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

514 total complaints in the last 3 years.
162 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:02/05/2023
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.
My primary care physician sent a prescription for 5 capsules of Tessalon cough medicine, Friday 2/3/2023 after a telehealth consultation on my itchy throat dry cough fits, to *** Mail Order Pharmacy. I found this out only after I opened my email on Saturday 2/4/23. The email stated that they changed the Tessalon brand name to generic Benzonatate, I called them immediately because, this is the medication I needed most for my cough. *** acting like Nazis as usual, won't release the medication because they said it is only 5 capsules, it should be more like 30 days supply. So why are they in the retail business, if they dictate the amount over and above the doctor's ***************************** So I agreed to the generic Benzonatate because this is available at ********* close to my house, I need this medication badly, and ask them if they can forward the prescription to *********. Here comes now the *** **** redtape, they said I have to call ********* for them to call *** to forward the prescription. This was Saturday past 5pm, ********* close at 6pm. After a few minutes I called *** to confirm ********* call, (they called),only to be told, that this issue should be taken with my doctor, and it will take 5 days to process the transfer of the prescription! This is torture! Meanwhile I am having coughing fits with pee now! and a nasty headache!!! *** is evil, needs to change their retail pharmacy practices to suit the needs of the patient, and also their hiring of pharmacists, looks like their pharmacists act like the evil gatekeeper to the medicine cabinet.
Customer Answer
Date: 02/15/2023
I have not heard from the business in response to my complaint.
Business Response
Date: 02/17/2023
CVS Caremark received a prescription for benzonatate 100mg 15 quantity for a 5 day supply on February 3, 2023. CVS Caremark was unable to fill the medication as it did not meet the minimum day supply requirement; mail order benefits are available for a 22 up to a 90 day supply. You spoke with a ************* Representative on February 4, 2023 who advised mail order cannot fill a 5 day supply of medication and advised you to have a retail pharmacy contact CVS Caremark to request to have the prescription transferred as ******************* must contact CVS Caremark to request the transfer. You also spoke with another ************* Representative on February 4, 2023 wanting to know if we had received a request from a retail pharmacy requesting the prescription be transferred; our records did not indicate a request had been received. CVS Caremark received a call from Nurse Line on February 4, 2023 advising you were upset that you were unable to obtain your medication; however, the caller was advised CVS Caremark was unable to dispense the medication as it was less than a 22 day supply. According to our records, on February 5, 2023, a retail pharmacy dispensed a different strength of benzonatate than the prescription received by CVS Caremark for 30 quantity for a 10 day supply; you were charged the applicable copay according to your Standard Option retail benefits.

I attempted to discuss your complaint with you today;however, you disconnected the call.
Initial Complaint
Date:02/03/2023
Type:Order 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.
As of 1/1/2023 Caremark required that the patient fill a generic form of Adderall XR as opposed to the brand. When the patient attempted to fill the script at CVS he was advised that there is NO generic Adderall XR available anywhere in *****************. As a result the brand had to be filled. Since the brand is on a higher tier the patient had to pay $100,00. instead of a nominal amount with the generic version. The company allowed brand up until this year. It seems like a money maker for the company as they are forcing patients to pay exorbitant amounts for medications that they are forced to purchase. Its not fair that the patient is put in the middle and has to pay so much. Its also interesting that as of last year when previously purchasing the brand the patient only paid $25.00. I am seeking reimbursement for the amount paid over and above the generic price. We dont know the amount of the generic as we were purchasing 90 days of the brand up until this year.
Customer Answer
Date: 02/17/2023
I have not heard from the business in response to my complaint.
Business Response
Date: 02/21/2023
February 21, 2023

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the State Farm Insurance Companies health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on February 6, 2023. Thank you for the opportunity to address the members concern regarding the cost of their prescriptions.

Upon review, we have verified that the members prescription was previously covered by their pharmacy benefit. As of January 1, 2023, the medication was no longer a preferred brand and now requires approval of prior authorization in order to be covered by the plan. The member was notified of this change by mail in October 2022. Due to medication backorders and stock issues, overrides are being placed to allow the member to obtain the brand name medication at the cost of the generic equivalent. The member may contact customer care at ************** to request that the override be placed for this medication on his profile.

Should you or the member have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,

***********************************
Member Advocate

Customer Answer
Date: 02/22/2023
[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.
I have spoken with the business and they assured me that I will be sent a check representing the difference between the cost of the generic and the brand price or $80.00. Providing this check is received it is resolved.

Regards,

*********************
Initial Complaint
Date:01/31/2023
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.
I ordered 3 medicines from caremark mail order at their website. i ordered these medicines on 01/13/23, at the time of order they showed me that you don't have to pay anything and it shows zero balance for me to pay. i got medicine and i start using it after 3 or 4 days i got email that you have to pay $288. when i checked price it is too high then other pharmacies. you can see attachment. when i called them they said it's because of insurance and deductible we can't return your order and hang up. next time ****** from resolution team said we can take your medicine back and will refund your money if medicine is not opened. i said i opened and i am using it she said oh then we ca't take it . i asked for the return policy they were unable to find return policy as it is not on their website. i asked them even if you can't take medicines back it should be written on your website. how you can run a business without providing your written policy to customer. she replied it is between ********************** and Us. next morning i called insurance **** said we have nothing to do with their return policy and high price you have to call them. i again called caremark and they said that we are not the one who decided about the price of medicine it is high because it's start of year and you did not meet your deductible. we are the one who plan coverage and let me see your coverage plan i said i would like to see my coverage plan as well. i logged in care **** account she said oh you can't see on mobile i logged in from laptop even then they were unable to show me my coverage plan. that is a secrete document which customer can't see. i said ok so your coverage allows you to charge $ 147 for a medicine if deductible is meet while it is available for $22 in ****et. charged me $120 for progesterone while it is available in $9 in ****et. it took me 4 hours with no result. ***** were unable to show their return policy on website and my coverage plan. it's simply cheating with customers with no check and balance.
Business Response
Date: 02/10/2023
February 10, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the KYNDRYL health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on January 31, 2023. Thank you for the opportunity to address the members concern regarding the cost of medications and the ability to return medications.

There are price disclaimers on Caremark.com that state drug cost are estimates and may not reflect actual out of pocket cost. The plan has granted an exception for the member to return the medications she ordered including what has been opened. Should the member wish to return those medications, she may contact customer care at ************** to request a mail tag.

Finally, we understand the level of service the member received did not meet with her or our expectations, and we sincerely apologize for any frustration or inconvenience she may have experienced. Feedback has been provided to each member of our customer care team with whom the member interacted with to improve the level of service our members receive. Should you or the member have any additional questions or concerns, please do not hesitate in contacting me at **************.

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

Customer Answer
Date: 02/11/2023
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.
[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 am going to ************* I am in boarding right now and will be back after two weeks please allow me to 20 days to make a return of medication. I have paid $288 to cvs please let them k ow that refund my money when they will get their medicine back.

I am unable to make return before 20 days. Please let me know the cvss response on it .
[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,
Tehmina

Business Response
Date: 02/14/2023
February 14, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

Thank you for the opportunity to address the members additional concern regarding the mail tag approval.

I have confirmed that the member will be able to request the mail tag upon their return. Should you or the member have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:01/30/2023
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 01/26/23 my wife *********************** requested three prescriptions to be filled and delivered. One of those Xcopri is almost $300. Caremark charged us $285.97. As of 01/30/23 that charge is still pending. They never shipped any of the three meds. On 01/30/23 my wife contacted them again and they agreed to fill the prescriptions and ship the meds overnight waiving the extra fee. On this same day, we began to see multiple debits and credits of varying amounts but we also had two more debits that were not credited back. One for $16.93 and one for $292.04. Spoke with ********** who told me he could not see any charges other than the $16 and $292. Meanwhile my checking account is overdrawn due to the extra debits by CVS Caremark and I am likely to start incurring overdraft fees as of 01/31/23. They need to refund the initial amount of $285.97 and stop making unauthorized withdrawals of varying amounts from my account. If I do incur overdraft fees, they should cover those as well
Business Response
Date: 02/17/2023
February 17, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the AT&T **** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on January 31, 2023. Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

Upon review, we have verified that three prescriptions were received from the members prescriber on January 23, 2023. The member called on January 30 and authorized payment to their credit card. Two of the medications shipped on January 30, 2023. The prescription for the medication that was not in stock was transferred to another Caremark pharmacy. That medication also shipped on January 30, 2023.

Finally, we understand the level of service the member received did not meet with their or our expectations, and we sincerely apologize for any inconvenience they 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 or the member have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:01/30/2023
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.
A prescription refill request was initiated on January 19. The order should have been delivered early the following week. Instead, I received a text and an email that there was an issue. I immediately called and was told it did not ship and that my insurance needed to be verified. Nothing had changed. I was assured it was taken care of and would arrive by the 26th. I was told if there was any issue I would be contacted. When I called on the 27th it had not shipped. I was then told there was no coverage. The coverage was still the same. I was then told it was a prior authorization. It was not a PA. My insurance company called to attempt to clear things up. I received a reply to my secure message stating that there was no coverage while both my insurance company and I were working to resolve the issue. This medication is a time-sensitive medication. There has been an issue each time I have ordered. There clearly is not understanding of how to process this medication. The date has now been changed to today for a refill request. I have spent over a week and countless hours on the phone attempting to resolve this issue. Upwards of five hours today alone. I was just told for a third time that the medication would be shipped, yet no tracking. The customer service and the continued negligence of delivery in a timely manner is completely unacceptable.
Business Response
Date: 02/08/2023
February 8, 2023

BBB serving Eastern *************, *****,************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the Wellmark health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on January 30, 2023. Thank you for the opportunity to address the beneficiarys concerns.

The order was shipped on January 27, 2023 and delivered on January 30, 2023 **** tracking number 1Z3F06Y2NW27742827).

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:01/27/2023
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 employer offered pharmacy coverage changed as of 1/1/2023 from Well Dyne RX to CVS Caremark. I received in writing that prior authorizations that I had with Well Dyne RX would be transferred over to the new plan with CVS Caremark as an attempt to minimize disruption in obtaining medication. I spent 1 hour on the phone with CVS to rectify the issue and understand why my medication was not being approved and why the prior authorization was not on file. I provided the prior authorization information to a representative at CVS who contacted Well Dyne RX on my behalf. On a recorded line a representative from CVS Caremark confirmed that indeed I did have a prior authorization on file with Well Dyne RX for a medication but they would not honor that prior authorization and that I would have to obtain a new one. I advised the representative per the documents I received for the pharmacy change the document states that ALL prior authorizations would transfer over to the new plan. There are no clauses, exceptions, or limitations listed on the document as to if some PA's would not be transfered over. The representative from CVS Caremark stated that they will not extend or offer a exception to my prior authorization. My concern is that CVS Caremark falsely advertised that they would accept existing prior authorizations in order to minimize medication disruptions, yet in this case they failed to do that. I was also not provided an adequate reasoning as to why the document I was given stated all prior authorizations would be transferred over and why that was not completed. I am asking CVS to honor what they promised as part of the new coverage.
Customer Answer
Date: 02/07/2023
I have not heard from the business in response to my complaint.
Business Response
Date: 02/09/2023
February 9, 2023
BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705
Complaint # ********
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the Nouryon health plan, of which the
beneficiary is a member. This letter is in response to the correspondence we received from your office
on January 28, 2023. Thank you for the opportunity to address the members concern regarding the
coverage of their medication.
Upon review, we have verified that the members prescription is not covered by the plan. The previous
prior authorization was reviewed for transfer to the members new plan effective January 1, 2023. The
previous prior authorization could not be transferred due to the medication being excluded from
coverage under the new prescription benefit plan. We have not received any prior authorization
requests for this members medication. The members prescriber may submit a prior authorization
request by calling **************.
Should you or the member have any additional questions or concerns, please do not hesitate in
contacting me at **************.
Sincerely,
***********************************
Member Advocate
Customer Answer
Date: 02/09/2023
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:01/27/2023
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.
Cvs Caremark is refusing to refill my prescription prescribed by my actual doctor unless I pay full price ? When did a drug plan become a medical doctor or know what my actual medical doctor wants me to take or they wont pay and suggest I get another drug !
Business Response
Date: 02/10/2023
February 10, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

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

Upon review, we have confirmed that effective January 1, 2023, the members medication in question
requires a prior authorization in order to be covered by the plan. We have not yet received a request by
the member of their prescriber. The member or their prescriber may submit a request for prior
authorization by calling **************.

Should you or the member have any additional questions or concerns, please do not hesitate in
contacting me at **************.

Sincerely,
***********************************
Member Advocate
Initial Complaint
Date:01/26/2023
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.
Date of transaction 12/21/2022CVS Pharmacy ******************************************************************* Store #**** 4:25pmThere was discrepancy with prescription coverage that began 11/25/22.This goes back and forth until 12/20/22.I spoke to the pharmacy tech and stated I will cover the prescription and deal with my health insurance myself.She said, "no problem", the prescription will be ready in an hour and it's $100, I said thank you I go to pick up the prescription, the pharmacy tech states-we're out and don;t know when we're getting more.He said we have the brand in stock and its $400, I said no, is there a local pharmacy that has generic in stock?He comes back and says yes,Touchstone has it in stock.My doctor sends the prescription to touch stone,I go to pick it up and it's $380.99I said generic, she said yes.This is the cost of the brand?I could have paid for brand @Tacketts mill.I called CVS 800 issues I was told it is the pharmacist's choice what to charge for a prescription. A store 3 miles apart same zip code,This is the most unethical behavior. CVS a pharmacy I use to trust I could afford that-my bank account that is overdrawn. From 11/25-12/21. This stems from Caremark denying my prescription written by a licensed physician that I have been with for fourteen years- only *************************** prior insurance covered it-caremark also Caremark reason of denial-one hundred percent not true. Its prescribed for what Caremark says reason for denial.$608 error by me, I explained not having my prescription, it isnot morally or ethically ok CAREMARK to deny a prescription to be covered, lie denial. CVS to charge $280 more for the same generic script that CVS 3 miles apart is asking$100 Tacketts Mill sent me there to not charge me $400,did not have the generic in stock. CVS Touchstone says oh well and Caremark says sorry, file a claim.
Business Response
Date: 02/02/2023
February 2, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ****************** plan,of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on January 26, 2023. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, the medication in question requires a prior authorization for coverage consideration. A prior authorization request was received on December 1, 2022 and December 7, 2022. Both prior authorizations were denied because the prescriber did not provide names of alternative medications that had been tried by the beneficiary and why the medications failed.

The beneficiary or physician may submit a first-level appeal to CVS Caremark and, if denied,submit a second-level appeal. Appeals can be sent via 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:01/23/2023
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 1/3/23 I submitted a request through CVS specialty secure messaging online to have full amount of charge for my Humira refill submitted through my credit card on file.Next day I received response saying I needed to adjust my threshold for allow amount on my credit card to be higher so I did as requested. They also informed me the meds has been shipped and my copay is $6697.56.Then later I asked through messaging again to have paper receipt mailed to me.They turned around and told me there has been a confusion and they submitted the charge to copay assistance card instead. I have been calling multiple times to get this resolved. The billing department turned around and told me that they do not accept request through secure messaging. When I was talking to the person online. They should have told me to call and not responding and implied that my request was received and followed. Now I am unable to get different medications due to not having my deductible met because of their mishandling.
Business Response
Date: 02/03/2023
February 3, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

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 January 24, 2023. Thank you for the opportunity to address the members concern regarding the denial of their prescription claims.

The third-party copay assistance funds were reversed and the amount of $6,697.56 was refunded back to the members copay assistance card. An email was sent to the member on January 27, 2023, advising that the refund has been completed. Once the member is ready to pay the balance, she can do so on Caremark.com or contacting Specialty pharmacy customer care to make the payment at **************.

Should you or the member have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,

***********************************
Member Advocate

Customer Answer
Date: 02/03/2023
[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. Please be sure to complete my request by sending me my receipt for credit card payment.

Regards,

*****************************
Initial Complaint
Date:01/21/2023
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.
My primary insurance changed ***s to CVS Caremark for 2023. I called the CVS Caremark Specialty Pharmacy twice the week of January 16th in an attempt to order my medication. Two separate phone representatives told me my insurance was not valid, which I knew was not the case, and refused to help me further. I had to call back with my primary insurance and spend over 1.5 hours of my work day on the phone before CVS Caremark finally acknowledged this was a problem with their system not being able to process my insurance correctly and that my coverage was in fact valid. The customer service representative said they would work on fixing the problem and call me when it was resolved, but this is not acceptable to me. My specialty medication is a biologic and carries a risk of an immune tolerance issue and/or loss of efficacy if I miss a dose. I need an immediate resolution to this issue so I can order and continue to take my medication and remain healthy. I have never had such an issue with my insurance until the *** changed to CVS, and I suspect this is a delay/stall tactic to deliberately avoid paying for my medication and to increase profits.
Business Response
Date: 01/31/2023
January 31, 2023

BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ********** Blue Shield of Massachusetts health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on January 22,2023. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, CVS Specialty was processing the medication in question using the previous insurance.This has been resolved. The medication in question has been processed through the current insurance, shipped and was scheduled for delivery on January 26,2023.

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

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