receive several of her prescriptions immediately because they were requested before allowed by her health plan (i.erefill too soon)Prime is a closed door pharmacy and does not accept cash for medicine that the health plan does not coverIn accordance with Prime's standard process, Prime filled the prescriptions on the earliest date allowed by the health plan
Prime communicates with members that they should allow 3-days to process prescriptions and an additional 5-days to allow for deliveryAs soon as the prescriptions were allowed by her health plan, Prime processed and shipped all of the member's prescriptions within Prime's standard processing guidelines
The complaint noted that Prime asked the member for identification information (driver's license number or social security number)Prime is required to request this information when processing prescriptions for controlled substances in Louisiana
Prime is licensed with the Louisiana Board of Pharmacy as a nonresident pharmacy and holds a current license without restriction or limitation
In researching this complaint, we listened to calls between the member or her designee and PrimeWe agree, Prime staff could have assisted the member or her designee betterWe have provided feedback with the management team to review process and, where appropriate, for employee coaching and developmentPer the request of her designee, Prime has transferred all of the member's prescriptions to another pharmacy
The member's designee requested a list of prescriptions filled by Prime be provided to a specific providerPrime has provided this information as requested
We regret any inconvenience this may have caused and appreciate you bringing this to our attention
If you have any questions or need additional information from Prime, please contact us at ***
Initial Consumer Rebuttal /* (3000, 27, 2015/08/17) */
***Document Attached***
They were not through with meThey have continued to harass my daughter and create problems for herIn addition, they made it extremely difficult to get one of her prescriptions after having them transferred to a local pharmacyIf this case was closed, on what basis was it closed?
Final Consumer Response /* (2000, 31, 2015/09/02) */
(The consumer indicated he/she ACCEPTED the response from the business.)
After taking my daughter's RXs over and requesting that PrimeMail replace her phone #s with mine and that they not call her ever again, they kept calling her and emailed herWith every contact, my daughter became suicidal and homicidalFortunately, we live too far from Irving for the homicidal ideations to become a problemI am enclosing the information I sent to the Louisiana State Board of Pharmacy
Re PHY.***, Case # 15-
Dear Counsel Finalet:
PrimeMail has let you to believe they are doing and have been doing everything as they would be expected to doPlease let me remind you that because of interactions with PrimeMail, my daughter has become suicidal; and now I find out homicidal toward themBecause of the adverse reactions and fear for my daughter's life, I have asked that all interactions needed on her behalf go through me and she not be contacted for anythingI have requested this on both the Customer Service side and the Pharmacy sideI also requested that all of her RXs be transferred to the Nelson Road CVS here in Lake CharlesNeither of those requests has been honored
In order to make my point, I want you to see the amount of time spent on the phone with PrimeMail and BCto try to resolve the RX problems faced by my daughterShe tried to manage her medications by herself for years, but PrimeMail has played with her mind until she kept bringing the phone to me to try to get her medicationsIt got so bad, her husband and I determined that it would be best if I handled all her RXs
Type Local Number Remote Number CallName Date/***e Duration (seconds)
Outbound (337) *** (800)*** BCBS TX 2015-07-19:55:
Outbound (337) *** (800)*** BCBS TX 2015-07-15:26:
Outbound (337) *** (877) *** 2015-06-14:16:
Outbound (337) *** (877) *** 2015-06-14:14:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:51:
Outbound (337) *** (877) *** 2015-06-16:22:
Outbound (337) *** (800)*** BCBS TX 2015-06-15:54:
Outbound (337) *** (800)*** BCBS TX 2015-06-14:03:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:54:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:50:
Inbound (337) *** (903) *** BLUE CROSS & BL 2015-06-13:34:
Outbound (337) *** (800)*** BCBS TX 2015-06-15:14:
Outbound (337) *** (800) *** 2015-06-15:05:
Outbound (337) *** (800) *** 2015-06-14:58:
Outbound (337) *** (800) *** 2015-06-14:49:
Outbound (337) *** (800)*** BCBS TX 2015-06-12:17:
Outbound (337) *** (800) *** 2015-06-15:52:
Outbound (337) *** (800)*** 2015-06-20:26:
Outbound (337) *** (877) *** 2015-06-20:37:
Outbound (337) *** (877) *** 2015-06-15:34:
Outbound (337) *** (877) *** 2015-06-15:34:
My Ooma Home (337) ***
Call Logs
Line Type Phone Number Name Date Duration
***Inbound call (888) *** Service Jul-12:PM 2:+ Add to Blacklist
Next, you will see screenshots of calls received from *** from PrimeMailPlease note the deceptive use of different phone numbersWhen these numbers are called, they are answered with, "Thank you for calling PrimeMail."
In addition to contacting *** repeatedly, they have continued to contact *** and not about his medication
There really is no reason they cannot call me, I gave them my cell # *** and my home # ***I have repeatedly asked that the Pharmacy side and the Customer Service side not contact *** for anythingI will be more than happy to answer any questions or provide any needed information they may needEspecially, since we had all RXs transferred to the Nelson Road CVS, there should be no reason to call ***The problem is, they want the business and they do not care for one second about her mental health and the possibility that any call could push her over the edge
The guns have been removed from the house, but medications have notThe very medications that she takes are here at the houseOne of her suicidal ideations is to overdose on WarfarinIt is readily availableI have exhausted my savings paying people to stay with her for a suicide watchNone of this would be necessary if PrimeMail would leave her alone and stop contacting herShe is very raw from previous interactionsOf course, prime mail repeatedly says they do not contact her
They also say that her doctors have not had to repeatedly submit her RXs, but if you contacted her doctors, you would get a very different storyHer doctors are Amanda *** at *** and the main number is *** and Linda ***/Sara *** + Barbie (Receptionist) *** and Barbie also emails PrimeMailBarbie's email is ***@thePsychiatricCenter.com
Because of the inhumane treatment of my daughter, I request that PrimeMail allow my daughter fill all her prescriptions locally with the same discount they have for mail order RXsAs a matter of fact, to ensure that they no longer make unnecessary calls, they should extend the same courtesy to her husband, *** (DOB ***.) By allowing all RXs for this family to be filled locally at the same discount they would get if they used the mail order service, there would be no reason for PrimeMail to contact either one of themWhen *** is called, he gets in trouble at work; consequently, he has quit taking his medication*** gets suicidal and homicidal when contacted by PrimeMailGetting their RXs locally, with the discount, is the perfect answer and a small price to pay for lying about contacting my daughter and about upsetting her repeatedly and unnecessarily
The screen shots did not show upThe numbers from where the calls were placed are: ***, calls listed as Massachusetts, calls from *** and a PrimeMail Survey from [email protected]
Because of the aggressive inhumane stalking of PrimeMail toward my daughter, I want them to approve all of her medications at the mail order price to be filled at her local pharmacyIt is the very least they could doAfter all, I have spent my money and time ensuring her safety and letting her calm down when she was homicidalNo of that would have happened if PrimeMail had just left her alone as requested and as I was told they would doThey supposedly have all the phone calls on tapeI am not sure has the hours of time to listen to all the run around and lies they have told us, but I am told it is all thereBecause ***'s insurance is through her husband's work, and because that she relies on medication to keep her stable and able to live a life, the least PrimeMail can do is to allow all of her medications to be obtained locally at the mail price since PrimeMail found it necessary to harass and stalk herI still need to remain the contact person for all information and for Prime Mail to let me know how to get the mail order price on all of ***'s medication
Final Business Response /* (4000, 42, 2015/10/12) */
***Document Attached***
Please see the following attached response
You recently contacted the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)You stated you were informed that the prescription you purchased out of pocket would qualify for a 100% reimbursementYou stated after mailing your
pharmacy receipts for reimbursement by certified mail, you received a signed return receipt showing that your information had been receivedYou are expecting your refund to be $*** We understand your request for a timely reimbursementOn January 15, 2018, we received a reimbursement request for *** for three different dates of service, November 1, and 14, The prior authorization (PA) allowing *** to be covered under your pharmacy benefits became effective November 14, thru May 14, The paper claim date of service November 14, 2017, was processed and paid with a refund of $***, due to the PA approvalThe payment will be mailed on January 31, On January 21, 2018, the PA for *** was backdated giving a new coverage date for the medicationThe coverage date is now November 1, thru May 1, On January 29, 2018, the remaining paper claims were processedEach claim will be reimbursed at $***Please allow to to weeks to receive this payment Your total reimbursement for the claims will be $***
Initial Business Response /* (1000, 5, 2015/10/23) */
Dear Mr***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy ("Prime")In your complaint, you requested Prime update the doctor's fax number in our
files and that we determine why we haven't been receiving responses from your doctor's office
The complaint stated that you submitted a refill request through Prime's Prescriber Outreach Program on October On October 12, you had confirmed with your doctor's office that they submitted a new prescription to PrimeOn October 9, October 13, and October you called Prime to check on the status of your refill request
We researched your account and found:
-Prime takes customer service very seriouslyWe appreciate you for providing us detailed information about your experienceWe provide feedback to our agents on what our members expect and the agents receive continuous training to provide the expected customer serviceProviding a high level of customer service is always Prime's goal
Prime wants to make sure all experiences with us are positiveBecause of this, we monitor member callsAfter reviewing the information that you've provided and listening to the calls, we agree that agents could have taken other steps to better assist youWe have documented and forwarded this incident to the appropriate management teams for employee coaching and feedback
-Prime contacted your doctor's office on October and confirmed the doctor's fax number for refill requests is ***-***-***We have updated our files to reflect this corrected fax number
-Prime confirmed with the doctor's office that they use an electronic prescribing systemThe doctor's office's electronic prescribing system can send prescriptions for controlled and non-controlled substances
-According to our records, Prime has history of receiving electronic prescriptions from your doctor for non-controlled substances
-For the refill request in question, the doctor's office may have tried to submit an electronic prescription to PrimeHowever, *** is a controlled substance and Prime is unable to accept electronic prescriptions for controlled substances at this timeIf a doctor submits an electronic prescription to Prime for a controlled substance, the doctor may receive an error message from our electronic prescribing software vendor notifying them Prime did not accept the electronic transmissionOur software vendor does not provide Prime with an error message of the doctor's failed attempt of sending an electronic prescriptionPrime accepts controlled substances prescriptions by mail, facsimile or verbally over the phone from the doctor's office
-On October 16, Prime received a faxed prescription for *** from your doctor
-On October 23, your order shipped via United Parcel Service (UPS)
We regret any inconvenience this may have caused and appreciate you bringing this to our attentionIf you have further questions or concerns, please call PrimeMail ***Our member services are available hours a day days a week
Thank you
Mercy Clinic Pharmacy at Pulaski was contacted and confirmed they are concerned with the coverage of Drug A (Test Strips)The pharmacy stated the member paid $out of pocket using a drug discount card for Drug B (Test Strips) on August 12, 2016; however, they are not requesting to have the
member reimbursed or to have Drug B coveredThe pharmacy confirmed the member will be using Drug A going forward and they would like this drug to be covered for her next fillAs background, Drug A requires Step Therapy (ST)Step Therapy requires the previous use of one or more drugs before coverage of a different drug is providedIf the member’s health plan's Drug List (Formulary) reflects that Step Therapy is used for a specific drug, her doctor must submit a Coverage Determination request form to her health plan for approvalThe member has the option to request her doctor to complete the Coverage Exception form, they can request a Coverage Exception electronically online at www.myprime.com, or by contacting Member Services at the number provided on the back of her insurance cardOn August 4, 2016, a Step Therapy request for Drug A was received and denied on August 5, 2016, because the member must have an approved condition for the use of this drugThese include: Taking a drug to treat diabetes in the past days.Taking a drug that affects the member’s blood sugar in the past days.Gestational diabetes.Diabetes that needs blood sugar monitoring and the member must have a lab test provided by her doctor to diagnose her conditionAdditionally, the member’s doctor must provide a valid diagnosis code to verify she has an approved condition for use of the drug, which they did notBased upon the information provided from the member’s doctor, she did not meet these criteria at the time of the reviewThe member and her doctor were sent a letter with the decision in detail, which included her right to appeal.On August 10, 2016, a Step Therapy request for Drug A was receivedBased on the information provided from the member’s doctor’s office, they did not provide a valid diagnosis code to verify she has an approved condition for use of the drugThe member’s doctor’s office was contacted twice to obtain the correct diagnosis code; however, Prime Therapeutics was unable to verify the information needed to complete the reviewOn August 11, 2016, a fax was sent to the member's doctor’s office instructing them to resend the Coverage Exception for Drug A with the proper diagnosis code and the fax also explained the request was not reviewable due to the missing information.On August 30, 2016, the member’s insurance received a paid claim for a qualifying diabetic drugThis means the member will be able to fill Drug A for up to days from August 30, 2016, with a copay of $On September 2, 2016, Mercy Clinic Pharmacy at Pulaski was contacted and provided this information.As a result, Mercy Clinic Pharmacy at Pulaski received a paid claim for Drug A with a copay of $for the member on September 6, We have reviewed the Mercy Clinic Pharmacy at Pulaski’s calls and the member’s doctor’s office’s calls to our Member Service Department and the appropriate actions were takenUnfortunately, we are not able to designate a specific person for the pharmacy or the doctor’s office to contactFor future inquiries, the pharmacy is encouraged to contact our Pharmacy Help Desk at ###-###-####
I am rejecting this response because: I have waited since November of as that is when I sent the 1st Prescription Claim form requesting reimbursement for prescriptionsA month later I was sent a letter from PRIME THERAPEUTICS stating the pharmacy receipt was missing a letter code of sorts and I was advised to once again go to the pharmacy in order to get a different prescription receipt which I did and mailed to Prime by certified mailWhy you couldn't call the pharmacy yourself vsmaking me continue to wait on the monies owed to me was ridiculousSo no, nothing on your Parr has been taken care of in a timely manner I have been waiting now WEEKS to receive my refund!!! At the very least since you have no problem taking your sweet time you could have mailed a check to me that you state you mailed it on January 31st overnight mail! When I get a medical bill I pay it on time though Prime takes their sweet time and gets your monies to you whenever you feel like itOh and I had even sent emails to PRIME THERAPEUTICS and never received any response to my emails! I hope I don't deal with this company in the future! My complaints will be posted for the public to see on Revdex.com website so other patients will be aware of how this company could careless about refunding monies to individuals and do not respond to emails when reaching out for help! I had to get Revdex.com involved and I'm positive if I hadn't reached out to Revdex.com I would never had Prime send me the refunds that I am due! Thank gosh for the Revdex.com!
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me
Initial Business Response / [redacted] (1000, 6, 2015/10/02) */ Dear Ms***: You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns with Prime charging your credit card for the full amount of your co-pay for your medication, despite your request not to process the paymentYou have asked that Prime refund your co-pay in the amount of $because your credit card was charged against your wishes Our records show that you placed a call to Prime and spoke with a Member Service Agent (MSA) on September 10, 2015, requesting to refill a prescription for [redacted] You told the MSA that you wanted the cost of the medication to be split between two credit cards and asked to be contacted if this could not be doneOur records indicate that the MSA notated the order with your instructions During processing of your order, one of your credit cards was declinedThe next available form of payment on file, another of your credit cards, was used to complete the order according to Prime's standard processWe regret that the notation concerning your payment was inadvertently missedThis incident has been documented and reported to the correct supervisor for employee coaching Unfortunately Prime is unable to refund the $co-pay for your medication because it was correctly assessed in accordance to your pharmacy benefitsWe are willing work with you to cover any charges that you incurred as a resultPlease contact us for further information about this Prime regrets any inconvenience you may have experiencedWe evaluate all concerns regarding our members that are brought to our attention, and we will keep record of yours for future referenceIf you have further questions or concerns, please call Our member services are available hours a day days a week Initial Consumer Rebuttal / [redacted] (3000, 8, 2015/10/05) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do not agree with the results, however I feel there is nothing further I can do, so I am assuming this will be closedHowever I hope you will note I was a dissatisfied client with Prime Therapeutics
According to your account, there is a Utilization Management Program included in your current pharmacy benefits under your BCBSNJ planThis means that some medications need prior authorization (pre-approval) before they can be obtained using your pharmacy benefitsFor a list of medications in this program and other helpful information, please register at www.myprime.comAfter further review of your account, we found that your Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) Pharmacy benefits have changed as of October 1, According to your current pharmacy benefits [redacted] and **are a part of a Quantity Limits (QL) ProgramQL are applied to certain drugs based on the approved dosing limits established during the FDA approval processIf your doctor would like to prescribe an amount that would exceed this limit, he/she must submit a PA request to Horizon BCBSNJ for reviewThe information submitted should explain why you need to exceed the quantity limitOn October 5, 2017, Prime received a PA for **Based on information provided by your doctor, the request was denied because the information provided failed to meet pre-established criteriaThe decision was made by a panel of pharmacists who are trained to review all prior authorization requests based on your pharmacy benefitsIt was determined that your prescribed dose can be reached with a lower quantity of a higher strength that does not exceed the quantity limitPlease be advised that you have the right to appeal any services or coverage determination’sWhen you make an appeal, you are requesting the coverage determination to be reconsideredTypically, details about the appeal process are mailed with the coverage determination letterIf you have not received this information, please contact BCBSNJWe found no Prime errors during the process of your medication reviewOn October 25, 2017, [redacted] Pharmacy was able process your medication **
Initial Business Response / [redacted] (1000, 5, 2015/06/19) */ Dear Mr [redacted] , You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns about your prescription for [redacted] not being filled I have researched your account and found that you spoke with a Pharmacy Technician on June 11, The Pharmacy Technician explained that your prescription could not be filled because the quantity exceeded the allowable amount that can be filled via mail order, pursuant to your prescription benefits of your health insurance plan In order for your prescription to be filled at PrimeMail, your doctor must contact PrimeMail to clarify the prescription or complete the prior authorization form that was faxed to him on May 27, The prior authorization form explains why the medication is needed to treat your conditionThe form must be returned to [redacted] for review To date, we have not received any indication from [redacted] that they have received the completed prior authorization form from your doctorAlso, the prescription has not been clarifiedIt has been placed on holdPlease contact your doctor and follow up regarding this matter If you have further questions or concerns, please call PrimeMail(r), [redacted] Our member services are available hours a day, 7days a week Initial Consumer Rebuttal / [redacted] (3000, 7, 2015/06/27) */ (The consumer indicated he/she DID NOT accept the response from the business.) The Pharmacy Technician said she would call Blue Shield to see what quantity they would approveShe asked me if I would accept the day quantity and I said I would and that I just wanted them to order it so I can get my prescriptionBrittney said she would immediately put in the order and I would receive an email confirming the order and that she would have it delivered overnightNo email was ever received and I kept checking the PrimeMail website to see if it was available on my personal site It was never ever mentioned to me that this prescription had to go back through my doctor like PrimeMail said in their response Being that PrimeMail cannot deliver a product like they promised and that they put in information in their response that was never mentioned to me I seem to have no other choice but to go elsewhere for all my prescriptions since they cannot be trusted Final Business Response / [redacted] (4000, 9, 2015/07/07) */ You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that your prescription [redacted] was not filled and shipped overnight as you anticipated I understand your concerns with not receiving your medication as expectedI have researched your account and found that on May 26, 2015, Prime received a prescription for ***Upon processing the prescription, Prime received a rejection from Blue Shield of California (BSC) stating that a Prior Authorization (PA) was required to fill the medication due to the quantity limits in place under your plan benefitsA letter was sent to you on May 27, with this information On June 11, 2015, you called and spoke with a Pharmacy Technician who advised you that your prescription was rejected and that a PA would be required in order for Prime to fill itShe advised you that Prime would reach out to your plan to verify how the prescription should be entered and that once the issue was resolved, the order would be processed and shipped to you Next Business DayOn June 12, 2015, Prime called BSC and was advised a PA would need to be completed by your doctor in order for the medication to be processed On June 30, and July 7, 2015, I contacted BSC and was told that to date, no PA has been receivedYour prescription has been placed on hold and can be processed once Prime has received the proper approvals from your health planPlease contact your doctor to follow up on this issue We regret any inconvenience this may have causedIf you have further questions or concerns, please call PrimeMail [redacted] Our member services are available hours a day days a week Final Consumer Response / [redacted] (3000, 11, 2015/07/08) */ (The consumer indicated he/she DID NOT accept the response from the business.) Again PrimeMail has their facts incorrectI was told by the Pharmacy Technician that the problem was solved and that she would put in the order and have it shipped overnightYour answer that you keep relaying to the Revdex.com is different than what was told to me Being that you continue to get your facts wrong and refuse to follow through with what was promised I am going to gladly take my business elsewhereThere is no need to continue this complaint because PrimeaMail is NOT a company I want to do business
I am rejecting this response because: I understand the Revdex.com's role in this matter, and we are more than willing to accept an adequate resolution to our complaintI stated our desired resolution: a reversal of the termination of the contract The only ongoing matter is that after filing our appeal, we have not been notified by Prime Therapeutics of any advancement of the appeal or any changes we might make to advance the appeal ourselvesOur understanding of this situation is that the appeal process is a farce, probably a legal requirement meant to solidify the termination: i.e., They "gave us a chance" to appealHowever, since the only communication we have received from Prime Therapeutics is at the behest of the Revdex.com, we are not convinced that this appeal is being handled in a fair mannerThe Revdex.com can attest to the quality and informative value of the ONLY communication which we have received from Prime Therapeutics since formally filing this "appeal." A determination of the appeal is not sufficient, as we believe it to be a foregone conclusion based on our interaction (or lack thereof) with the contracting department at Prime Therapeutics, namely with Bill DevineThis may be a run of the mill business interaction for employees at Prime Therapeutics, but for employees of DrZ's Pharmacy, this is a decision that may impact their future as employeesWe also have patients of ours who are Prime members that would like this matter resolved so that they can know where they are to receive their next refillSo we have to take this matter a little more seriously and urgently than might be standard practice for Prime Therapeutics
After reviewing your account, we found there is a Utilization Management Program included in your current Horizon Blue Cross Blue Shield New Jersey (Horizon BCBSNJ) planThis means that some medications need prior authorization (pre-approval) before they can be obtained We understand the urgency to receive your medication when you need itWe have reviewed your concerns and found on October 5, 2017, we received an urgent PA request for ***, to be taken a twice dayYour plan benefit allows this medication to be dispensed with a maximum quantity of tablets in days On October 6, 2017, the PA was denied stating your requested dose can be reached with a lower quantity of a higher strength, which does not exceed the quantity limitFor example: you can obtain the [redacted] instead of the [redacted] twice a day that was requestedA letter of denial was mailed to you and a faxed copy was sent to your doctor On October 25, 2017, [redacted] was able process [redacted] for 30-day supply Prime is the pharmacy benefits manager (PBM) for BCBSNJ, which means we administer the prescription drug benefits of your health planPrime conducts all reviews of PA requests from physicians for members with BCBSNJ prescription drug coverage pursuant to the BCBSNJ health plan benefits, and in accordance with all applicable laws and regulations
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me
Initial Business Response /* (1000, 5, 2016/01/18) */
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that you received an order that you did not authorizeYou are
requesting a refund of $to be applied to the balance on your account
We understand your concern with receiving a medication you were not expectingAfter researching your account, we found that on January 5, 2016, Prime received an electronic prescription for ***Prime's process is to fill and ship any prescriptions received by a member or their doctor in good faith, unless Prime is notified otherwiseThere were no instructions accompanying the prescription advising not to fill it
As a one-time courtesy, your account has been credited in the amount of $to the balance on your accountTo guarantee that prescriptions are not filled, instructions must be sent with each prescription stating "Do Not Fill" or "Profile" on each prescription
We regret any inconvenience this may have causedIf you have further questions or concerns, please call ***Our member services department is available hours a day days a week
Initial Consumer Rebuttal /* (2000, 7, 2016/01/18) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I agree that they have righted the wrong that has occurred and going forward if I do have to use them for any prescriptions I will make it very clear to my doctor who is writing the prescription as to where it should be sent for fulfillmentI thank them for making this right
Dear Ms***,
You contacted the Revdex.com (Revdex.com) about your recent experience with Prime Therapeutics LLC (Prime)Specifically, you have concerns that your prior authorization (PA) requests for your medications have been deniedYou stated you want Prime to be absolved from
your medical insurance and would like all decisions regarding your medical coverage to be handled directly with Blue Cross Blue Shield of Illinois (BCBSIL)
After reviewing your account, we found there is a Utilization Management Program included in your current BCBSIL planThis means that some medications need prior authorization (pre-approval) before they can be obtainedOn May 20, 2016, Prime received a PA request for XXXX and on May 24, for XXXX, which were denied. On June 2, 2016, detailed letters informing you of the reason for the denials were mailed to you and faxed to your doctorThe letters also included the process for appealing the PA decision
Prime is the pharmacy benefits manager (PBM) for BCBSIL, which means we administer the prescription drug benefits of your employer’s health plan. Prime conducts all reviews of PA requests from physicians for members with BCBSIL prescription drug coverage pursuant to the BCBSIL health plan benefits and in accordance with all applicable laws and regulationsIf the specific criteria is met, the health plan benefits will be applied and if the criteria is not met, a member may choose to appeal the decision and ultimately may receive the medication at the full cost, without insurance benefits
We regret any inconvenience this may have causedIf you have further questions or concerns, please call ###-###-####Our member services department is available hours a day days a week
On February 1, 2018, you were provided with a response to your concerns through the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)You stated you are rejecting that response because you still have not received the reimbursement for the three prescriptions and you have been waiting for since November We understand your concerns about receiving your reimbursementPaper claim reimbursements typically takes up to to weeks to processIf additional information is needed, the process can take longerPrime cannot process paper claim requests without the proper prescription receipts On December 7, 2017, our records show a letter was mailed to you requesting detailed pharmacy receiptsOn January 9, 2018, we received all the proper information to process your paper claims As stated in the letter on February 1, 2018, the claim from November 14, 2017, was processed and the payment was mailed January 31, Our records show that payment has been cashed as of February 7, On January 29, 2018, the paper claim for November and were processed with a refund of $ The payment will be mailed on February 14, 2017, via next day delivery
I spoke with Mrs*** yesterday in reference to her billing concernMrs*** is expecting reimbursement for monies she paid towards her medication order in June At the time, the member was enrolled in co-pay assistanceHowever, she requested the pharmacy not use the program
assistance as the monies would not be applied to her accumulatorsThe pharmacy complied and reversed the claim to the co-pay assistance and charged her cc for the amount dueMrs*** spoke with a billing specialist at the pharmacy in Dec and was advised to submit for reimbursement from the co-pay assistance program directly by sending in the payment receipt from the pharmacy as well as the EOB she received from her primaryMrs*** explained to me yesterday that she did as the billing specialist advised and submitted the reimbursement request along with the documents to the co-pay assistance program on 12/19/On 12/20/in the AM she received a request for more documentation which she explained she immediately sent in to themHowever, she had not heard back from the co-pay assistance as of weeks agoI connected the member with the co-pay assistance program yesterday so that we can obtain a status on her reimbursement requestMrs*** was advised by the specialist at the co-pay assistance program that the request was forwarded to the manufacturer of the medication for review and consideration as the days for reimbursement from them had lapsed by the time they received all the information they needed from herThe specialist advised Mrs*** and myself that a decision is expected to be received from the manufacturer in about a weekMrs*** and I agreed to and scheduled a f/u with them next week Wed 2/Please advise if there is anything more needed at this time
Initial Business Response /* (1000, 5, 2016/02/05) */
Reference: Case ***
Dear Mr***,
You contacted the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)Specifically, you stated you're concerned about not receiving reimbursement for several
paper claims that you have submitted for review
We have had an opportunity to research your account and found that to date, we have not yet received any paper claim requests for reimbursementTo better assist you, you may fax paper claim requests to me directly at *** and I will be happy to forward them to the appropriate party or you can mail paper claims to the following address:
Prime Therapeutics (Commercial)
BCBSNC ***
Lehigh Valley, PA 18002-
We regret any inconvenience this delay may have causedPlease feel free to contact me directly if you have any questions or require additional informationOur member services are available hours a day days a week
Sincerely,
2/19/
Dear Mr***,
You recently contacted the Revdex.com about your experience with Prime Therapeutics Specialty Pharmacy LLC ("Prime Specialty Pharmacy")Specifically, you were concerned about inconsistent information provided about the delivery of your order
Thank you for bringing this to our attentionWe have researched your concern and found opportunities for improvementI've credited your account in the amount of $to reimburse you for the cost of the additional medicine
We regret that your experience with Prime Specialty Pharmacy did not meet your expectationsPrime Specialty Pharmacy strives to provide exceptional service while ensuring you receive the medicine you need to feel better and live wellPlease know that we are committed to exceeding your expectations with all future interactions
If you have further questions or concerns, please call Prime Specialty Pharmacy Our member services are available hours a day days a week
Thank you,
Al ***
Director Specialty Pharmacy Member Services
Prime Therapeutics Specialty Pharmacy LLC
I am rejecting this response because: there were instances prior to december 12th where errors were acknowledged by reps from prime this matter should have long been resolved and your firm has zero credibility given the incompetence and lies I have been fed on prior occasions I asked for tracking information or other proof that payment will be remitted, and for the payment to be expedited, neither of which has been offered I have zero interest in how you manage future cases, I want my case resolved at once and my requests met. have the payment sent by express courier and tracking information forwarded if these conditions cannot be met I will have no choice to pursue a combination of: a demand letter will be sent promptly to your legal address, followed by legal recourse, and additional complaints to state or federal government insurance and consumer related entities requesting a review of your licensing and order of approval as needed
Initial Business Response /* (1000, 5, 2015/10/26) */
Reference: Case# ***
Dear Ms***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you have concerns that your credit
card was charged $for an order that you believe you did not authorize
We can understand your concern with being charged for a prescription order that you did not authorizeAfter researching your account, we found that Prime received a prescription for *** on September 17, The prescription is subject to prior authorization, pursuant to your health plan pharmacy benefitsPrime's agent worked with Blue Shield of California (BSC) to provide the prior authorization request form to your doctorOn September 30, 2015, you called and requested that Prime not fill the prescription because of the cost of the medicationAt your request, Prime's agent did not process the order for the medication
On October 1, 2015, Prime received a new prescription from your doctor's office for ***The order was processed and shipped the same dayPrime considers the receipt of a fax, telephone, or an electronic prescription from a doctor's office to be an initiation of a prescription drug order and we will process the order as such in good faith, unless instructed otherwise by the member or the doctor
On October 6, 2015, you called and stated that you did not authorize Prime to fill the medication and requested a refund of $A case was opened to research your concerns, and Prime determined the October order was for the same medication as the September order, which had been canceledAlthough the order was a brand new prescription and was processed in good faith pursuant to Prime's standard practices, the pharmacist you spoke with informed you that a return mailer would be sent to you to send the medication back to Prime, and that a refund would be applied to your credit card
The pharmacist should have informed you that the refund would be processed upon Prime's receipt of the medicationWe have provided this information to the appropriate supervisor for employee coaching and development
On October 12, 2015, you called and stated you had not received your refundThe agent you spoke with told you that a refund would be processed once Prime received the medicationShe indicated that after the medication is received, a credit would be applied to your card within hours, but it could take up to days to show on your bank accountYou requested to have a check mailed to you overnight instead of a credit card refundThe agent placed a request to the Accounting department and noted your requestPrime's Accounting department is only able to process a refund in the same manner the funds were receivedSince the payment was processed through a credit card, a refund can only be processed to your credit cardWe have provided this information to the appropriate supervisor for employee coaching and development
On October 14, 2015, Prime received the returned medicationA credit was applied to your credit card on October 15, Each bank has its own guidelines that determine when the credit is posted to a member's accountWe have been advised that the average time is business days, but may take up to days to post to your account
We regret any inconvenience this may have causedIf you have further questions or concerns, please call PrimeMail ***Our member services are available hours a day days a week
Initial Consumer Rebuttal /* (2000, 7, 2015/10/27) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I wouldn't say I'm totally satisfied as I feel their customer service practices need to be thoroughly reviewed but I did receive my refund days after it was issued, which was weeks after my initial conversationI will be sending this information to our provider for their review and sure hope they decide to change mail order pharmacies in the futureI never had issues until they switched to Prime
Initial Business Response /* (1000, 20, 2015/07/28) */
The member's designee contacted the Revdex.com on behalf of the member about her recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime)In the complaint, the member's designee's concerns were
about the time it took Prime to process prescriptions and customer service issues
Prime provides pharmacy benefit management and mail order pharmacy services for this member's health planThe health plan provides Prime with coverage and eligibility information, which Prime uses when creating pharmacy profilesThe health plan provided Prime coverage and eligibility information for this member using a hyphenated last name so Prime created a pharmacy profile for the member with a hyphenated last name
Prime received prescriptions from three doctors between October and June Several prescriptions were written for the member with a non-hyphenated last name rather than the hyphenated last namePrime created a pharmacy profile for the non-hyphenated last nameThere was no coverage or eligibility information available for the non-hyphenated last namePrime staff reached out to the doctor, health plan, and member to address missing eligibility information and differences in the last nameUpon confirmation that this was the same person, Prime merged the profiles into a single profile using the member's hyphenated last name, the name on file with the health plan
Prime recommends the member work with her prescribers and health plan to make certain her last name is consistently noted to avoid this issue in the futurePlease note that if Prime receives another prescription written for the non-hyphenated last name, a profile without coverage information may be created and she may have a similar issue again
The complaint indicated Prime "lost" prescriptionsThere is no record of Prime losing any prescriptionsGiven the duplicate profiles and inconsistent use of the member's name, there was some confusion on calls with the member and her designees and Prime
Ultimately, the member did not receive several of her prescriptions immediately because they were requested before allowed by her health plan (i.erefill too soon)Prime is a closed door pharmacy and does not accept cash for medicine that the health plan does not coverIn accordance with Prime's standard process, Prime filled the prescriptions on the earliest date allowed by the health plan
Prime communicates with members that they should allow 3-days to process prescriptions and an additional 5-days to allow for deliveryAs soon as the prescriptions were allowed by her health plan, Prime processed and shipped all of the member's prescriptions within Prime's standard processing guidelines
The complaint noted that Prime asked the member for identification information (driver's license number or social security number)Prime is required to request this information when processing prescriptions for controlled substances in Louisiana
Prime is licensed with the Louisiana Board of Pharmacy as a nonresident pharmacy and holds a current license without restriction or limitation
In researching this complaint, we listened to calls between the member or her designee and PrimeWe agree, Prime staff could have assisted the member or her designee betterWe have provided feedback with the management team to review process and, where appropriate, for employee coaching and developmentPer the request of her designee, Prime has transferred all of the member's prescriptions to another pharmacy
The member's designee requested a list of prescriptions filled by Prime be provided to a specific providerPrime has provided this information as requested
We regret any inconvenience this may have caused and appreciate you bringing this to our attention
If you have any questions or need additional information from Prime, please contact us at ***
Initial Consumer Rebuttal /* (3000, 27, 2015/08/17) */
***Document Attached***
They were not through with meThey have continued to harass my daughter and create problems for herIn addition, they made it extremely difficult to get one of her prescriptions after having them transferred to a local pharmacyIf this case was closed, on what basis was it closed?
Final Consumer Response /* (2000, 31, 2015/09/02) */
(The consumer indicated he/she ACCEPTED the response from the business.)
After taking my daughter's RXs over and requesting that PrimeMail replace her phone #s with mine and that they not call her ever again, they kept calling her and emailed herWith every contact, my daughter became suicidal and homicidalFortunately, we live too far from Irving for the homicidal ideations to become a problemI am enclosing the information I sent to the Louisiana State Board of Pharmacy
Re PHY.***, Case # 15-
Dear Counsel Finalet:
PrimeMail has let you to believe they are doing and have been doing everything as they would be expected to doPlease let me remind you that because of interactions with PrimeMail, my daughter has become suicidal; and now I find out homicidal toward themBecause of the adverse reactions and fear for my daughter's life, I have asked that all interactions needed on her behalf go through me and she not be contacted for anythingI have requested this on both the Customer Service side and the Pharmacy sideI also requested that all of her RXs be transferred to the Nelson Road CVS here in Lake CharlesNeither of those requests has been honored
In order to make my point, I want you to see the amount of time spent on the phone with PrimeMail and BCto try to resolve the RX problems faced by my daughterShe tried to manage her medications by herself for years, but PrimeMail has played with her mind until she kept bringing the phone to me to try to get her medicationsIt got so bad, her husband and I determined that it would be best if I handled all her RXs
Type Local Number Remote Number CallName Date/***e Duration (seconds)
Outbound (337) *** (800)*** BCBS TX 2015-07-19:55:
Outbound (337) *** (800)*** BCBS TX 2015-07-15:26:
Outbound (337) *** (877) *** 2015-06-14:16:
Outbound (337) *** (877) *** 2015-06-14:14:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:51:
Outbound (337) *** (877) *** 2015-06-16:22:
Outbound (337) *** (800)*** BCBS TX 2015-06-15:54:
Outbound (337) *** (800)*** BCBS TX 2015-06-14:03:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:54:
Outbound (337) *** (800)*** BCBS TX 2015-06-13:50:
Inbound (337) *** (903) *** BLUE CROSS & BL 2015-06-13:34:
Outbound (337) *** (800)*** BCBS TX 2015-06-15:14:
Outbound (337) *** (800) *** 2015-06-15:05:
Outbound (337) *** (800) *** 2015-06-14:58:
Outbound (337) *** (800) *** 2015-06-14:49:
Outbound (337) *** (800)*** BCBS TX 2015-06-12:17:
Outbound (337) *** (800) *** 2015-06-15:52:
Outbound (337) *** (800)*** 2015-06-20:26:
Outbound (337) *** (877) *** 2015-06-20:37:
Outbound (337) *** (877) *** 2015-06-15:34:
Outbound (337) *** (877) *** 2015-06-15:34:
My Ooma Home (337) ***
Call Logs
Line Type Phone Number Name Date Duration
***Inbound call (888) *** Service Jul-12:PM 2:+ Add to Blacklist
Next, you will see screenshots of calls received from *** from PrimeMailPlease note the deceptive use of different phone numbersWhen these numbers are called, they are answered with, "Thank you for calling PrimeMail."
In addition to contacting *** repeatedly, they have continued to contact *** and not about his medication
There really is no reason they cannot call me, I gave them my cell # *** and my home # ***I have repeatedly asked that the Pharmacy side and the Customer Service side not contact *** for anythingI will be more than happy to answer any questions or provide any needed information they may needEspecially, since we had all RXs transferred to the Nelson Road CVS, there should be no reason to call ***The problem is, they want the business and they do not care for one second about her mental health and the possibility that any call could push her over the edge
The guns have been removed from the house, but medications have notThe very medications that she takes are here at the houseOne of her suicidal ideations is to overdose on WarfarinIt is readily availableI have exhausted my savings paying people to stay with her for a suicide watchNone of this would be necessary if PrimeMail would leave her alone and stop contacting herShe is very raw from previous interactionsOf course, prime mail repeatedly says they do not contact her
They also say that her doctors have not had to repeatedly submit her RXs, but if you contacted her doctors, you would get a very different storyHer doctors are Amanda *** at *** and the main number is *** and Linda ***/Sara *** + Barbie (Receptionist) *** and Barbie also emails PrimeMailBarbie's email is ***@thePsychiatricCenter.com
Because of the inhumane treatment of my daughter, I request that PrimeMail allow my daughter fill all her prescriptions locally with the same discount they have for mail order RXsAs a matter of fact, to ensure that they no longer make unnecessary calls, they should extend the same courtesy to her husband, *** (DOB ***.) By allowing all RXs for this family to be filled locally at the same discount they would get if they used the mail order service, there would be no reason for PrimeMail to contact either one of themWhen *** is called, he gets in trouble at work; consequently, he has quit taking his medication*** gets suicidal and homicidal when contacted by PrimeMailGetting their RXs locally, with the discount, is the perfect answer and a small price to pay for lying about contacting my daughter and about upsetting her repeatedly and unnecessarily
The screen shots did not show upThe numbers from where the calls were placed are: ***, calls listed as Massachusetts, calls from *** and a PrimeMail Survey from [email protected]
Because of the aggressive inhumane stalking of PrimeMail toward my daughter, I want them to approve all of her medications at the mail order price to be filled at her local pharmacyIt is the very least they could doAfter all, I have spent my money and time ensuring her safety and letting her calm down when she was homicidalNo of that would have happened if PrimeMail had just left her alone as requested and as I was told they would doThey supposedly have all the phone calls on tapeI am not sure has the hours of time to listen to all the run around and lies they have told us, but I am told it is all thereBecause ***'s insurance is through her husband's work, and because that she relies on medication to keep her stable and able to live a life, the least PrimeMail can do is to allow all of her medications to be obtained locally at the mail price since PrimeMail found it necessary to harass and stalk herI still need to remain the contact person for all information and for Prime Mail to let me know how to get the mail order price on all of ***'s medication
Final Business Response /* (4000, 42, 2015/10/12) */
***Document Attached***
Please see the following attached response
You recently contacted the Revdex.com about your recent experience with Prime Therapeutics LLC (Prime)You stated you were informed that the prescription you purchased out of pocket would qualify for a 100% reimbursementYou stated after mailing your
pharmacy receipts for reimbursement by certified mail, you received a signed return receipt showing that your information had been receivedYou are expecting your refund to be $*** We understand your request for a timely reimbursementOn January 15, 2018, we received a reimbursement request for *** for three different dates of service, November 1, and 14, The prior authorization (PA) allowing *** to be covered under your pharmacy benefits became effective November 14, thru May 14, The paper claim date of service November 14, 2017, was processed and paid with a refund of $***, due to the PA approvalThe payment will be mailed on January 31, On January 21, 2018, the PA for *** was backdated giving a new coverage date for the medicationThe coverage date is now November 1, thru May 1, On January 29, 2018, the remaining paper claims were processedEach claim will be reimbursed at $***Please allow to to weeks to receive this payment Your total reimbursement for the claims will be $***
Initial Business Response /* (1000, 5, 2015/10/23) */
Dear Mr***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy ("Prime")In your complaint, you requested Prime update the doctor's fax number in our
files and that we determine why we haven't been receiving responses from your doctor's office
The complaint stated that you submitted a refill request through Prime's Prescriber Outreach Program on October On October 12, you had confirmed with your doctor's office that they submitted a new prescription to PrimeOn October 9, October 13, and October you called Prime to check on the status of your refill request
We researched your account and found:
-Prime takes customer service very seriouslyWe appreciate you for providing us detailed information about your experienceWe provide feedback to our agents on what our members expect and the agents receive continuous training to provide the expected customer serviceProviding a high level of customer service is always Prime's goal
Prime wants to make sure all experiences with us are positiveBecause of this, we monitor member callsAfter reviewing the information that you've provided and listening to the calls, we agree that agents could have taken other steps to better assist youWe have documented and forwarded this incident to the appropriate management teams for employee coaching and feedback
-Prime contacted your doctor's office on October and confirmed the doctor's fax number for refill requests is ***-***-***We have updated our files to reflect this corrected fax number
-Prime confirmed with the doctor's office that they use an electronic prescribing systemThe doctor's office's electronic prescribing system can send prescriptions for controlled and non-controlled substances
-According to our records, Prime has history of receiving electronic prescriptions from your doctor for non-controlled substances
-For the refill request in question, the doctor's office may have tried to submit an electronic prescription to PrimeHowever, *** is a controlled substance and Prime is unable to accept electronic prescriptions for controlled substances at this timeIf a doctor submits an electronic prescription to Prime for a controlled substance, the doctor may receive an error message from our electronic prescribing software vendor notifying them Prime did not accept the electronic transmissionOur software vendor does not provide Prime with an error message of the doctor's failed attempt of sending an electronic prescriptionPrime accepts controlled substances prescriptions by mail, facsimile or verbally over the phone from the doctor's office
-On October 16, Prime received a faxed prescription for *** from your doctor
-On October 23, your order shipped via United Parcel Service (UPS)
We regret any inconvenience this may have caused and appreciate you bringing this to our attentionIf you have further questions or concerns, please call PrimeMail ***Our member services are available hours a day days a week
Thank you
Mercy Clinic Pharmacy at Pulaski was contacted and confirmed they are concerned with the coverage of Drug A (Test Strips)The pharmacy stated the member paid $out of pocket using a drug discount card for Drug B (Test Strips) on August 12, 2016; however, they are not requesting to have the
member reimbursed or to have Drug B coveredThe pharmacy confirmed the member will be using Drug A going forward and they would like this drug to be covered for her next fillAs background, Drug A requires Step Therapy (ST)Step Therapy requires the previous use of one or more drugs before coverage of a different drug is providedIf the member’s health plan's Drug List (Formulary) reflects that Step Therapy is used for a specific drug, her doctor must submit a Coverage Determination request form to her health plan for approvalThe member has the option to request her doctor to complete the Coverage Exception form, they can request a Coverage Exception electronically online at www.myprime.com, or by contacting Member Services at the number provided on the back of her insurance cardOn August 4, 2016, a Step Therapy request for Drug A was received and denied on August 5, 2016, because the member must have an approved condition for the use of this drugThese include: Taking a drug to treat diabetes in the past days.Taking a drug that affects the member’s blood sugar in the past days.Gestational diabetes.Diabetes that needs blood sugar monitoring and the member must have a lab test provided by her doctor to diagnose her conditionAdditionally, the member’s doctor must provide a valid diagnosis code to verify she has an approved condition for use of the drug, which they did notBased upon the information provided from the member’s doctor, she did not meet these criteria at the time of the reviewThe member and her doctor were sent a letter with the decision in detail, which included her right to appeal.On August 10, 2016, a Step Therapy request for Drug A was receivedBased on the information provided from the member’s doctor’s office, they did not provide a valid diagnosis code to verify she has an approved condition for use of the drugThe member’s doctor’s office was contacted twice to obtain the correct diagnosis code; however, Prime Therapeutics was unable to verify the information needed to complete the reviewOn August 11, 2016, a fax was sent to the member's doctor’s office instructing them to resend the Coverage Exception for Drug A with the proper diagnosis code and the fax also explained the request was not reviewable due to the missing information.On August 30, 2016, the member’s insurance received a paid claim for a qualifying diabetic drugThis means the member will be able to fill Drug A for up to days from August 30, 2016, with a copay of $On September 2, 2016, Mercy Clinic Pharmacy at Pulaski was contacted and provided this information.As a result, Mercy Clinic Pharmacy at Pulaski received a paid claim for Drug A with a copay of $for the member on September 6, We have reviewed the Mercy Clinic Pharmacy at Pulaski’s calls and the member’s doctor’s office’s calls to our Member Service Department and the appropriate actions were takenUnfortunately, we are not able to designate a specific person for the pharmacy or the doctor’s office to contactFor future inquiries, the pharmacy is encouraged to contact our Pharmacy Help Desk at ###-###-####