Initial Business Response /* (1000, 10, 2016/01/28) */
We found that Prime Mail made no errors when processing the member's prescription orderAs a onetime courtesy we have credited the members account for $leaving the remaining balance of $I have written the member a letter
explaining how this occurred and how to prevent it
Initial Consumer Rebuttal /* (2000, 13, 2016/02/05) */
(The consumer indicated he/she ACCEPTED the response from the business.)
This was the expected response
Initial Business Response /* (1000, 5, 2015/09/04) */
Dear Mr***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you had concerns about receiving prescription orders that you were
not expectingYou stated that you reached out to Prime and requested to have your account closed to avoid further activity, and you were told by a representative at Prime that this could not be doneYou asked to have Prime cancel your account and refund you for the medications you did not order
I have researched your account and found that on July 30, 2015, Prime received an electronic prescription for *** from the office of Dr***Shortly after the prescription was sent, Dr*** called to cancel itThe order was not voided and it was mailed to you on July 30,
On July 31, 2015, Prime received an electronic prescription for *** from Dr***This prescription could not be processed when it was received because it was too soon to be filled, pursuant to your health plan benefitsPrime has a courtesy process in place to put prescriptions on hold and to restart them automatically when allowed to be processed by the health planThe order was set to be restarted on August 22, The notification call for this order was made on August 6, to let you know
Prime's current process for commercial health plan members is to fill and ship any prescriptions received by a member or their doctor in good faith, unless Prime is notified otherwiseTo guarantee that prescriptions are not filled, instructions must be sent with each prescription stating "Do Not Fill" or "Profile" on each prescriptionThere were no instructions accompanying the Truvada prescription advising not to fill it
Our records show that you placed a call to Prime and spoke with a Member Service Agent (MSA) on August 4, 2015, requesting that Prime not send you any prescriptionsThe MSA failed to contact the pharmacy to stop the August 22, restart orderConsequently, the medication was processed and shipped on August 24,
These oversights have been documented and reported to the correct supervisors for employee coaching
After reviewing your account, I found that a Supervisor at Prime told you that you will receive a refund check for the restart order that was not cancelledThis information is incorrectRefunds are issued in the same manner in which the original payment was madeAccordingly, the co-pays for the two mail orders have been refunded to ***, for a total refund of ***Both of your prescriptions for *** have been discontinued
In regards to your Prime account, Prime has been contracted by your health plan, Blue Shield of California (BSC) to be the mail order provider for your prescriptions under your pharmacy benefitsYour enrollment with Prime is managed by BSC, and only your health plan can enroll you or withdraw your membership with PrimeIn an effort to assist you until you have had an opportunity to reach out to BSC, we have added a note to your account to contact you prior to shipping any medications
We sincerely regret any inconveniences that you may have experiencedWe take your views of the customer service very seriouslyThank you for giving detailed information about your experiencePrime is committed to high levels of customer service and wants to make all of your experiences with us positive and we hope to exceed your expectations with all future interactionsWe are always looking for ways to improve our level of serviceIf you have further questions or concerns, please call ***Our member services are available hours a day 7days a week
Sincerely,
Initial Consumer Rebuttal /* (2000, 7, 2015/09/08) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Initial Business Response /* (1000, 5, 2016/02/12) */
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 the amount you were charged for a 90-day fill at PrimeMail was...
higher than what you were quoted.
Thank you for contacting Prime with your concerns. We understand that your concerns have been already addressed by your health plan and that this matter has been resolved.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call [redacted]. Our member services department is available 24 hours a day 7 days a week.
Due to the confidential nature of Prime Therapeutics' network contracts, specific information regarding this matter cannot be disclosed. Prime Therapeutics has been working directly with the pharmacy in regards to this matter.
Dear Ms. [redacted] You contacted the Revdex.com about your recent experience with PrimeMail®, Prime Therapeutics LLC’s mail order pharmacy (Prime). You stated that $355.51 was charged to your credit card for a prescription that was mistakenly requested by your doctor.We...
understand your concerns surrounding the incorrect medication being requested and the unexpected charge to your account. After researching your account, we found that a return mailer was sent to you on May 27, 2016 along with a confirmation email providing the tracking number. Once Prime receives the medication, your credit card will be refunded in the amount of $355.51.We have confirmed that the incorrect prescription was removed from your profile.If you have further questions or concerns, please call Prime at [redacted]. Our member services are available 24 hours a day 7days a week . Prime Therapeutics made the following annotations---------------------------------------------------------------------...⇄ NOTICE: The information contained in this communication may be confidential, and is intended only for the use of the recipients named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication, or any of its contents, is strictly prohibited. If you have received this communication in error, please return it to the sender immediately and delete the original message and any copy of it from your computer system. If you have any questions concerning this message, please contact the sender.
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.
According to your account, there is a Utilization Management Program included in your current pharmacy benefits under your BCBSNJ plan. This means that some medications need prior authorization (pre-approval) before they can be obtained using your pharmacy benefits. For a list of medications in this program and other helpful information, please register at www.myprime.com. After 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, 2017. According to your current pharmacy benefits ** and **are a part of a Quantity Limits (QL) Program. QL are applied to certain drugs based on the approved dosing limits established during the FDA approval process. If your doctor would like to prescribe an amount that would exceed this limit, he/she must submit a PA request to Horizon BCBSNJ for review. The information submitted should explain why you need to exceed the quantity limit. On 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 criteria. The decision was made by a panel of pharmacists who are trained to review all prior authorization requests based on your pharmacy benefits. It was determined that your prescribed dose can be reached with a lower quantity of a higher strength that does not exceed the quantity limit. Please be advised that you have the right to appeal any services or coverage determination’s. When you make an appeal, you are requesting the coverage determination to be reconsidered. Typically, details about the appeal process are mailed with the coverage determination letter. If you have not received this information, please contact BCBSNJ. We found no Prime errors during the process of your medication review. On October 25, 2017, ** Pharmacy was able process your medication **.
Initial Business Response /* (1000, 5, 2016/02/05) */
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 authorize. You are...
requesting a refund of $300.00 to be applied to your credit card. You are also requesting your credit card to be removed from Prime's system.
We understand your concern with receiving a medication you were not expecting. After researching your account, we found that Prime faxed your doctor's office a request to obtain a new prescription for [redacted] after receiving a request from you through the www.MyPrimeMail.com website. Prime received a prescription, but was unable to fill due to the strength provided. Prime contacted the doctor's office for clarification on the strength and was provided with a new prescription for [redacted]. The prescription was correctly filled as prescribed by your doctor.
On February 1, 2016, you spoke with one of our licensed pharmacists and informed them you could no longer take the [redacted]. During the call, as a one-time courtesy, your credit card was credited in the amount of $300.00. Your credit card has been removed from our system.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call [redacted]. Our member services department is available 24 hours a day 7 days a week.
Initial Consumer Rebuttal /* (2000, 7, 2016/02/08) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I appreciate that they are refunding my card. However, it is unfortunate now that I feel so uneasy about using this convenient service. I hope this does not happen to anyone else in the future.
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 complaint. I 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 ourselves. Our 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 appeal. However, 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 manner. The 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 Devine. This may be a run of the mill business interaction for employees at Prime Therapeutics, but for employees of Dr. Z's Pharmacy, this is a decision that may impact their future as employees. We 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 refill. So we have to take this matter a little more seriously and urgently than might be standard practice for Prime Therapeutics.
(The consumer indicated he/she DID NOT accept the response from the business.)
I contacted the company today and was told I owed a balance. I informed the rep of this credit and they have no record of this or any complaint that was filed. I do not trust this company to actually do this. I provided them with the info in this response and the case number. They were still not able to locate and even asked if I had filed the complaint against a different company. These people show no record of this complaint so I assume they will not be giving me any credit. Please let me know what I can do to assure this was handled. Can I get something in writing from the company showing this agreement. Thanks
Initial Business Response /* (1000, 6, 2015/10/02) */
Dear Ms. [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 with Prime charging your credit card for the full...
amount of your co-pay for your medication, despite your request not to process the payment. You have asked that Prime refund your co-pay in the amount of $100.00 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 done. Our records indicate that the MSA notated the order with your instructions.
During processing of your order, one of your credit cards was declined. The next available form of payment on file, another of your credit cards, was used to complete the order according to Prime's standard process. We regret that the notation concerning your payment was inadvertently missed. This incident has been documented and reported to the correct supervisor for employee coaching.
Unfortunately Prime is unable to refund the $100.00 co-pay for your medication because it was correctly assessed in accordance to your pharmacy benefits. We are willing work with you to cover any charges that you incurred as a result. Please contact us for further information about this.
Prime regrets any inconvenience you may have experienced. We evaluate all concerns regarding our members that are brought to our attention, and we will keep record of yours for future reference. If you have further questions or concerns, please call 1.866.346.7200. Our member services are available 24 hours a day 7 days a week.
Initial Consumer Rebuttal /* (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 closed. However I hope you will note I was a dissatisfied client with Prime Therapeutics.
Hello, After review, we are unable to research the member issue. No information was provided for the son's account. I left a message on the phone number provided. In order to research this we need member name, date of birth, and address.
I am rejecting this response because:
This company is just regurgitating things we’ve talked about on the phone and they did not and will not accept the reasons that the medication was prescribed the way it has been since 2012. The medication first of all does not work the way it was supposed to. For the 32 mg dose is too much at once and basically knocks you out for eight to ten hours. Secondly due to the side affects it is better to take half the dosage every 12 hours. Less nausea, tiredness, and feeling not in control. But the main reason I am at odds with this company is when the insurance changed in October the contract and agreement was that there would be NO changes in coverage for services. My meds and also my wife’s meds along with the school district she works for us now a mess due to this breech in contract. Also prior authorization is nothing more than the insurance company’s way of making it difficult for patients and doctors to receive or prescribe expensive medications. Furthermore this last explanation of a bunch of pharmacists and doctors reviewing and deciding that a medication could be prescribed better is a blatant lie. I have a letter saying one doctor who is not a pain management specialist rather an internal medicine doctor made the decision to change the way the meds are given to me without any consultation with me or my doctor. I find it offensive and arrogant that someone with no knowledge of my condition can say my doctor don’t know what he’s doing and how I react to a medication. This is insurances way of trying not to pay or to save a few dollars as in my case. Once again I’m going to say this. The contract agreement between insurance the insured was that no treatments or prescribed meds would change. I respectfully insist at this point that I be allowed to fill my meds as I have since 2012. And this prior authorization nonsense stop immediately!
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) plan. This 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 it. We have reviewed your concerns and found on October 5, 2017, we received an urgent PA request for [redacted], to be taken a twice day. Your plan benefit allows this medication to be dispensed with a maximum quantity of 30 tablets in 25 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 limit. For example: you can obtain the [redacted] instead of the [redacted] twice a day that was requested. A 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 plan. Prime 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.
Initial Business Response /* (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, 2015. 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, 2015. The prior authorization form explains why the medication is needed to treat your condition. The 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 doctor. Also, the prescription has not been clarified. It has been placed on hold. Please 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 24 hours a day, 7days a week.
Initial Consumer Rebuttal /* (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 approve. She asked me if I would accept the 60 day quantity and I said I would and that I just wanted them to order it so I can get my prescription. Brittney said she would immediately put in the order and I would receive an email confirming the order and that she would have it delivered overnight. No 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 /* (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 expected. I have researched your account and found that on May 26, 2015, Prime received a prescription for [redacted]. 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 benefits. A letter was sent to you on May 27, 2015 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 it. She 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 Day. On 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, 2015 and July 7, 2015, I contacted BSC and was told that to date, no PA has been received. Your prescription has been placed on hold and can be processed once Prime has received the proper approvals from your health plan. Please contact your doctor to follow up on this issue.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call PrimeMail [redacted]. Our member services are available 24 hours a day 7 days a week.
Final Consumer Response /* (3000, 11, 2015/07/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Again PrimeMail has their facts incorrect. I was told by the Pharmacy Technician that the problem was solved and that she would put in the order and have it shipped overnight. Your 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 elsewhere. There is no need to continue this complaint because PrimeaMail is NOT a company I want to do business.
Initial Business Response /* (1000, 5, 2015/10/22) */
Dear Ms. [redacted],
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime). Specifically, you stated that Prime did not ship your order as promised on...
October 12, 2015. You also have concerns about being charged for [redacted] that you believe should have been provided to you at no charge. You are requesting a refund of $[redacted] for the charges that were made to your credit card.
Prime can understand your frustration if you did not receive your medications when expected and you had credit card charges for [redacted] that you believed were provided at no charge. We have reviewed your account and found on October 2, 2015, you contacted Prime and requested a refill of [redacted] and [redacted]. You also requested that Prime reach out to your doctor for a new prescription for [redacted]. The [redacted] were processed before the [redacted] prescription, which resulted in a $** charge for the [redacted], when they should have processed at no cost to you. The order total for the two prescriptions was $[redacted].
On October 3, 2015, you contacted Prime about being charged for the [redacted]. The Prime agent you spoke with told you there was an error in processing. You requested that the order be cancelled. You were told that your order was already processing and since the pharmacy was closed, a request would be sent to have the order cancelled. The order was cancelled on October 6, 2015.
On October 9, 2015, an agent from Blue Shield California (BSC) contacted us on your behalf to inquire about order status on [redacted]. She was informed that the order would not be shipped to you on that date because Prime does not ship temperature sensitive medicines on Fridays, and that your order would ship on Monday, October 12. The BSC agent also requested that Prime fill the [redacted] and [redacted] and stated you were aware of the cost. She stated you were almost out of medication and you would need to obtain a retail fill, and that she would take care of that for you. Prime informed her that your refund of $[redacted] had already been applied back to your credit card.
Credit cards are charged at the time an order is processed to be filled. Refunds issued to credit cards take a minimum of 3 business days, an average of 7 business days and can take up to 30 business days to be credited to your bank account, depending on the financial institution. Prime's accounting team confirmed the refund in the amount of $[redacted] was issued by Prime on October 8, 2015, to your credit card ending [redacted].
On October 12, 2015, you contacted Prime to check your order status. You were informed the order had not yet shipped. The order was expedited and [redacted] and the [redacted] were shipped to you on October 12, 2015, via United Parcel Service (UPS) overnight delivery at no cost to you. Per the UPS website, the prescriptions were delivered to you on October 13, 2015. If you incurred any costs related to a retail fill prior to receiving your order from Prime, please contact us to discuss reimbursement for any copayment.
Prime regrets that we were unable to meet your expectations. We have identified opportunities for improvement based on our research and feedback has been provided to various departments for process improvements.
If you have further questions or concerns, please call Prime at [redacted]. Our member services are available 24 hours a day, 7 days a week.
Initial Business Response /* (1000, 10, 2015/08/31) */
Reference: Case [redacted]
Dear Ms. [redacted],
You recently contacted the Revdex.com about your experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy ("Prime"). In your complaint, you stated that Prime filled...
your prescription with a different generic medicine than what your doctor had prescribed. You stated that when you contacted Prime to ask about your medicine, you were told that the doctor must specify no substitution is allowed in order for you to get your preferred generic medicine.
I can understand your concerns about your medication. I have researched your account and found that Prime filled your prescription accurately following our generic substitution policy. Pharmacy law permits pharmacists to substitute a less expensive United States Food and Drug Administration (FDA)-approved generic equivalent medicine, unless you or your doctor specifies otherwise. There was no indication from you or your doctor that substitution was not allowed for this medication.
Prime uses generic medicines which have been approved by the FDA and determined to be identical (or bioequivalent) to brand name or other generic drugs in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Once a medicine is available as a generic, there can be several companies (also known as manufacturers) that choose to make the generic version of the medicine. These companies have to meet the FDA standards noted above but the medicines may differ in name, color, shape, size, and cost.
Prime's goal is to deliver the lowest total cost of care for you. When Prime purchases medicines, we try our best to get the best price from medicine manufacturers.
If you require Prime to use a specific generic medicine, you have options available to you. The first option is to have the doctor note a specific manufacturer or medicine is medically necessary on the prescription. This note must be included on all prescriptions (current and future) sent to Prime. Prime will order medicine from that specific manufacturer and will make a note on the prescription to make sure that particular brand is dispensed throughout the life of that prescription. The other option is to use the prescription we have on file and have Prime make a note that a specific manufacturer was requested by you, rather than by the doctor. This may result in a higher out of pocket cost to you than if the doctor specifies a specific brand is medically necessary. We ask that you contact us at the number provided below to talk about these options and decide on our next steps.
Prime strives to provide exceptional service while ensuring you receive the medicine you need to feel better and live well. Please know that we are committed to exceeding your expectations with all future interactions. If you have further questions or concerns, please call PrimeMail(r) [redacted]. Our member services are available 24 hours a day 7days a week.
There is no additional information in regards to this matter available at this time. As previously communicated, Prime Therapeutics is reviewing the appeal received by the pharmacy. The results of the appeal review will be communicated directly to the pharmacy when complete.
I am rejecting this response because: I have waited since November of 2017 as that is when I sent the 1st Prescription Claim form requesting reimbursement for 3 prescriptions. A month later I was sent a letter from PRIME THERAPEUTICS stating the pharmacy receipt was missing a 3 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 mail. Why you couldn't call the pharmacy yourself vs. making me continue to wait on the monies owed to me was ridiculous. So no, nothing on your Parr has been taken care of in a timely manner. I have been waiting now 10 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 it. Oh 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 /* (1000, 10, 2016/01/28) */
We found that Prime Mail made no errors when processing the member's prescription orderAs a onetime courtesy we have credited the members account for $leaving the remaining balance of $I have written the member a letter
explaining how this occurred and how to prevent it
Initial Consumer Rebuttal /* (2000, 13, 2016/02/05) */
(The consumer indicated he/she ACCEPTED the response from the business.)
This was the expected response
Initial Business Response /* (1000, 5, 2015/09/04) */
Dear Mr***,
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime
Therapeutics LLC's mail order pharmacy (Prime)Specifically, you had concerns about receiving prescription orders that you were
not expectingYou stated that you reached out to Prime and requested to have your account closed to avoid further activity, and you were told by a representative at Prime that this could not be doneYou asked to have Prime cancel your account and refund you for the medications you did not order
I have researched your account and found that on July 30, 2015, Prime received an electronic prescription for *** from the office of Dr***Shortly after the prescription was sent, Dr*** called to cancel itThe order was not voided and it was mailed to you on July 30,
On July 31, 2015, Prime received an electronic prescription for *** from Dr***This prescription could not be processed when it was received because it was too soon to be filled, pursuant to your health plan benefitsPrime has a courtesy process in place to put prescriptions on hold and to restart them automatically when allowed to be processed by the health planThe order was set to be restarted on August 22, The notification call for this order was made on August 6, to let you know
Prime's current process for commercial health plan members is to fill and ship any prescriptions received by a member or their doctor in good faith, unless Prime is notified otherwiseTo guarantee that prescriptions are not filled, instructions must be sent with each prescription stating "Do Not Fill" or "Profile" on each prescriptionThere were no instructions accompanying the Truvada prescription advising not to fill it
Our records show that you placed a call to Prime and spoke with a Member Service Agent (MSA) on August 4, 2015, requesting that Prime not send you any prescriptionsThe MSA failed to contact the pharmacy to stop the August 22, restart orderConsequently, the medication was processed and shipped on August 24,
These oversights have been documented and reported to the correct supervisors for employee coaching
After reviewing your account, I found that a Supervisor at Prime told you that you will receive a refund check for the restart order that was not cancelledThis information is incorrectRefunds are issued in the same manner in which the original payment was madeAccordingly, the co-pays for the two mail orders have been refunded to ***, for a total refund of ***Both of your prescriptions for *** have been discontinued
In regards to your Prime account, Prime has been contracted by your health plan, Blue Shield of California (BSC) to be the mail order provider for your prescriptions under your pharmacy benefitsYour enrollment with Prime is managed by BSC, and only your health plan can enroll you or withdraw your membership with PrimeIn an effort to assist you until you have had an opportunity to reach out to BSC, we have added a note to your account to contact you prior to shipping any medications
We sincerely regret any inconveniences that you may have experiencedWe take your views of the customer service very seriouslyThank you for giving detailed information about your experiencePrime is committed to high levels of customer service and wants to make all of your experiences with us positive and we hope to exceed your expectations with all future interactionsWe are always looking for ways to improve our level of serviceIf you have further questions or concerns, please call ***Our member services are available hours a day 7days a week
Sincerely,
Initial Consumer Rebuttal /* (2000, 7, 2015/09/08) */
(The consumer indicated he/she ACCEPTED the response from the business.)
Initial Business Response /* (1000, 5, 2016/02/12) */
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 the amount you were charged for a 90-day fill at PrimeMail was...
higher than what you were quoted.
Thank you for contacting Prime with your concerns. We understand that your concerns have been already addressed by your health plan and that this matter has been resolved.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call [redacted]. Our member services department is available 24 hours a day 7 days a week.
Due to the confidential nature of Prime Therapeutics' network contracts, specific information regarding this matter cannot be disclosed. Prime Therapeutics has been working directly with the pharmacy in regards to this matter.
Dear Ms. [redacted] You contacted the Revdex.com about your recent experience with PrimeMail®, Prime Therapeutics LLC’s mail order pharmacy (Prime). You stated that $355.51 was charged to your credit card for a prescription that was mistakenly requested by your doctor.We...
understand your concerns surrounding the incorrect medication being requested and the unexpected charge to your account. After researching your account, we found that a return mailer was sent to you on May 27, 2016 along with a confirmation email providing the tracking number. Once Prime receives the medication, your credit card will be refunded in the amount of $355.51.We have confirmed that the incorrect prescription was removed from your profile.If you have further questions or concerns, please call Prime at [redacted]. Our member services are available 24 hours a day 7days a week . Prime Therapeutics made the following annotations---------------------------------------------------------------------...⇄ NOTICE: The information contained in this communication may be confidential, and is intended only for the use of the recipients named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication, or any of its contents, is strictly prohibited. If you have received this communication in error, please return it to the sender immediately and delete the original message and any copy of it from your computer system. If you have any questions concerning this message, please contact the sender.
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.
According to your account, there is a Utilization Management Program included in your current pharmacy benefits under your BCBSNJ plan. This means that some medications need prior authorization (pre-approval) before they can be obtained using your pharmacy benefits. For a list of medications in this program and other helpful information, please register at www.myprime.com. After 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, 2017. According to your current pharmacy benefits ** and **are a part of a Quantity Limits (QL) Program. QL are applied to certain drugs based on the approved dosing limits established during the FDA approval process. If your doctor would like to prescribe an amount that would exceed this limit, he/she must submit a PA request to Horizon BCBSNJ for review. The information submitted should explain why you need to exceed the quantity limit. On 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 criteria. The decision was made by a panel of pharmacists who are trained to review all prior authorization requests based on your pharmacy benefits. It was determined that your prescribed dose can be reached with a lower quantity of a higher strength that does not exceed the quantity limit. Please be advised that you have the right to appeal any services or coverage determination’s. When you make an appeal, you are requesting the coverage determination to be reconsidered. Typically, details about the appeal process are mailed with the coverage determination letter. If you have not received this information, please contact BCBSNJ. We found no Prime errors during the process of your medication review. On October 25, 2017, ** Pharmacy was able process your medication **.
Initial Business Response /* (1000, 5, 2016/02/05) */
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 authorize. You are...
requesting a refund of $300.00 to be applied to your credit card. You are also requesting your credit card to be removed from Prime's system.
We understand your concern with receiving a medication you were not expecting. After researching your account, we found that Prime faxed your doctor's office a request to obtain a new prescription for [redacted] after receiving a request from you through the www.MyPrimeMail.com website. Prime received a prescription, but was unable to fill due to the strength provided. Prime contacted the doctor's office for clarification on the strength and was provided with a new prescription for [redacted]. The prescription was correctly filled as prescribed by your doctor.
On February 1, 2016, you spoke with one of our licensed pharmacists and informed them you could no longer take the [redacted]. During the call, as a one-time courtesy, your credit card was credited in the amount of $300.00. Your credit card has been removed from our system.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call [redacted]. Our member services department is available 24 hours a day 7 days a week.
Initial Consumer Rebuttal /* (2000, 7, 2016/02/08) */
(The consumer indicated he/she ACCEPTED the response from the business.)
I appreciate that they are refunding my card. However, it is unfortunate now that I feel so uneasy about using this convenient service. I hope this does not happen to anyone else in the future.
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 complaint. I 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 ourselves. Our 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 appeal. However, 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 manner. The 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 Devine. This may be a run of the mill business interaction for employees at Prime Therapeutics, but for employees of Dr. Z's Pharmacy, this is a decision that may impact their future as employees. We 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 refill. So we have to take this matter a little more seriously and urgently than might be standard practice for Prime Therapeutics.
(The consumer indicated he/she DID NOT accept the response from the business.)
I contacted the company today and was told I owed a balance. I informed the rep of this credit and they have no record of this or any complaint that was filed. I do not trust this company to actually do this. I provided them with the info in this response and the case number. They were still not able to locate and even asked if I had filed the complaint against a different company. These people show no record of this complaint so I assume they will not be giving me any credit. Please let me know what I can do to assure this was handled. Can I get something in writing from the company showing this agreement. Thanks
Initial Business Response /* (1000, 6, 2015/10/02) */
Dear Ms. [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 with Prime charging your credit card for the full...
amount of your co-pay for your medication, despite your request not to process the payment. You have asked that Prime refund your co-pay in the amount of $100.00 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 done. Our records indicate that the MSA notated the order with your instructions.
During processing of your order, one of your credit cards was declined. The next available form of payment on file, another of your credit cards, was used to complete the order according to Prime's standard process. We regret that the notation concerning your payment was inadvertently missed. This incident has been documented and reported to the correct supervisor for employee coaching.
Unfortunately Prime is unable to refund the $100.00 co-pay for your medication because it was correctly assessed in accordance to your pharmacy benefits. We are willing work with you to cover any charges that you incurred as a result. Please contact us for further information about this.
Prime regrets any inconvenience you may have experienced. We evaluate all concerns regarding our members that are brought to our attention, and we will keep record of yours for future reference. If you have further questions or concerns, please call 1.866.346.7200. Our member services are available 24 hours a day 7 days a week.
Initial Consumer Rebuttal /* (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 closed. However I hope you will note I was a dissatisfied client with Prime Therapeutics.
Hello, After review, we are unable to research the member issue. No information was provided for the son's account. I left a message on the phone number provided. In order to research this we need member name, date of birth, and address.
I am rejecting this response because:
This company is just regurgitating things we’ve talked about on the phone and they did not and will not accept the reasons that the medication was prescribed the way it has been since 2012. The medication first of all does not work the way it was supposed to. For the 32 mg dose is too much at once and basically knocks you out for eight to ten hours. Secondly due to the side affects it is better to take half the dosage every 12 hours. Less nausea, tiredness, and feeling not in control. But the main reason I am at odds with this company is when the insurance changed in October the contract and agreement was that there would be NO changes in coverage for services. My meds and also my wife’s meds along with the school district she works for us now a mess due to this breech in contract. Also prior authorization is nothing more than the insurance company’s way of making it difficult for patients and doctors to receive or prescribe expensive medications. Furthermore this last explanation of a bunch of pharmacists and doctors reviewing and deciding that a medication could be prescribed better is a blatant lie. I have a letter saying one doctor who is not a pain management specialist rather an internal medicine doctor made the decision to change the way the meds are given to me without any consultation with me or my doctor. I find it offensive and arrogant that someone with no knowledge of my condition can say my doctor don’t know what he’s doing and how I react to a medication. This is insurances way of trying not to pay or to save a few dollars as in my case. Once again I’m going to say this. The contract agreement between insurance the insured was that no treatments or prescribed meds would change. I respectfully insist at this point that I be allowed to fill my meds as I have since 2012. And this prior authorization nonsense stop immediately!
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) plan. This 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 it. We have reviewed your concerns and found on October 5, 2017, we received an urgent PA request for [redacted], to be taken a twice day. Your plan benefit allows this medication to be dispensed with a maximum quantity of 30 tablets in 25 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 limit. For example: you can obtain the [redacted] instead of the [redacted] twice a day that was requested. A 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 plan. Prime 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.
Initial Business Response /* (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, 2015. 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, 2015. The prior authorization form explains why the medication is needed to treat your condition. The 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 doctor. Also, the prescription has not been clarified. It has been placed on hold. Please 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 24 hours a day, 7days a week.
Initial Consumer Rebuttal /* (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 approve. She asked me if I would accept the 60 day quantity and I said I would and that I just wanted them to order it so I can get my prescription. Brittney said she would immediately put in the order and I would receive an email confirming the order and that she would have it delivered overnight. No 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 /* (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 expected. I have researched your account and found that on May 26, 2015, Prime received a prescription for [redacted]. 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 benefits. A letter was sent to you on May 27, 2015 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 it. She 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 Day. On 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, 2015 and July 7, 2015, I contacted BSC and was told that to date, no PA has been received. Your prescription has been placed on hold and can be processed once Prime has received the proper approvals from your health plan. Please contact your doctor to follow up on this issue.
We regret any inconvenience this may have caused. If you have further questions or concerns, please call PrimeMail [redacted]. Our member services are available 24 hours a day 7 days a week.
Final Consumer Response /* (3000, 11, 2015/07/08) */
(The consumer indicated he/she DID NOT accept the response from the business.)
Again PrimeMail has their facts incorrect. I was told by the Pharmacy Technician that the problem was solved and that she would put in the order and have it shipped overnight. Your 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 elsewhere. There is no need to continue this complaint because PrimeaMail is NOT a company I want to do business.
Initial Business Response /* (1000, 5, 2015/10/22) */
Dear Ms. [redacted],
You contacted the Revdex.com about your recent experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy (Prime). Specifically, you stated that Prime did not ship your order as promised on...
October 12, 2015. You also have concerns about being charged for [redacted] that you believe should have been provided to you at no charge. You are requesting a refund of $[redacted] for the charges that were made to your credit card.
Prime can understand your frustration if you did not receive your medications when expected and you had credit card charges for [redacted] that you believed were provided at no charge. We have reviewed your account and found on October 2, 2015, you contacted Prime and requested a refill of [redacted] and [redacted]. You also requested that Prime reach out to your doctor for a new prescription for [redacted]. The [redacted] were processed before the [redacted] prescription, which resulted in a $** charge for the [redacted], when they should have processed at no cost to you. The order total for the two prescriptions was $[redacted].
On October 3, 2015, you contacted Prime about being charged for the [redacted]. The Prime agent you spoke with told you there was an error in processing. You requested that the order be cancelled. You were told that your order was already processing and since the pharmacy was closed, a request would be sent to have the order cancelled. The order was cancelled on October 6, 2015.
On October 9, 2015, an agent from Blue Shield California (BSC) contacted us on your behalf to inquire about order status on [redacted]. She was informed that the order would not be shipped to you on that date because Prime does not ship temperature sensitive medicines on Fridays, and that your order would ship on Monday, October 12. The BSC agent also requested that Prime fill the [redacted] and [redacted] and stated you were aware of the cost. She stated you were almost out of medication and you would need to obtain a retail fill, and that she would take care of that for you. Prime informed her that your refund of $[redacted] had already been applied back to your credit card.
Credit cards are charged at the time an order is processed to be filled. Refunds issued to credit cards take a minimum of 3 business days, an average of 7 business days and can take up to 30 business days to be credited to your bank account, depending on the financial institution. Prime's accounting team confirmed the refund in the amount of $[redacted] was issued by Prime on October 8, 2015, to your credit card ending [redacted].
On October 12, 2015, you contacted Prime to check your order status. You were informed the order had not yet shipped. The order was expedited and [redacted] and the [redacted] were shipped to you on October 12, 2015, via United Parcel Service (UPS) overnight delivery at no cost to you. Per the UPS website, the prescriptions were delivered to you on October 13, 2015. If you incurred any costs related to a retail fill prior to receiving your order from Prime, please contact us to discuss reimbursement for any copayment.
Prime regrets that we were unable to meet your expectations. We have identified opportunities for improvement based on our research and feedback has been provided to various departments for process improvements.
If you have further questions or concerns, please call Prime at [redacted]. Our member services are available 24 hours a day, 7 days a week.
Initial Business Response /* (1000, 10, 2015/08/31) */
Reference: Case [redacted]
Dear Ms. [redacted],
You recently contacted the Revdex.com about your experience with PrimeMail(r), Prime Therapeutics LLC's mail order pharmacy ("Prime"). In your complaint, you stated that Prime filled...
your prescription with a different generic medicine than what your doctor had prescribed. You stated that when you contacted Prime to ask about your medicine, you were told that the doctor must specify no substitution is allowed in order for you to get your preferred generic medicine.
I can understand your concerns about your medication. I have researched your account and found that Prime filled your prescription accurately following our generic substitution policy. Pharmacy law permits pharmacists to substitute a less expensive United States Food and Drug Administration (FDA)-approved generic equivalent medicine, unless you or your doctor specifies otherwise. There was no indication from you or your doctor that substitution was not allowed for this medication.
Prime uses generic medicines which have been approved by the FDA and determined to be identical (or bioequivalent) to brand name or other generic drugs in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Once a medicine is available as a generic, there can be several companies (also known as manufacturers) that choose to make the generic version of the medicine. These companies have to meet the FDA standards noted above but the medicines may differ in name, color, shape, size, and cost.
Prime's goal is to deliver the lowest total cost of care for you. When Prime purchases medicines, we try our best to get the best price from medicine manufacturers.
If you require Prime to use a specific generic medicine, you have options available to you. The first option is to have the doctor note a specific manufacturer or medicine is medically necessary on the prescription. This note must be included on all prescriptions (current and future) sent to Prime. Prime will order medicine from that specific manufacturer and will make a note on the prescription to make sure that particular brand is dispensed throughout the life of that prescription. The other option is to use the prescription we have on file and have Prime make a note that a specific manufacturer was requested by you, rather than by the doctor. This may result in a higher out of pocket cost to you than if the doctor specifies a specific brand is medically necessary. We ask that you contact us at the number provided below to talk about these options and decide on our next steps.
Prime strives to provide exceptional service while ensuring you receive the medicine you need to feel better and live well. Please know that we are committed to exceeding your expectations with all future interactions. If you have further questions or concerns, please call PrimeMail(r) [redacted]. Our member services are available 24 hours a day 7days a week.
There is no additional information in regards to this matter available at this time. As previously communicated, Prime Therapeutics is reviewing the appeal received by the pharmacy. The results of the appeal review will be communicated directly to the pharmacy when complete.
I am rejecting this response because: I have waited since November of 2017 as that is when I sent the 1st Prescription Claim form requesting reimbursement for 3 prescriptions. A month later I was sent a letter from PRIME THERAPEUTICS stating the pharmacy receipt was missing a 3 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 mail. Why you couldn't call the pharmacy yourself vs. making me continue to wait on the monies owed to me was ridiculous. So no, nothing on your Parr has been taken care of in a timely manner. I have been waiting now 10 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 it. Oh 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.