Business Profile

Health Insurance

CVS Caremark

Headquarters

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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:10/10/2024
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 was prescribed Wegovy 0.25 mg/0.5 by my internist, Dr. ******* on October 18, 2023 and again ( 1 mg/0.5 ml ( 112 day supply) by my endocrinologist on January 3, 2024. The ** was approved and covered by my employer health insurance. For nearly a year, my ************ said there was a shortage and they couldn't fill the **. I have called or gone into the pharmacy nearly every month. I was told it was best to buy it at a specialty pharmacy but my employer only uses CVS Caremark. I have tried to contact Caremark ******************************************** but have not been successful in getting my ** filled. Every day, there are advertisements for Wegovy on TV, radio, social media. It is everywhere. How is it that Caremark has denied me this ** for a year?
Business Response
Date: 10/12/2024
On behalf of *****************. I would like to apologize to Ms. ***** ****** for the problem she encountered with her local CVS. At ***,our goal is to be a trusted partner in our patients' health care. When we find that we have disappointed a patient, we believe that it is important to understand what happened and to take the appropriate action.
Our field leadership team has taken steps to address the issues raised by Ms. ******* reinforcing with the pharmacy team the importance of communicating professionally and effectively to support patient care. Field leadership team spoke to ********* to apologize for their experience and the disruption of treatment caused by the medication being out of stock and thanked her for her feedback,assuring her that the team will be coached on handling such situations in the future. Additionally, the pharmacy team was able to transfer her prescription to another location that had the medication in stock. Ms. ****** was satisfied with the resolution and appreciated the follow-up. She was also provided with district leaders phone number for direct contact should any future concerns arise.
Initial Complaint
Date:10/09/2024
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.
My husband went to his spine back doctor yesterday in severe pain from sciatica and neuropathy. This is a CHRONIC condition. The doctor is scheduling another injection but while we wait for "pre-authorization"; he prescribed him ********* without ******* due to kidney/liver issues. We tried to pick up RX and CVS said the doctor needed to present "prior authorization". ??? Why? The doctor issued the script yesterday and sent it to CVS electronically to prevent fraud. CVS Caremark REFUSED to fill prescription until the doctor can fill out an authorization form and submit it to them and THEN they might release his medication??? My husband is in SEVERE pain and we need his meds NOW! The doctor is in surgery today so we may not get any approval until next week? And you call this healthcare??? Biggest bunch of thieves in the country. What's worse - if we were drug addicts - we could probably get the meds on the street FASTER than we can though our insurance company. I'm seeking restitution for pain and suffering and for general lack of empathy with the situation. A REAL person has REAL pain and cannot get help. If he were gay - they'd give him his HIV meds super fast. If he were one of the gender-benders - they'd jump through hoops to get him his "trans" medication. But because he's an older white male - we have to jump through hoops AND the doctor is forced to jump through hoops when he ALREADY authorized this medication? They should be shut down immediately!
Customer Answer
Date: 10/21/2024
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 #:22401529

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 9,2024. Thank you for the opportunity to address the member's concerns.

The requested medication is a formulary drug for the members plan and requires prior authorization for coverage. On October 9, 2024, the members prescriber submitted a prior authorization request for the requested medication that included the required clinical information for approval. The prior authorization request was approved until April 7, 2025. Approval notifications were sent to the member and their prescriber on October 9, 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 **************.

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.]

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,
****
They have not even addressed the original problem. When a DOCTOR prescribes a brand new medication AND electronically sends that RX directly to the Pharmacy - there should be no further requirements on CVS Caremark to INTERFERE with the patient from receiving the medication. CVS Caremark refused to fill medication without FURTHER involvement from the doctor. Basically - the doctor had to "approve" his own prescription and until he jumped through this EXTRA CVS CAREMARK hoop - CVS refused to give patient his much needed medication. Their policy is WRONG and let's them play DOCTOR for no good reason.

Business Response
Date: 11/04/2024
November 4,2024

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 28, 2024. Thank you for the opportunity to address the member's concerns.

The members plan requires that members obtain approval for certain medications before the plan will cover the medication. The approvals are generally referred to as prior authorization. The members plan requires an approved prior authorization for coverage of the requested medication.

On October 9, 2024, the members prescriber submitted a prior authorization request for the requested medication that included the required clinical information for approval. The prior authorization request was approved until April 7, 2025. Approval notifications were sent to the member and their prescriber on October 9, 2024.

In addition, the members plan information for formulary documents and prior authorization requirements is available on the plan sponsors website, **************************************************************.

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: 11/12/2024
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.
They keep saying the same thing - the fact is they PREVENT patients from receiving critical medication in a timely manner for absolutely no reason. It's part of THEIR policy and they won't change it. But they are NOT doctors and refusing to give a patient medical care because of their additional "form" that needs filled out by the doctor approving his very own prescription - it makes ZERO sense. I mean - how does it go ...... Hi doc! I see you've sent in an electronic prescription for patient x. Can you now fill out ANOTHER sheet of paper saying you approve this prescription that you wrote today? RIDICULOUS!

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:10/09/2024
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 recently started a new injectable medication to treat my ******************** and was forced to use CVS Specialty mail service (by my insurance policy). It has been 3 months and it has been issue after issue from the start. I received my first month's supply in July 2024. September 2024 I went to request a refill and was told that prior authorization was needed AFTER I already started the medication. How was I able to receive the first month's supply without a prior authorization? Since this is a new medication it should have been explained to me that my *** will need to obtain authorization so I can continue on the medication. I wasn't told this until I called to refill my medication (with only 1 injection left). This caused a delay and as a result I missed an injection. My doctor's office was able to obtain authorization and enter a new prescription with ********************* an entire year. It is now October 2024 and I logged in to schedule a refill and discovered that the prescription was deactivated. How? I called CVS Specialty and was told that there are no notes as to WHY the prescription was deactivated or WHEN. How is there no record of a prescription being deactivated? Why was I not notified that the prescription was deactivated? The only resolve the pharmacist offered was to call my *********** for a new prescription (AGAIN). My doctor is on vacation and unable to enter a new order. So now I will miss yet another injection. This entire experience has been extremely frustrating and inconvenient. I used to use Express Scripts for my long-term medications and NEVER had these issues. There is such a lack of care which is appalling coming from a company handling people's medications. Having to miss ANOTHER injection is unacceptable and harmful for my medical condition. CVS Specialty should be ashamed and I am extremely disappointed in how this situation is being handled.
Customer Answer
Date: 10/20/2024
I have not heard from the business in response to my complaint.
Business Response
Date: 10/24/2024
October 23,2024

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

Complaint #: 22401295

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 9, 2024. Thank you for the opportunity to address the member's concerns.

The member had an approved coverage request for the requested medication from their previous plan that was valid from June 30, 2024, through August 30, 2024, which allowed the member to fill their prescription for the requested medication on July 15, 2024.

The requested medication is a formulary drug for the members plan and requires an approved coverage request. On September 4, 2024, CVS Caremark notified the members prescriber that a new coverage request would need to be submitted for coverage of the requested medication.

On September 9, 2024, 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 required clinical information for approval.

On September 12, 2024, the members prescriber submitted an appeal that included new clinical information and the coverage request was approved until September 12, 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 **************.

Respectfully,

****** ****
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.
Can you explain why my prescription was cancelled the day after it was approved by my insurance on 9/12? And why I was not informed until I called to place a refill request? And why my ******* *** did not cancel the prescription, was never notified that the prescription was cancelled and a new one was required at the very least.
Regards,
*****

Business Response
Date: 11/21/2024
November 21,2024

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 28, 2024. Thank you for the opportunity to address the member's concerns.

On September 18, 2024, the prescriber submitted an electronic form requesting to discontinue a previously received prescription.Because the request came directly from the prescribers office, it did not trigger an alert to the member.

The prescriber has since provided a new prescription that was processed, shipped, and delivered to the member.

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:10/08/2024
Type:Product 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.
Two claims were filed by Caremark with the insurance who initially paid $13,832.32 leaving a balance owed of $120 on each ($240 total) which was incorrect. The insurance realized this error and corrected both claims by reversing the initial payments of $13,832.32 and issuing new payments of $13,****** for each with $0 balance owed. After the initial payment was made by the insurance of $13,832.32 to CVS Caremark, I paid the balance initially owed on each claim for a total of $240. For the last 6 months, CVS Caremark has not reimbursed me for the overpayments after repeated request by the insurance and me. The last refund call was made by the insurance on 8/16/24 which I was privy to. They also sent a written request through internal systems to CVS Caremark right after to process the refund to me. As of today, no refund has been issued and CVS Caremark continues to give me and the insurance the run around by passing the **** within the organization departments. -- - - - - - - - - - - - - - - - - - - - - - - -- - - - - - -- - - - - - - - - - - - - - - - - - - - CLAIMS:1.) 7/26/23 Claim #***************, Rx #********, and processed 3/25/24 @ 9:05:33 CST or 21:05:33 with an initial insurance payment of $13,832.32 ($120 balance owed by me) and redone for $13, ****** ($0 balance owed by me). - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2.) 8/21/23 Claim #***************, Rx #********, processed 3/25/24 @ 9:05;34 CST or 21:05:34 with the initial insurance payment of $13,832.32 ($120 balance owed by me) and redone for $13, ****** ($0 balance owed by me).
Business Response
Date: 10/23/2024
October 22, 2024

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

Complaint #: 22398532

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 9, 2024. Thank you for the opportunity to address the member's concerns.

On October 21, 2024, the mailing address was confirmed with the member and the check is being reissued and should be received within thirty (30) days.

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: 11/06/2024
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 am rejecting this response because, initially, CVS Specialty told both the insurance company and me that no refund had been issued until I filed this complaint. After I submitted the complaint, they began reaching out about the money, claiming that a check was sent in March 2024, but it was returned and not accepted by me, with no further details provided. I clarified that this was incorrect; I have not received any payment, nor have any checks been returned to me. Furthermore, my address has been verified with them multiple times, which they acknowledged, and they had no record of any payment being sent to me prior to the complaint being filed. They then confirmed this information and stated that another department would be dealing with the refund matter and would reach out to me afterward. A few days later, I received information from that area that a refund was being mailed to me (7-10 days for receipt) instead of being credited back to my card. They mentioned it was too late to process it that way according to their process. CVS Specialty's response came two days prior to their compliant reply to me via the Better Business Bureau. I decided to wait until today, November 6, 2024, to see if the refund would arrive, but it has not. Additionally, they did not provide a tracking number, leaving me uncertain if it was actually sent and if their claims were valid. I cannot accept this response because I have not received any refund. Please ask CVS Specialty to provide proof that the refund was mailed; if not, a full refund needs to be credited back to my card (provided in policy or to be confirmed by phone) as an exception to resolve this issue once and for all. Therefore, closing this complaint.]

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,
Mercedeas

Business Response
Date: 12/13/2024
December 13, 2024

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

Complaint #: 22398532

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on November 7, 2024. Thank you for the opportunity to address the member's concerns.

Our ****************** confirmed that a check was mailed to the Complainant on December 2, 2024. The Complainant requested for proof that the check has been mailed, however, the check was mailed First Class U.S. Mail and no tracking number provided. Attempts were made to reach the Complainant to confirm receipt but, no response.

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: 02/06/2025
On October 22, 2024, CVS Caremark claimed they had previously sent me a payment that was returned, but they were unable to provide any evidence as the incident never occurred. On that same day, they alleged to be sending another payment, verifying the address once again--even though they had consistently sent medications to my correct address for years. However, they then mentioned an unexplained address discrepancy. Throughout this ordeal, the Executive Team admitted they were experiencing difficulties with the billing and reimbursement department, who asked for my patience and additional time. They assured me that they would inform BBB that their requests were being ignored for the complaint to remain open since it was scheduled to close for their lack of response. Furthermore, I was told that the payment had been sent, but without any confirmation, tracking details, amounts, or verification of the mailing address which was untrue. As shown in their final response from December 16, 2024, the Executive Team never received any information from the so-called internal departments, despite management escalation, and continued to stall. It wasn't until after the NY incident that the missing refund money and other disputed amounts suddenly appeared right before the Christmas Holiday, December 25, 2024. Thank you BBB for your assistance and resolving the issue with a refund for me.
Initial Complaint
Date:10/07/2024
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.
My employer changed our health insurance to **** in June. I have been paying my premiums all along. As a result of that change, I am supposed to get my medications through Caremark instead of Express Scripts. I have called Caremark several times every week to try to get them to begin to send my medications since July. I gave them my list of medications months ago. My doctor faxed a list of my medications months ago. Caremark claimed they did not receive the fax so my doctor mailed me proof that he sent the list to them twice. They continued to lie. I went to my doctor three weeks ago, paid $30 and sat in his office while he sent the order for medications to them electronically. They still claim he didn't refill the medications. I have run out of Prevastatin. They will not send it to me and the *** pharmacy claims it hasn't been renewed (the 3rd lie). These creatures should not be in business!!!!!!! In a while I will not have medication to treat any of my medical conditions while I continue to pay my premiums!
Business Response
Date: 10/14/2024
Tell us why here...
October 14, 2024

BBB serving Eastern Massachusetts, Maine, Rhode Island, and Vermont
5 Mt. Royal Ave. Suite 100 Marlborough, MA 01752-1927
Phone: 508-652-4800
Complaint #: 22385299

To Whom it May Concern,

This letter is in response to the correspondence we received from your office on October 7, 2024. Thank
you for the opportunity to address the member's concerns.

Our records show a prescription transfer request was received on August 20, 2024. Upon review, the
request required additional information from the prescriber.

On August 29, 2024, the prescriber’s office advised the mail order pharmacy that the patient must be
seen in their office before any medications would be approved. On October 8, 2024, a new prescription
was received, and the previous prescription was placed on hold. The order was delivered on October 9,
2024.

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 1-866-526-4075.

Respectfully,
Cordia Paul
Advocate
Customer Answer
Date: 10/19/2024
[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 #22385299. I understand that by choosing to accept the business response that my complaint will be closed as resolved.

Regards,

Louise Birnbaum
Initial Complaint
Date:10/04/2024
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.
After hitting my max-out-of-pocket and questioning why i was being asked to pay for a prescription at the pharmacy, Caremark has been unable to resolve this issue due to IT issues that they blame on United HealthCare, and UHC blames Caremark. I even offered to give Caremark the *** showing I owed nothing for this specific claim, and they refuse to look at it, or resolve so that I can pick up my medication.
Business Response
Date: 10/16/2024
Good Afternoon,
Please see our response to Case # ******** for **** *****.
Initial Complaint
Date:09/27/2024
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.
*** sends me medicine in which I don't remember asking to have to sign for package, they say I did but I don't remember that. *** tried to bring medicine for 3 days in a row. Our door **** stopped working & he didn't knock. Finally we caught him today when he dropped off medicine. Medicine is very hot, ice packs are melted and very warm. Don't know if this sat on a hot *** truck or what process it's been through, don't feel safe taking this injecting it into my body, CVS says you can leave it out for 30 days, however what temperature did this reach before it got to me? I don't want to take it right now due to getting flu & covid shots, which pharmacy said wouldn't be as effective if I take this shot so I wanted to wait. I call company who refuses to send me another dose. This medicine costs my insurance $15,000 & **** who was very rude, refusing to give me address of company that sent it to me, or do anything about it, told me to throw it away. I will not be using this company to get any more refills after this ordeal.
Business Response
Date: 10/08/2024
****************************************************************************** | T: **************
October 8, 2024
BBB serving *********************, *****, ************, and *******
5 Mt. *********. Suite 100
***********, MA 01752-1927
Complaint # ********
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the ****** NE ******** health plan, of
which the beneficiary is a member. This letter is in response to the correspondence we received from
your office on September 30, 2024. Thank you for the opportunity to address the beneficiarys concerns.
Per notes on this account, patient requested signature required during the first order placed in March
2024, as the system defaults signature required.
Our records show, the order shipped on September 23, 2024, and was delivered on September
26, 2024 through *** Tracking# 1Z0R544V4262623982.
On September 26, 2024, the member called and requested a new order. Member spoke to a pharmacist
who advised the medication is stable up to 30 days per manufacturer guidelines. As a result, the
members request was denied.
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:09/26/2024
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 broke seceral bones in my leg and when I went to pick up prescription, I was told I need-prior authorization. they forced me to pay out of pocket for the medication. this happeded twice. I was forced to be in pain.
Business Response
Date: 10/16/2024
Good Morning,
Please see our response to Complaint # ******** **** ****.
Initial Complaint
Date:09/23/2024
Type:Order 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.
Date of the transaction: The original prior authorization request was submitted on August 20, 2024 and multiple appeals have been filed since then.The amount of money you paid the business: There is no direct payment to CVS Caremark for this issue, but the delay in receiving my prescribed medication has caused significant personal health consequences.What the business committed to provide you: CVS Caremark, as the pharmacy benefits manager for my health plan, is supposed to facilitate access to medically necessary prescription medications.What the nature of the dispute is: CVS Caremark has repeatedly denied prior authorization requests for my prescribed medication, despite the submission of detailed medical documentation from my healthcare provider. Appeals have been made, and the medication remains inaccessible, causing serious delays in my treatment. Additionally, CVS Caremark has not facilitated a true information seeking effort as the documentation provided included the information needed, but the prior auth form was not completed to their satisfaction. I have spent hours on the phone attempting to correct these errors, but I have no agency in the matter. Whether or not the business has tried to resolve the problem: CVS Caremark has denied multiple appeals, and their responses have been delayed and lacking in transparency by requiring I wait for a letter in the mail or call the company to gain insight into the denial reasons - obvious delay tactics and patient disenfranchisement. Any relevant details of the business' actions: Their lack of cooperation and continued denials seem to be a systematic issue designed to delay or prevent access to necessary medications.
Business Response
Date: 09/30/2024
September 30, 2024

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

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on September 23, 2024. Thank you for the opportunity to address the members concern.

The requested medication is a formulary drug for the members plan and is covered with prior authorization. On August 20, 2024, the members prescriber submitted a prior authorization request for the requested medication that was denied due to not meeting the Plans criteria for coverage.

On August 21, 2024, the members prescriber submitted an urgent 1st level appeal that was denied due to not meeting the Plans criteria for coverage.

On August 24, 2024, the members prescriber submitted an external review request for the requested medication that was denied due to not meeting the Plans criteria for coverage.

On September 24, 2024, a new prior authorization request was initiated for the requested medication. The members prescriber provided new clinical information and the prior authorization request for the requested medication was approved until January 24, 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,
********* *******
Advocate

Customer Answer
Date: 09/30/2024
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 # *******

The response I received from CVS Caremark is wholly inadequate and dismissive. Stating that my prior authorization "did not meet policy requirements" without providing a specific and detailed explanation of which criteria were not met is unacceptable and lacks transparency. This approach prevents me from understanding the rationale for denial and obstructs my ability to address the issue effectively.

Throughout this process, I have spent countless hours on the phone with various representatives, each providing conflicting and inconsistent explanations for the denial. This lack of clear communication and accountability is not just frustratingits unethical. It is evident that CVS Caremarks processes are designed to discourage policyholders from accessing the care they are entitled to under their health plan by obfuscating information and making it unnecessarily difficult to obtain answers.

The prolonged delays in addressing this matter led to an unacceptable disruption in my treatment, forcing me to go without my prescribed medication for an extended period. As a result, I suffered adverse side effects, which also compromised the effectiveness of other medications I take for separate conditions. These impacts significantly affected my day-to-day functioning and professional responsibilities. For those who do not have the time, resources, or medical knowledge to navigate these barriers, the consequences could be even more severe.

CVS Caremarks actions are not just inefficientthey are dangerous. By intentionally dragging out the authorization process, limiting access to information, and subjecting policyholders to excessive wait times, CVS Caremark appears to be prioritizing profit over patient health and safety. This strategy of using attrition to wear down patients until they give up seeking necessary care is not just unethical but may also be illegal under state and federal regulations.

If I do not receive a detailed and clear explanation of why my prior authorization was denied, including the specific policy criteria that were not met, and if my case is not resolved immediately, I will escalate this matter to the following entities:

The Texas Department of Insurance, for a formal investigation into CVS Caremarks unfair practices.
The U.S. *******************, if there are potential violations of ***** regulations for employer-sponsored health plans.
The ************************ (FTC), for deceptive business practices that may violate consumer protection laws.
The Office of the Attorney General, to report CVS Caremarks actions as a form of healthcare fraud.
This is not a threatit is a promise to hold CVS Caremark accountable for obstructing my access to care. I expect an immediate resolution and a commitment to improve these processes to prevent further harm to patients.

Regards,
*******

Business Response
Date: 10/02/2024
October 2, 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 1, 2024. Thank you for the opportunity to address the members concern.

The requested medication is a formulary drug for the members plan and is covered with prior authorization. On August 20, 2024, the members prescriber submitted a prior authorization request for the requested medication that was denied due to not meeting the Plans criteria for coverage. An explanation of the denial and appeal rights was sent to the member and their prescriber on August 20, 2024.

On August 21, 2024, the members prescriber submitted an urgent 1st level appeal that was denied due to not meeting the Plans criteria for coverage. An explanation of the denial and external review rights was sent to the member and their prescriber on August 23, 2024.

On August 24, 2024, the members prescriber submitted an external review request for the requested medication that was denied due to not meeting the Plans criteria for coverage. An explanation of the denial was sent to the member and their prescriber on September 21, 2024.

On September 24, 2024, a new prior authorization request was initiated for the requested medication. The members prescriber provided new clinical information and the prior authorization request for the requested medication was approved until January 24, 2025. There is a paid claim for the requested medication on September 24, 2024, at the members pharmacy.

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: 10/03/2024
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 # ********.
To Whom It May Concern,

Thank you for your response, but Im afraid its still not acceptable. While I see that the most recent prior authorization request has finally been approved, your letter doesnt actually address the core issues I raised in my complaint.

From the start, the denials I received were vague and lacked any real explanation of why my medication wasnt approved. I called multiple times and was given a different story each time, leaving both me and my doctors office completely in the dark. This process was chaotic, frustrating, and an enormous waste of time for everyone involved. And whats worsethere was no easy way to access detailed information about why I was denied or what exactly I needed to do next. You keep saying, It didnt meet the Plans criteria, but what does that even mean?

To make matters worse, this entire situation required a ridiculous amount of effort not only from me, the patient, but also from my provider and their staffprofessionals who prescribed the medication knowing exactly what I need based on my condition and history. Forcing a doctor and their team to repeatedly justify their decisions to a for-profit institution that has no insight into my medical history or treatment goals is a blatant show of disrespect for both the patient and the healthcare provider. Why should healthcare professionals, who spend years becoming experts in their fields, have to jump through hoops to satisfy a company that exists solely to make money?

The way CVS Caremark handles prior authorizations makes it painfully clear that your goal is to create as many roadblocks as possible in hopes that people like me will just give up. You bury us in red tape, provide minimal information, and force us to spend hours navigating a process that should be straightforward. At this point, it feels like CVS Caremarks policy is to delay and deny as long as you can to protect the bottom line.

Going forward, heres what I need to see:

A detailed explanation of why the initial request and appeals were denied, including which exact criteria were not met and why.
An assurance that CVS Caremark will streamline communication and access to information so that patients and providers dont have to spend hours deciphering vague denials or trying to get a straight answer.
If I dont receive this, I will be escalating my complaint to the Texas Department of Insurance, the Centers for ******** & ******** Services, and the **** as well as exploring every possible avenue to ensure CVS Caremark is held accountable for its practices.

Patients shouldnt have to battle their insurance company just to access prescribed care, and doctors shouldnt have to beg for approval on behalf of their patients. Its time CVS Caremark stops acting like a gatekeeper and starts respecting the people it claims to serve.

Sincerely,
Regards,
*******
Initial Complaint
Date:09/21/2024
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.
Our insurance coverage uses CVS Caremark for its prescription coverage. We dont get to pick. We dont have a CVS within an hour drive of our house. I am on a hormone patch treatment and I get VERY sick if I dont have them. *** has refused to allow me to pick up my medication at my local pharmacy, and I requested them to be mailed to me over a month ago and still havent received them. I did NOT want my medicine mailed to me and begged and begged for them to cover it at my local pharmacy and they declined over and over until I had no choice. Last month I had to pay out of pocket to get my patches and will have to pay again because they never mailed them to me. I should have access to the medication I am prescribed and this company has made it to where I do not. So, we already pay for prescription coverage and now I have to pay for my prescriptions to because they will NOT cover it. I am basically being charged for a service I dont receive.
Customer Answer
Date: 10/02/2024
[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,

******** *******

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