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:07/04/2023
Type:Billing 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.
On November 23, 2022, CVS Caremark sent me and billed me $207.50 for a prescription for Flovent that I did not order or authorize, so I disputed the charge with my credit card company ************** I informed CVS that I was willing to abide by ************* decision, as a neutral third party, on the merits of the case and if they ruled in favor of CVS then I would pay the bill. However, *********** informed me that I won the case as of June 28, 2023. So I called CVS on July 3 to ask that the $207.50 be removed from my CVS account balance but CVS refused to acknowledge or accept that I won the case. *********** did remove the charge to my credit card but CVS refuses to remove it from my account balance at CVS. My CVS account number is ********. The *********** case number is ***************.
Business Response
Date: 07/07/2023
July 7, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the **** Federal health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on July 4, 2023. Thank you for the opportunity to address the members concern regarding billing.

On July 6, 2023 a one-time credit of $207.50 was applied to the members account.

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: 07/07/2023
[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:07/01/2023
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.
For about two weeks now I have tried to have a medication refilled. I have called CVS Caremark several times to no resolution of this matter. My doctor nurse have sent in the prior authorization as requested twice, but every time I call I am told they have not received it. I just need a resolution in order for my medication to be filled and covered by my insurance. I hate this company and wish my employer would choose someone else for prescription coverage. This does not make any sense that I am having to deal with this. I need answers and my medication filled and covered by the insurance that I pay for biweekly.
Business Response
Date: 07/11/2023
July 11, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the *********** health plan,of which the beneficiary is a member, however prior authorizations are not handled by Caremark. This letter is in response to the correspondence we received from your office on July 2, 2023. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, a prior authorization is required for the medication in question. Prior authorizations are not managed by Caremark they are managed by *********** whose phone number is ************. Member and/or prescriber can contact *********** to request a status update.

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: 07/11/2023
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,
******
Initial Complaint
Date:06/30/2023
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.
Without reason, I have been receiving robocalls from CVS Caremark on and off for years , 3 or more each day to my home phone **********. They are now daily. They claim to be determining coverage, but I have no prescriptions there. It is a nuisance. Loud robocalls at the worst times, disruptive and taking up my answering machine. I called more than once for help and they are sincerely trying to help me on the phone but its a computer glitch, not a human error . They filed a do not call order which may or may not work, within ***************************************** They cannot take my home phone out of their system for some reason. They made my cell the default per my request - less disruptive- but it still came through on my home phone. I should have some kind of recourse to eliminate my number. Thank you.
Business Response
Date: 07/11/2023
CVS Caremark Part D Services
******************************************************************************************; 78238

07/11/2023

Better Business Bureau of Eastern *************, *****, ************ and *******

Complaint #********

Dear Sir or Madam,

Thank you for giving ** the opportunity to address our members concerns regarding receiving automated calls from CVS Caremark.

Weve confirmed that the member was successfully placed on the Do Not Call list on 06/30/2023 after contacting ************* on 06/29/2023.

Please feel free to contact me directly with any questions or concerns regarding this response.

Sincerely,

*********************
Senior Consultant
Customer Answer
Date: 07/12/2023
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.
I have not recently received the robocalls as of recent and appreciate the business attention to my situation.

Regards,

*********************************
Initial Complaint
Date:06/27/2023
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 purchasing a drug called Wegovy during the past 4 months. The drug is expensive and I have a high deductible insurance. My deductible is $5250. After my deductible is exhausted, my insurance will begin to kick-in.So far I have spent over $4000 on the drug (see detail below for the 4 dosages), but on the Caremark/CVS website it only shows that $2700 is applied toward my deductible. I have spent countless hours on the phone with Caremark/CVS and they still can't seem to sort this out. I am reaching out for help. Thank you.DateDosageOut of Pocket 3/10/20230.25 mg $1,035.75 4/8/20230.5 mg $906.08 5/4/20231.0 mg $906.08 5/23/2023 $(906.08)5/23/2023 $1,035.75 (The transaction for the 1.0 mg had to be reprocessed after I got Prior Authorization for the drug. The net effect is that I paid $1035.75)5/31/20231.7 mg $1,035.75 Total Out of Pocket $4,013.33 Total Reflected in Deductible (as of 6/28/23)$2,698
Customer Answer
Date: 07/08/2023
I have not heard from the business in response to my complaint.
Business Response
Date: 07/13/2023
July 12, 2023

BBB serving Eastern *************, *****, ************, and *******
************************************************************************************************************************-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the Healthfirst ** Exchange health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 27, 2023. Thank you for the opportunity to address the members concern regarding the deductible.

Upon review, it appears that any concerns the member has regarding discrepancies with the deductible must be handled by the Healthfirst health plan. The member may telephone his plan at Healthfirst Member Services 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,
*********************************
Member Advocate
Customer Answer
Date: 07/17/2023
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 have already called Healthfirst and they told me that only Caremark can correct the discrepancy. So basically they are bouncing me back and forth and giving me the runaround.

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: 07/21/2023
July 21, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the Healthfirst ** Exchange health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on July 17, 2023.Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

When a member contacts CVS Caremark about an accumulation concern, the plan has asked that CVS Caremark transfer the member to Healthfirst Member Services for assistance. We apologize for any inconvenience the member may have experienced.

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: 07/24/2023
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.
As I mentioned earlier, Caremark and Healthfirst are bouncing me back and forth. I believe the error lies with Caremark since they have not included all the medications I paid for towards my deductible. If they really want to solve the problem, we can all do a conference call (Caremark, Healthfirst and me) so they dont bounce me back and forth, and we can go through the list of each of the 5 or 6 purchases of Wegovy to see which one they missed. The problem is really simple to solve if they have the will to do it and are committed to really care for their clients. We just need to audit the medications I purchased and identify the problem.

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:06/23/2023
Type:Sales and Advertising 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 MD and I decided to start Ozempic, I was pre- diabetic, had abnormal labs and *** I could not lose weight, menopause made it tough. I had may *** and downs with blood sugars. I called my insurance, Caremark said ok to start Ozempic- no prior auth needed. I started in April and May - no probs with med pick up. The night I was due for my injection- I went to pick up my ozempic and CVS told me not covered- ** needed. MD tried to help, denied etc, No notice, no wean- I suffered with withdrawal issues, sugars and woozy. I became sick from no meds- being cut off abruptly. I called insurance to ask for a temp supply to avoid feeling sick etc. No accommodation- basically tough luck- sorry. Unfair, cruel, no communication this was coming.
Business Response
Date: 06/28/2023
June 26, 2023

BBB serving Eastern *************, *****, ************, and *******
************************************************************************************************************************-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ****************** of ************ health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 26, 2023. Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

Upon review, we have verified that as of June 15, 2023 the Plan requires an approved coverage request to obtain the medication. On June 20, 2023 the members prescriber submitted a coverage request for the medication that was denied due to not meeting the Plans criteria for coverage.

The member or the prescriber may file an appeal for coverage by mail or fax to:
Prescription Claim Appeals MC 109 - CVS Caremark
P.O. Box 52084
*******, ** 85072
Fax: **************

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:06/23/2023
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.
In May 2023, my health insurer made an adjustment to a health insurance claim from March 2023. The adjustment resulted in a $151.95 decrease in my spend against my combined healthcare/pharmacy deductible of $3000 dollars. Instead of properly applying out of pocket spending from subsequent claims like my health insurer did, *** decided that I needed to pay an additional $151.95 against the deductible and this was reflected in the price of the next prescription I picked up. I have spent over 6 hours on the phone with ***. I have escalated this issue to CVS Caremark's highest tier of phone support. My account has been submitted for manual review twice. I have had a 3-way call with the health insurer and CVS Caremark (at ***' recommendation) where the health insurance rep explained clearly to the *** rep that the problem was a billing problem on ***' side. All with no resolution. At each and every opportunity, CVS Caremark refuses to make the issue right. At this point I feel that *** has stolen from me and left me no recourse. I cannot choose another provider as CVS Caremark is the only pharmacy benefit manager offered by my employer.You can see in the attached documentation from my health insurer that my out of pocket spending against my $3000 deductible is $3151.95. This should not be possible.
Customer Answer
Date: 07/03/2023
I have not heard from the business in response to my complaint.
Business Response
Date: 07/05/2023
July 5, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the *********Sandoz health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 23, 2023. Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

Upon review, on May 18, 2023, ****** Pharmacy reversed the claim in question which. On May 22, 2023 the claim was reprocessed and the plans deductible was met.

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: 07/06/2023
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.
This does not address the claim whatsoever. The deductible should have been met months earlier based on out of pocket spending eligible (and counted by the health insurance company) towards the deductible. CVS helpfully ignores this spending in their calculations.The claim they are referring to was because I asked the pharmacy to try and re-bill the insurance to see if CVS had corrected the error in their calculations (they had not). It is not related to the situation whatsoever.

The actual claim that was reversed and precipitated the problem occurred in March 2023 per multiple representatives at CVS. Then subsequent out of pocket spending occurred between March and May 2023 that should havce satisfied the deductible. Indeed, the health insurance provider indicates that that spending did infact meet the deductible. Due to an error at CVS this subsequent spending has not been counted.
Therefore when I picked up a script on May 22, I was overbilled by $151 because my deductible was not considered met by CVS, but it had in fact been met.

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: 07/13/2023
July 12, 2023

BBB serving Eastern *************, *****, ************, and *******
********************************************************************************************************************************************************
Complaint #********

To whom it may concern:

CVS Caremark (Caremark)is in receipt of your July 10, 2023, letter with the members response.

As previously noted,the member had not met his deductible when he filled his prescription in March 2023, and no reimbursement is owed. The member should direct any deductible questions to his health 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,

*********************************
Member Advocate
Initial Complaint
Date:06/22/2023
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 am obligated to use CVS Caremark as part of my employers health plan. In late May of 2023, a **************************** was sent from my doctor to Caremarks mail order pharmacy. I did not receive my medication, which is essential to my daily functioning, for approximately one month. My doctor, my doctors office, the pharmacist, and I all called CVS Caremark many times over the course of a month because their system kept introducing roadblocks to me getting my medication. Every single time, I had to speak to their senior team before the roadblock was resolved, but even then, I received no updates on my order. This process continues for weeks, making me lose tens of hours out of my workday - out of my life. I have raised this with my employer and have begun a company-wide discussion about my employers partnership with Caremark. There are many people who have had similar experiences and are deeply frustrated with Caremark. This month, I was told that my prescription would be sent via mail order pharmacy, and since I am traveling, I cannot pick it up from my regular pharmacy. They decided to charge me the full price of my medication, even after I met my deductible. They did not resolve my situation and I have decided to write this complaint and raise it within my company.
Business Response
Date: 07/06/2023
July 6, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the Booz *************************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 23, 2023. Thank you for the opportunity to address the members concerns

Upon review, we have verified that delays were due to a shortage of the generic medication. The members order was delivered on May 24, 2023 per **** website tracking # **********************.

We confirmed that the Plan has a deductible amount of $1,600 that is integrated in the Plans $2,650 out of pocket amount. The members deductible was met on May 5, 2023. As of June 28, 2023, the member has accumulated $2,338.25 towards the out-of-pocket amount. The member can go to Caremark.com to view cost summary.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. We sincerely apologize for any frustration or inconvenience the member may have experienced. Feedback has been provided to each member of our customer care team with whom the member interacted with in an effort to improve the level of service our members receive. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

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

Customer Answer
Date: 07/10/2023
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.
Caremark has not acknowledged its role in delaying the delivery of my medication. The medication delivered at the end of *** was only delivered after significant delays. In June, no medication was delivered because Caremark stopped providing an override on brand medication due to a shortage of the generic supply. There were no notifications that this had occurred. I simply did not receive any correspondence nor my medication when it was due in June. Instead, I saw that I would have to pay the full price of the brand name medication with no additional explanation. I did not receive my medication from Caremark's mail order pharmacy in the month of June as a result of this. Instead, I had to ask my provider to prescribe a different medication that I was unfamiliar with. This, of course, created a lot of consternation on my part because a new medication now needed a prior authorization, a process that resulted in additional delays and confusion on the part of Caremark. I want to emphasize that the prime issue is the lack of communication, follow-up, and knowledgeable dialogue with Caremark representatives. I also received a letter in the mail telling me that my new medication would no longer be covered. This is a direct contradiction to their yearly formulary where I can clearly see that my new medication should be covered. No explanation was provided for this letter that I received. Lastly, a Caremark representative by the name of ************* emailed me on *** 23 to follow up about my poor experience. I emailed him back asking to speak about it, but I did not receive any replies even after I sent multiple emails to him. Where is *************? See below:

Dear NAMAN,

Thank you for taking the survey for CVS Caremark/Aetna your PBM on 05/22/2023. We appreciate your feedback about your experience with Caremark services and regret that you didnt receive the level of service expected.

Wed love to hear more from you on how we can improve our service and resolve this issue for you as quickly as possible. If youd like to share more about your experience, please reply to this email with the best time, date and phone number to reach you. We try our best to call at the requested time during our normal call hours, Monday-Friday 8am to 7pm central.

We value your input and hope to hear from you soon.

With your best interest at heart,

*************
Customer Support

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,
Naman

Business Response
Date: 07/24/2023
July 21, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the Booz *************************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on **** 23, 2023. Thank you for the opportunity to address the members concerns

Upon review, we have verified that the delays with the order placed in **** were related to being refilled too soon and the higher cost for the brand medication required the members approval.

The member was sent communication regarding the order status on **** 2, 2023, because it was too early to fill the medication and was advised that the order would be processed on **** 11, 2023. The previous order shipped on May 22, 2023. On **** 15, 2023 and **** 16, 2023 the member was a sent text message to inform them that the medication was placed on hold due to its higher cost and we requested the members approval.

We value our members and remain committed to our purpose, bringing our heart to every moment of your health. We apologize for any inconvenience the member may have experienced. Feedback has been provided to each member of our customer care team with whom the member interacted with in an effort to improve the level of service our members receive. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,
*********************************
Member Advocate
Initial Complaint
Date:06/21/2023
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.
On June 14, 2023 I had a prescription filled for a new eye drop, Simbrinza, for worsening of my glaucoma resulting in vision loss. My ophthalmologist sent a new prescription in directly to Caremark mail order. I was charged $90.00 without my knowledge and had to wait several days to receive the rx. After receiving the eye drop, I compared prices and found out that a retail pharmacy, such as CVS, the cost would have been $30 for the same eye drop, same strength and amount. Caremark told me I can call and find out the price of the drug before it is filled. I explained I was in the ophthalmologist examination chair and had my eyes dilated for exam and could not call around and find out the lowest prices. This was very grave situation at hand due to elevated eye pressure while at the ophthalmologist office.The Caremark mail order drug company, charged 3 times as much as a retail pharmacy, such as CVS, without notifying me. 1. I called Caremark today, June 21, 2023 and spoke with a customer representative and supervisor. They offered to cancel the prescription, but did not offer me any type of reimbursement. The prescription RX# ********* for Simbrinza. Order # ************** I am a senior citizen, retired RN, with poor vision and pay for my own medical insurance premiums and prescription co-pays. I am at a real disadvantage having to check prescription costs with my own pharmacy insurance companies to determine which plan costs less for medication. Why are there different prices for the same drug at CVS/Caremark? What can I do about this situation and what can be done to make sure this doesnt happen again.
Business Response
Date: 06/22/2023
We verified an electronic prescription was received on June 13, 2023 for a 30 day supply of Simbrinza 0.02%. The prescription was filled and shipped on June 14, 2023 via UPS. Retail Pharmacy and Mail Order Pharmacy are two separate benefits; therefore, you were charged the applicable mail order copay.
Please refer to the ********** and ******************* Plan Benefit brochure (** ******), Section 5(f). Prescription Drug Benefits, which explains your Standard Option prescription drug benefits:

Under Standard Option, the calendar year deductible does not apply to prescriptions filled through the Retail Pharmacy ********************* Prescription Drug Program, or the Specialty Drug *************************************** Option, some drugs, nutritional supplements and supplies are not covered (see pages *******); we may also exclude certain ****approved drugs when multiple generic equivalents/alternative medications are available. If you purchase a drug, nutritional supplement, or supply that is not covered or a drug specifically excluded from coverage on the formulary, you will be responsible for the full cost of the item.

Under Standard Option, we use a preferred formulary for certain drug classes. If you purchase a drug in a class included in the managed formulary that is not on the managed formulary, you will pay the full cost of that drug since that drug is not covered under your benefit

Where you can obtain them. Under Standard Option, you may fill prescriptions at a Preferred retail pharmacy, at a Non-preferred retail pharmacy, or through our ************ Prescription Drug Program. We pay a higher level of benefits when you use a Preferred retail pharmacy, our ************ Prescription Drug Program or our Specialty Drug Pharmacy Program.
If you choose to get the brand-name drug and your providers prescription allows for generic substitution, your applicable cost share for a brand-name drug will be the drug tier cost-share plus the difference in the costs of the brand-name and generic drugs. Your expenses for dispense as written prescriptions do not count toward your catastrophic protection out-of-pocket maximum. Previously, if the providers prescription allowed for generic substitution and you chose to get the brand-name drug, you were responsible only for the drug tier cost-share

The Standard Option prescription drug program is based on a 5 Tier formulary preferred drug list. The formulary lists medications available to your physician in prescribing the safest, most clinically appropriate, and cost-effective medications. An independent panel of physicians and pharmacists regularly reviews the list; therefore, the list may change over time. Please refer to your ********** and ******************* Benefit Plan brochure (** ******), Section 5(f),

Prescription Drug Benefits:
Standard Option You Pay
Retail Pharmacy Mail Order Pharmacy
Tier 1 Up to $7.50 copayment for each purchase up to a 30-day supply
($22.50 copayment for a 31 to 90-day supply)
Note: You pay a up to a $5 copayment for each purchase up to a 30-day supply ($15 copayment for 31 to 90-day supply) when ******** Part B is Primary. Up to $15 copayment for a 22 to 90-day **************: You pay a up to a $10 copayment for a 22 to 90-day supply when ******** Part B is Primary
Generic Drugs
Tier 2
Preferred Brand-Name Drugs 30% of the Plan allowance for each purchase of up to a 90-day supply Up to $90 copayment for a 22 to 90-day supply
Tier 3
Non-Preferred Brand-Name Drugs 50% of the Plan allowance for each purchase of up to a 90-day supply Up to $125 copayment for a 22 to 90-day supply
Tier 4 30% of the Plan allowance for up to a 30-day supply only Preferred Specialty Drugs must be obtained through the Specialty Drug Pharmacy Program
Preferred Specialty Drugs
Tier 5
Non-Preferred Specialty Drugs 30% of the Plan allowance for up to a 30-day supply only

Note: Benefits for Tier 4 and Tier 5 specialty drugs purchased at a Preferred retail pharmacy are limited to one purchase of up to a 30-day supply for each prescription dispensed. All refills must be obtained through the Specialty Drug Pharmacy Program. For further information regarding the Specialty Drug Pharmacy Program, please call the toll-free number at **************.

Non-preferred Retail Pharmacies-You pay 45% of the Plan allowance, plus any difference between our allowance and the billed amount.

If you have any further questions, please call our toll-free number at ************** (TTY: 711) and a ************* Representative will be happy to assist you, 24 hours a day, seven days a week. You may also access our website at www.fepblue.org.
Initial Complaint
Date:06/15/2023
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.
CVS Caremark will not allow authorization for the medication I need despite prior authorizations submitted by my doctors. The supervisor and representative I have spoken with claimed CBS Caremark has not paid for synthroid medication since April 2022, when in fact they covered and paid for the medication in May 2023. Additionally, they wanted me to take the generic brand of the medication. However, it had been documented that I went into heart failure on the generic medication. Therefore, my doctor has prescribed synthroid since 2009. I have no thyroid organs. I cant ****** with my health with CVS Caremark. Additionally, my lungs are failing because they will not allow me get the medication that is best for me even though they do pay for it. My doctor has completed a prior authorization for that medication as well. I have ask for the appeal process, on to be met with respect and push back. Im fed up with this company. Im frustrated and dont know where to go from here.
Business Response
Date: 06/22/2023
June 22, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ******************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 15, 2023. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, a prior authorization is required for the medication in question. CVS Caremark called the members doctor and initiated a verbal prior authorization on June 16, 2023. The prior authorization was approved as of June 16, 2023.

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:06/14/2023
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.
On June 7, ********************** a prescription for novolog insulin. I need this to live since I am diabetic. She had to increase my dose and therefore increase the prescription amount. A week later and they are telling me there is a problem and can't fill it. I spent over an hour on the phone with 2 different representative that got me no where. Their system is useless and all they care about is profit. It is the worst prescription company out there and I've used many. The best they could answer is in five business days. I need this medicine to live and I'm tired of being jerked around. Quit worrying about your profit and help me because if I die you won't be able to get any more money from me. Logic states fix the problem so you can continue to bleed me dry. This is stressing me out and increasing my blood sugar levels because of the stress and then I need more insulin which leads me right back to the original problem of you denying my prescription and not contacting me about it immediately. Now I am leaving for vacation in a week and there is no mail where I'm going. So now if the insulin is shipped there will be no one here to receive it and it will go bad and be useless and you will pay for a replacement since this is your error from the beginning.
Business Response
Date: 06/20/2023
June 20, 2023

BBB serving Eastern *************, *****, ************, and *******
************************************************************************************************************************-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ****************. health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on June 15, 2023. Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

The members prescriber submitted a coverage request that was approved by the Plan until June 14, ****. The prescription has been processed and shipped.

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: 06/21/2023
[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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