Business Profile

Health Insurance

CVS Caremark

Headquarters

This business is NOT BBB Accredited.

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Complaints

This profile includes complaints for CVS Caremark's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

516 total complaints in the last 3 years.
164 complaints closed in the last 12 months.

If you've experienced an issue

Submit a Complaint

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:11/11/2024
Type:Customer Service Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am 66 years old and a diabetic and heart patient. I have two CVS Caremark prescription coverages through Retirment Plan from ***** and from my present job with the City of ************. *** charged hefty co-payments in the last two years. Contacted the *** resolution department and no satisfactory explanation given. I did request them to use one of my prescription plan to use as a secondary coverage to cover prescription co-pay charges. Requesting your assistance to resolve this matter.
Business Response
Date: 11/19/2024
November 19, 2024

BBB serving *********************, *****, ************, and *******
****************************************************************************************************************************************

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on November 11, 2024. Thank you for the opportunity to address the members concern.

Plan management has agreed to reprocess all claims during the 2023 and 2024 plan year. This process could take up to 30 days to complete and the member will be contacted at the conclusion of their claims being reprocessed.

Going forward, for the coordination of benefits to work properly the members City of Philadelphia insurance should be processed first followed by their Septa plan.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
********* *******
Advocate

Customer Answer
Date: 11/20/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. Please reimburse all co-pays CVS and US1 Pharmacy collected from 2023 February till November 2024.
Thanks

Regards,

****** ********
Initial Complaint
Date:11/09/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been on *** for the past year reimbursed through CVS Caremark. I have gotten multiple forms of HRT generics that have been ineffective to the point that I have reached out to the *** and the manufacturer. I have blood tests to show a zero blood level post treatment. At my recent visit to my physician I requested a branded product. She proceeded to write a product for me that requires a prior authorization and step edit. The step edits meds on the approved formulary list DO NOT treat systemic symptomatology! This is lunacy! My physician was writing me a vaginal ring to treat hot flashes. The products Caremark is insisting I use are topical gels and creams that only treat vaginal dryness. This is not a concern or symptom I have.They denied my request For a vaginal ring stating that I need to use a cream or a gel. What CVS Caremark is telling me is that I need to treat a disease state that I currently do not have in order to be possibly approved down the line for one that does?!What they are actually asking is for my gyn to commit fraud by prescribing something that I do not need and that will treat nothing I am suffering from. What this does is cost me more months of sleep, comfort, cardiovascular protection, osteoporotic protection. I could understand if the step edits were actually treating systemic menopausal symptoms, but to ask my physician to commit fraud, as well as having me pay a co-pay for something that is NOT medically indicated is despicable. In addition - My physician also tried to get me a different brand of patch, which CVS also prohibited by telling the pharmacy my co-pay was close to $500 when Ive already met my annual out-of-pocket max ****** you come back with any nonsense about peer to peer reviews- I was told my plan does not allow for them. In addition, I work in Pharma, I am not uneducated on how this works, nor am I clueless as to product indications, pharmaceutical contracting, and GPO negotiations. Try me.
Business Response
Date: 11/19/2024
November 19, 2024

BBB serving *********************, *****, ************, and *******
****************************************************************************************************************************************

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on November 9, 2024. Thank you for the opportunity to address the members concern.

The requested medication is a non-formulary drug for the members plan and requires an approved coverage request. On March 26, 2024, the members prescriber submitted a coverage request for the requested medication and CVS Caremark faxed the criteria form for the requested medication to the prescribers office for completion. On April 1, 2024, the coverage request was auto-closed due to no response from the prescribers office.

On November 6, 2024, the members prescriber submitted a new coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage.

On November 12, 2024, a new coverage request for the requested medication was initiated that included the clinical information required for approval and the coverage request for the requested medication was approved until November 12, 2025.

CVS Caremark records show a paid claim for the requested medication on November 12, 2024.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
********* *******
Advocate

Customer Answer
Date: 11/24/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.
This DID NOT address any of my concerns. Firstly it was submitted by two different providers. Giving me info from last April is irrelevant.
Secondly - this says nothing about the step edit meds being of a different class and used completely for different indications. So you have towed the company line while managing to ignore my complaint.
Let me be more clear. When I called after the initial denial - I called Aetna and asked to be transferred to *** as I work in the Industry and told my doctor, I would find out everything necessary to put through the prior off.
The man I spoke to Aetna Chip Not only refused to transfer me, but would only and definitively tell me it was denied and that I needed to be on topical products instead of *******. He vehemently repeated I had to be on those and he couldnt email me the info or tell me where to find it beyond waiting for the mail - AND ITS STILL NOT HERE.

He refused to give any other information. If you were going to have Aetna field your calls, you need to inform them on how to handle prescription medication information. THIS WAS SOPHOMORIC.
When I returned home later, I called CVS directly again; with the specific intent of getting information on what my need my physician needed to provide. The representative who helped me tried multiple times to reach somebody in the prior auth department and the response she got was that they refused let me say that again refused-to speak to a patient and that my doctor knew what she needed to do and they refused to help at all
Clearly my physician DID NOT initially know what to do or she would have submitted it correctly the first time!
The PA department basically said that patients are too dumb to understand so we wont communicate with them. This is gross. Explain to me how this is allowed when patients are the ones who pay for the plan!

FAQ

Regards,
S

Business Response
Date: 12/06/2024
December 6, 2024

BBB serving *********************, *****, ************, and *******
****************************************************************************************************************************************

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on December 3, 2024. Thank you for the opportunity to address the members concern.

The requested medication is a non-formulary drug for the members plan and requires an approved coverage request. On March 26, 2024, the members prescriber submitted a coverage request for the requested medication and CVS Caremark faxed the criteria form for the requested medication to the prescribers office for completion. On April 1, 2024, the coverage request was auto-closed due to no response from the prescribers office.

On November 6, 2024, the members prescriber submitted a new coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage. On November 8, 2024, the member called ************* to determine why the coverage request for the requested medication was denied. The ************* Representative informed the member that the requested medication was a non-formulary drug for the members plan and is only covered if the member has tried and failed the formulary alternatives. The ************* Representative directed the member to call the prior authorization department during business hours and provided the member with the prior authorization departments phone number.

On November 11, 2024, the member called ************* to confirm what clinical information was needed for coverage of the requested medication. The ************* Representative informed the member that their prescriber needed to submit a letter of medical necessity on the members behalf. In addition, the ************* Representative provided the member with the formulary alternatives of the requested medication.

On November 12, 2024, a new coverage request for the requested medication was initiated that included the clinical information required for approval and the coverage request for the requested medication was approved until November 12, 2025.

CVS Caremark records show a paid claim for the requested medication on November 12, 2024.

We have asked management to review this matter for coaching, training, and process improvement opportunities.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
********* *******
Advocate

Customer Answer
Date: 12/09/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.
Thank you for submitting it for review. That is hopeful. However, I see that yet again what I was originally writing in about was ignored. As you so perfectly put - alternatives were suggested - however those alternatives ARE NOT IN A CLASS THAT TREATS THE CONDITION! A localized cream or gel treatment DOES NOT treat systemic symptomatology!
Can this please be addressed?
Also what was ignored is that the *** prior auth department REFUSED to get on the phone with both myself (the patient - AND my physician as they dont do peer-to-peers)
Did I miss this being addressed? I DONT NEED A TIMELINE - I LIVED IT! What are you doing?
If theres no peer to peer available for physicians and they wont speak to patients how would either myself or the physician get any info besides from the Aetna *** WHO IM NOT COMFORTABLE DISCUSSING THIS WITH
Providing timelines is hostile.
Id like to know why a topical and localized treatment a step edit for a systemic concern?
I see you are just checking boxes Im happy to make this more public to get it noticed

Regards,
S
Initial Complaint
Date:10/25/2024
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Medicine that wasn't ordered was delivered by CVS Caremark on June 13, 2024 with a bill for $190 after insurance was applied. The medication, Opzelura, was never ordered and was sent in error. I have confirmed with my dermatologist that the prescription was never entered into the system.On September 18, 2024, I called the customer service line and spoke with a manager about the situation. It was agreed that since I didn't order the medication that they would provide a return label for me to send back the medication and get the charges removed. As I was waiting for the return label to be sent, I received a letter (dated October 15th) that the bill had been sent to collections.*** has agreed that I never ordered the medication and agreed that the next action was them to send a return label. Having not sent the return label, they sent the bill to collections. For resolution, I would like them to remove the collections on the bill and send the label so that the medication can be returned.
Business Response
Date: 11/11/2024
Please see our response to ********.
Initial Complaint
Date:10/25/2024
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Issue arises from repeated failures of the Respondent to process claims through insurance carrier for specialty medication. Medication was prescribed to Complainant for on-going treatment of pre-existing medical conditions. In June of 2024, Respondent, **********************/*************************** failed to process the prescription properly. The Respondent claimed they were attempting to obtain pre-authorization for the medications and subsequently claimed they received approval, but only shipped a partial order. When processing, it was determined that an unexpected lapse of insurance coverage occurred, through no fault of Complainant. A third-party trust failed to send insurance premiums from employer deductions to the insurance carrier for coverage and as a result, coverage was unexpectedly canceled with a backdated cancellation date. It was explained to CVS Specialty that this was in error and that it would soon be resolved with a new carrier taking over insurance coverage for Complainant beginning July 1, 2024. However, Respondent failed to cancel the order and shipped a partial order that could not be used without the other part of the order. It was explained to Respondent several times that they needed to re-submit a claim to the insurance carrier for payment on the shipment, as well as shipment of the other half of the order. Respondent has failed to take any such action to resolve the alleged debt. On 09-20-2024, a letter was sent to Respondent again explaining the situation and providing the resolution and no direct response to the letter was generated. However, Respondent continues to send threatening letters and text messages about referring the file to collections. As of 10/25/2024, the insurance carrier shows no record of Respondent ever making an attempt to bill the alleged debt to them for the claim to be processed under the insurance which was confirmed to be active at the time of fulfillment.
Customer Answer
Date: 11/08/2024
I have not heard from the business in response to my complaint. They have issued yet another threatening letter alleging a debt, but continue to fail to respond to requests to verify the debt. I have issued a cease and desist letter to them as of today.
Business Response
Date: 11/12/2024
November 12,2024

BBB serving *********************, *****, ************, and *******
5 Mt. *********. ************************* **********
Phone:************

Complaint #: 22473076

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 28, 2024. Thank you for the opportunity to address the member's concerns.

As of November 6, 2024, the balance has been removed from the members account and all collection notifications have stopped.

We value our members and remain committed to our purpose, helping people on their path to better health. Should you have any additional questions or concerns,please do not hesitate in contacting me at **************.

Respectfully,

****** ****
Advocate
Customer Answer
Date: 11/14/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
While the response does claim to have removed the balance and stopped collections, I have not been provided with an explanation as to whether they will reprocess the other part of the order through the insurance company. The medication that was shipped and subsequently billed to me is of no use without the other part of the order, which should have been fulfilled after CVS confirmed the errors with the insurance company. I also desire an apology for the endless frustration that has come with attempting to resolve this matter and the threats of collection when all that had to be done was to submit the claim to the insurance carrier.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*******

Business Response
Date: 12/02/2024
December 2, 2024

BBB serving *********************,*****, ************, and *******
5 Mt. *********. ************************* **********
Phone: ************

Complaint #: 22473076

To Whom it May Concern,

This letter is in response to the rebuttal we received from your office on November 19, 2024. Thank you for the opportunity to address this concern.

Our records show, at the time of order shipment, the members coverage under the plan had terminated. As a result, the order was sent in error. The member should contact their current plan regarding their medication needs.

We remain committed to our purpose, helping people on their path to better health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Respectfully,

****** ****
Advocate
Initial Complaint
Date:10/21/2024
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
In April 2024 I went to the Caremark website to see what the price of Wegovy would be if I switched from ********* to Caremark delivery. The site said my cost was $0.00 so I decided to switch my prescriptions from the pharmacy I have used for over 10 years to Caremark because there was no cost for my scripts. I get several scripts filled and then a bill for $405, confused I called to try to get a resolution and was advised that the cost really wasn't $0.00 that it was $200 per script. This drained my *** account and then I received a bill. There is ABSOLUTELY no way I would have changed where I was getting my scripts filled at if the website would have advised it was going to cost me $200. Why in the world would I choose to pay $120 more than what I was advised on the phone call I would pay if I continued with *********?! I wouldn't, that's absurd. I want my account credited to paying only the $80 a month for the scripts I received through Caremark since you can see I switched back to ********* for several months.
Business Response
Date: 10/28/2024
October 28, 2024

BBB serving *********************, *****, ************, and *******
****************************************************************************************************************************************

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on October 22, 2024. Thank you for the opportunity to address the members concern.

CVS Caremark is not the administrator for the members HRA plan. The member can contact the *** administrator for additional information. Contact information for their HRA plan is found on the back of their ID card. Please note, there is a disclaimer on the ************************** website that states, The costs provided in this tool are estimates only and are not a guarantee of payment or benefits.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
********* *******
Advocate

Customer Answer
Date: 10/28/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
I never implied that you were in charge of my HRA plan, you are in charge of billing my plan which took the funds. What's the point of having a tool that doesn't provide accurate information?? Consumers go to the tool so they can make a decision on where they get their medications, the tool provided me the information that there was no charge for the medication so I proceeded to switch my script to CVS mail order. By charging me $200 per script drained my account and left me a bill for $400. I WOULD NOT have switched my medications from my pharmacy that I have been using for over 10 years if your "tool" provided accurate information. This is a shady business practice with the intension of tricking people to paying more for medication. I am asking for all orders to changed to $80 which is what my pharmacy would have charged me and return the excess amount back to where it was charged from or send to me in a check form.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
****

Business Response
Date: 11/12/2024
November 12, 2024

BBB serving *********************, *****, ************, and *******
****************************************************************************************************************************************

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on November 4, 2024. Thank you for the opportunity to address the members concern.

As stated previously, there is a disclaimer on the website that states, The costs provided in this tool are estimates only and are not a guarantee of payment or benefits. Additionally, we have asked management to review this matter for process improvement opportunities.

Further, the members request for reimbursement was denied by the plan. The member can review plan information at **************************.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
********* *******
Advocate

Customer Answer
Date: 11/12/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
So I am supposed to just accept that the website deliberately tricks consumers into thinking they are getting one price so the company can charge more? You all knew what the price was while billing my account and then sending me a bill. This was a deliberate mi's-representation to get more money. I would have never switched to mail order if the price was accurately shown when I went to price check. My account needs to corrected that is the only solution acceptable to this.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
****
Initial Complaint
Date:10/18/2024
Type:Delivery Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
*** Specialty delayed my patient care. They were supposed to have delivered the medication to my ********* and did not. They knew when I needed my medication and set my delivery to be delivered at night way past my appointment for injection. I still have not received my delivery. They are rude and make too many dumb excuses of their mistakes.
Business Response
Date: 11/04/2024
This is still showing open. Please confirm receipt.
October 24, 2024

BBB serving *********************, *****, ************, and *******
5 Mt. *********. ************************* **********
Phone:************

Complaint #: 22443296

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 23, 2024. Thank you for the opportunity to address the member's concerns.

The member placed the order on October 17, 2024. Tracking information with photo proof shows the order was delivered on October 18, 2024,to the members residence.

The providers office verified the patient received treatment as scheduled. The pharmacy has reached out to the member to make sure all concerns have been addressed but the attempts were unsuccessful.

We value our members and remain committed to our purpose, helping people on their path to better health. Should you have any additional questions or concerns,please do not hesitate in contacting me at **************.

Respectfully,

****** ****
Advocate
Initial Complaint
Date:10/17/2024
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was recently denied coverage for my medication Wegovy because I didnt meet the 6 month criteria of loosing 15 pounds in 6months. But I have only been on the medication for 5 months and I lost 12 pounds. But they are holding me to that criteria because my prior authorization expired after 6 months. But I have only been on medication for 5. I couldnt get the medication for the first month due to stock issues. I have no side effects from the medication and it has been working!! My appetite has decreased significantly and again I have lost 12 pounds in 5 months. October 28 th will be my 6 month anniversary of being on the medication and I am sure if given the chance I would meet the 15 pound loss criteria. I can not afford the medication without my insurance. I need this medicine. I am still overweight and have obesity health related problems. But they are withholding very much needed care from me. I want my last month of wegovy so I can keep loosing weight and meet their criteria so I can continue using wegovy which again has been working for me!
Customer Answer
Date: 10/29/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved.

Regards,

****** ****
Initial Complaint
Date:10/16/2024
Type:Sales and Advertising Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have had my doctor send over multiple prior authorizations for a medicine i need and with the required documents and this company is continuously denying the requests. 1st request was missing something so we sent it over, 2nd request, they stated I had the medicine before but it didn't work. Not true, I've never had the medicine. 3rd request denied bc missing documents but my doctor sent over at least 6 months of my records. This company just doesn't want to pay for the prescription. They tell you they can't discuss medical cases bc they're not doctors but want all my records to review so they can determine if I need it. Hmm, sounds like they are trying to act like doctors ??
Business Response
Date: 10/28/2024
October 28, 2024

BBB serving *********************, *****, ************, and *******
5 Mt. **********Suite 100
*************** 01752-1927

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on October 16, 2024.Thank you for the opportunity to address the members concerns.

The requested medication is a formulary drug for the plan and requires an approved coverage request. On February 26, 2024, the members prescriber submitted a coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage.

On April 2, 2024,the members prescriber submitted a coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage.

On October ******, the members prescriber submitted a coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage.The prescriber did not provide the clinical documentation required for coverage.

On October *******, the members prescriber submitted a coverage request for the requested medication that was denied due to not meeting the plans criteria for coverage.The prescriber did not provide the clinical documentation required for coverage.

On October *******, the members prescriber submitted a coverage request for the requested medication. The prescriber provided the required clinical documentation necessary for approval and the coverage request for the requested medication was approved until June 23, 2025.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
*******************
Member Advocate
Customer Answer
Date: 10/30/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]

Better Business Bureau:

I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved.

Regards,

***** *******
Initial Complaint
Date:10/15/2024
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I need an essential prescribed medication immediately and the company made several excuses as to why they were not covering. I am currently without essential medication!!
Business Response
Date: 10/22/2024

October 22, 2024

BBB serving *********************, *****, ************, and *******
5 Mt. *****************************
*************** 01752-1927

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on October 16, 2024.Thank you for the opportunity to address the members concerns.

The requested medication is a non-formulary drug for the members plan and requires an approved coverage request. On September 15, 2023, and September 22, 2023, the members prescriber submitted two separate coverage requests that were each denied due to not meeting the Plans criteria for coverage. The coverage requests were each denied because the prescriber did not provide the required clinical information for approval.

On October *******, the members prescriber submitted a new coverage request that was denied due to not meeting the Plans criteria for coverage. The prescriber did not provide the required clinical information for approval. An explanation of the denial and appeal rights was sent to the member and their prescriber on October 10, 2024. The member still has the option to request a first-level appeal with CVS Caremark.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
*******************
Member Advocate
Initial Complaint
Date:10/11/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
When called to tell them about a medication that seemed to watery for my 13month old who has pulmonary hypertension among other health problems, the computer had a glitch and downloaded what our normal prescription was and it was actually only suppose to replace the one bottle, they are now asking for me to send the medication back and trying to bill me when it was a technical/computer issue. I've been talking to the advocate within the company that we were assigned and she is also on my side and my old insurance is also on my side that CVS should just take the hit on this as it was a technical/computer problem.
Customer Answer
Date: 10/22/2024
I have not heard from the business in response to my complaint.
Business Response
Date: 10/22/2024
October 22,2024

BBB serving *********************, *****, ************, and *******
5 Mt. *********. ************************* **********
Phone:************

Complaint #: 22411186

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 15, 2024. Thank you for the opportunity to address the member's concerns.

The member can keep the medication.

This information was notated in the members account and provided to the members point of contact.

We value our members and remain committed to our purpose, helping people on their path to better health. Should you have any additional questions or concerns,please do not hesitate in contacting me at **************.

Respectfully,

****** ****
Advocate
Customer Answer
Date: 10/23/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
I want to make sure I am not charged for the medication as it was a mistake on the businesses technology.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*********

Business Response
Date: 11/01/2024
November 1, 2024

BBB serving *********************, *****, ************, and *******
5 Mt. *********. ************************* **********
Phone:************

Complaint #: ******** - REBUTTAL

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 15, 2024. Thank you for the opportunity to address the member's concerns.

That is correct, the member will not be charged for that reshipped quantity.

This information was notated in the members account and provided to the members point of contact.

We value our members and remain committed to our purpose, helping people on their path to better health. Should you have any additional questions or concerns,please do not hesitate in contacting me at **************.

Respectfully,

****** ****
Advocate
Customer Answer
Date: 11/04/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
It was not a reshipped it was a technical issue that happened on your guys end. I want to be absolutely sure that I will NEVER be charged for the shipment.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*********

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