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

515 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:11/10/2022
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.
It's completely unacceptable to block a prescription because of mandatory mail order requirements when you are a new customer that has not setup mail order yet.I'm without my medication because of this with absolutely no help for CVS. spending an hour on the phone to refill a prescription and then being refused is a medication.I will be doing everything I can to not use this insurance in the future for blocking me from a perscription.I am out of my medication and I don't have time to do this today. This should be illegal! I will expect a refund for any out of pocket costs.
Business Response
Date: 11/17/2022
November 17, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the Northwestern Mutual Home health plan,of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 10, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, Caremark has approved a one-time exception to allow medication to fill at ******* Drug for date of service 11-10-22. The pharmacy has reprocessed the medication and the member will need to visit the pharmacy to be refunded.

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

Sincerely,

*************************;
Member Advocate

Customer Answer
Date: 11/17/2022
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 already had to pay $36.41 for an emergency filing of my medication and need a refund for that.

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

FAQ

Regards,
*******

Business Response
Date: 11/29/2022
November 29, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the Northwestern Mutual Home health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 29, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we confirmed with ******* Drug 22 that a refund of $26.41 was processed to the member on November 20, 2022 as member had a $10 copay for the medication.

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

Sincerely,

*************************;
Member Advocate
Initial Complaint
Date:11/10/2022
Type:Billing 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 MY MEDICATION STELARA FROM CVS CAREMARK. I ALWAYS USE COPAY $5, WHICH PROGRAM IS PROVIDED BY *******. NOW WITHOUG KNOWING MY KNOWLEDGE THEY CHARGED ME $2953.80. I HAVE BEEN TRYING TO PAY THIS PAYMENT SINCE MARCH THROUGH VIRTUAL PROGRAM ASSISTANT CARD PROVIDED BY ******* AND THAT CARD IS NOT GOING THROUGH SYSTEM. EVERY MONTH I HAVE WASTED MY TIME AND ENERGY AFTER THIS 2 COMPANIES AND EACH REPRESENTATIVES GIVE ME DIFFRENT EXCUSES AND NOT TRYING TO RESOLVE THIS PAYMENT. NOW THEY HAVE BLOCK MY MEDICATION AS PAYMENT IS NOT GOING THROUGH. THIS IS THE ONLY MEDICATION I AM SURVING WITH AS I TRIED ALL DIFFERENT OTHER MEDICATION. PLEASE PLEASE PLEASE HELP AS I HAVE GIVEN UP WITH THIS BOTH COMPANIES.THANK YOU ********
Business Response
Date: 11/22/2022
November 22, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the Change Healthcare health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 10, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we determined the beneficiary had a balance of $2953.80 for her March 22, ******************************** question. When the beneficiary provided her copay assistance card during the order placement, it was incorrectly entered as a credit card. Therefore, the copay assistance was not billed, and a balance was left on the account. The specialty pharmacy advised they attempted to have the copay assistance billed on August 22, 2022,but it was denied for timely filling. The specialty pharmacy contacted the copay assistance program on November 16, 2022 to request the claim be processed and it was approved. The payment for $2953.80 was posted and cleared on November 16, 2022, leaving a $0.00 balance on the beneficiarys account.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:11/09/2022
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 recently denied (again) for a prior approval on a diabetes medication. Mounjaro, which is a diabetic medication. The reason giving was that I had not tried other medications on the formulary, which is not true. I have been on Victoza, *********, Metformin, insulin, and *******. There is a shortage of Ozempic and I cannot get it. I have been without my diabetes medication for over a month now. Rybelsus is the only one I have not tried. It was denied by CVS Caremark. Now they are telling me its available with a copay of more than $500. I do not understand!!! MOUNJARO is a diabetes medication. I pay my insurance every month!! There is no legitimate reason why it should have been denied. I would like an answer that is factual as to why it was denied!! A month is a long time to be without my medication!!! I need it ASAP!! I am enclosing my list of medications as far back as I can see, but they should be able to see that I have been prescribed every medication on their list!!
Business Response
Date: 11/16/2022
November 16, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug 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 November 9, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we determined the medication in question requires a prior authorization.A prior authorization request was denied on November 8, 2022 because the beneficiarys prescriber did not indicate that there has been a trial and failure of the required number of covered formulary alternatives. The prescriber has the option of submitting a new prior authorization request or a 1st level appeal. Appeal requests can be sent via mail or faxed to:

Prescription Claim Appeals MC 109 - CVS Caremark
P.O. Box 52084
*******, ** 85072
Fax: **************

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

Sincerely,

***********************************
Member Advocate
Customer Answer
Date: 11/16/2022
Caremark is my RX provider. They are able to look back and see that all those required meds have been prescribed. Why do I have to do an appeal for something that is in their records not to mention it was submitted by my physician in the PA request.

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,
****

Business Response
Date: 11/18/2022
November 18, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug 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 November 17,2022. Thank you for the opportunity to address the beneficiarys additional concerns.

As previously stated, the medication in question requires a prior authorization.The plan sponsor requires a letter of medical necessity which indicates the trial and failure of the required number of covered formulary alternatives. The prescriber can fax or mail this letter to:

Prescription Claim Appeals MC 109 - CVS Caremark
P.O. Box 52084
*******, ** 85072
Fax: **************

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:11/07/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am trying to log into my CVS Specialty Pharmacy account. This is where I am supposed to request medications, check prescription information, and pay for any medications. However, I am not allowed to access my account. I've changed my password but it still doesn't work. The only way to fix the problem is to spend time (based on too much previous experience with them, at least half an hour) during the work trying to get the account straightened out. There is no way to contact them other than through the patient portal (impossible if you cannot log into your account) and by phone during work hours (not convenient if you have a job). I will be missing out on my dose of medication solely because of this account issue.
Business Response
Date: 11/10/2022
The patient provided an inbound call to the pharmacy to follow up on the voicemail that was left. The patient stated that she was experiencing issues with logging into her CVS digital account and wanted to express her frustrations with getting the issues with the digital account resolved. The patient reached out to the web support team on 11-03-2022 and they could not assist her with the errors she was receiving on the digital account. The patient mentioned that she currently have access to her CVS digital account and on 11/04/2022 she placed an order on the digital account for her medication to arrive on 11/10/2022. The order is currently in shipped status,the patient did not express any other complaints and is satisfied.
Customer Answer
Date: 11/11/2022
[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:11/04/2022
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.
I discovered in August that CVS/CAREMARK mail service has been overbilling me for all of 2022 for two inhalers that I had been getting from their service ********************** Apparently, they had been billing the wrong insurance company even though they have had my new insurance information since January. They refuse to bill my correct insurance company (Blue Shield), even though I have had Blue Shield on the phone with them (along with myself) at least twice to confirm my insurance and help resolve the issue. I have been on multiple phone calls with them. Some of the representatives can not even find the charges/invoices that I refer to. They owe me somewhere around $500 I cannot get them to repay **** should be paying $15 per inhaler.On 3/24/22, they charged me ****** for 3 Spiriva inhalers & $204.71 for 3 Symbicort inhalers.On 6/8/22, they charged me $113.64 for 3 Symbicort inhalers.On 6/9/22, they charged $****** for 3 Spiriva inhalers.
Business Response
Date: 11/16/2022
November 16, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the BlueShield of California and Teledyne health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 4, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, Caremark was able to reverse the charges from the Teledyne health plan and refund $741.59 to the initial payment method. The claims in question were reprocessed under the BlueShield of California health plan leaving a balance of $180 due to no payment being setup on this account. Should you wish to add or make payment to your BlueShield of California account you can reach your customer service team at **************.

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

Sincerely,

*************************;
Member Advocate
Customer Answer
Date: 11/24/2022
[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:11/03/2022
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 CVS/Caremark as my prescription insurance coverage provider. I live in a rural town with 1 pharmacy that happens to be a ********* it is approximately 2 minutes from my home. The closest CVS is ***** minutes away on a good day with light traffic. My issue is that I am not allowed to choose which pharmacy I want they are forcing me to use CVS or mail order. What happened to consumer choice? I have asked for exceptions and if I could opt out and have been told that is against their policy. What kind of policy limits you to only using their stores? This is a monopoly! Please allow consumers to choose which pharmacy they want!
Business Response
Date: 11/09/2022
November 9, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug 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 November 4,2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we determined the beneficiary can fill non-maintenance medications at any pharmacy in network. The plan sponsor has adopted a program that allows its members a grace ****** to fill maintenance medications at any in-network pharmacy. Once the grace ****** has expired,members must fill such medications in accordance with that program.

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

Sincerely,

***********************************
Member Advocate
Customer Answer
Date: 11/09/2022
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,
****

I firmly understand your response but believe there are individual circumstances that should be considered in for the case of exceptions as noted in my original complaint. I live 30 minutes from the closest CVS, and 2 minutes from another pharmacy. Being in a rural area with not many options does not afford me the luxury to only use your stores. You say mail order is the next option. **** does not deliver mail to my home so I have to use the post office. Another inconvenience. If the package is too large and I get there after they close at 4:00 I will not get my medication. the local pharmacy 2 minutes from me is open until 9pm. Again why am I be forced to use your stores under these circumstances? I think there should be certain cases that should be considered for an opt out or exception. And for the reasons I have mentioned I don't believe that to be unfair.
Thank you kindly for your response and please consider allowing me to fill my prescriptions at the pharmacy of my choosing no matter if it is a maintenance drug or not. I am trying to not cheat the system by having my doctor write the script as (use as needed) like some of my co-workers. Please consider this instead of me using a loop hole.

Have a great day,

****
Business Response
Date: 11/17/2022
November 17,2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug 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 November 10, 2022. Thank you for the opportunity to further address the beneficiarys additional concerns.

The plan sponsor does not normally review individual requests and make exceptions. Nonetheless,the account team reached out to the plan sponsor. The plan sponsor would like to know if the member has tried Mail Order and had any issues with medications delivered to their PO Box. The member can call ************** to speak with the plan sponsor.

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

Sincerely,

***********************************
Member Advocate
Customer Answer
Date: 11/28/2022
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
Yes I have reached out to the plan and have had issues with mail order. Prescriptions that are delivered to the *********** on Friday are not available for pick up until Monday leaving me without medication for potentially 2 days. This is unacceptable. If the package does not fit in the ** Box it has to be handed over the counter. If I don't make it to the *********** or during closures for National Holidays I am at risk of not getting my medication on time. I need to be able to go to my local pharmacy that is open 7 days a week until 9pm weekdays and 7pm weekends and most holidays as pharmacies are not restricted tot National Holiday closures.

Regards,
****
Initial Complaint
Date:11/03/2022
Type:Service or Repair Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have had multiple spinal surgeries, with most of them being titanium fusions. I also suffer with Osteoporosis throughout my body. Until my pain specialist prescribed Nucynta ER, my pain levels were always around the level 10 ***** Nevertheless, I was still having to take Oxycodone 20mg every two hours to manage the pain. At my most recent visit, ***********************, (************************************** **************), upped the Nucynta ER from 100mg to 200mg to prevent me from needing so much Oxycodone; nevertheless, CareMark has so far refused to approve the medication. They intentionally make it hard for the prescribing doctors, requiring them to wait on hold to the point that they have to hangup. CareMark should be put out of business for their practices. Im sitting here in pain beyond my ability to withstand, while someone at CareMark sits behind a desk and play games with a certified, highly qualified doctor, who is specifically trained to understand how to treat patients who deals with chronic pain. My back, legs and arms feels like they are on fire. At this point I have reached my limit, wishing God would take me out of this painful body. If by chance anyone at CareMark takes five minutes to read this complaint, You Should Be Ashamed Of Yourselves for the way you treat your customers. If either of you have a heart, put yourself in the place of suffering patients and think about how you would want to be treated. When I called CareMark, they claimed they had sent a message to the doctor and waiting for his response. This is not true. My doctor is very responsive and checked again while I was on the phone, finding nothing from CareMark. This is CareMarks MO when they dont want to approve a medication. I went through the same thing when I resided in *******. A different doctor, different medication with the exact same response from CareMark. I am begging you, please help me not give up on life and approve my medication.
Initial Complaint
Date:11/02/2022
Type:Billing 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 over 3 years now they have been charging my credit card without my permission. I call and get the charges reversed each time. There is a note in my profile not to charge my card without my consent and they just did it again yesterday and today 11/1/2022 and 11/2/2022. I call and some times the customer service agent can't even find the pending charges. They also keep calling my doctor to see if they can switch to generic instead of trade name even when the prescription is written for brand name only.
Business Response
Date: 11/03/2022
The charge to Mr. ****** credit card on November 1, 2022 was for a medication from a prescription provided by his doctor on September 28, 2022 ; however, this order was placed in future fill because it was too soon to fill. This order placed a pending charge notice on his credit card. ************** was sent an email on September 28, 2022 advising the prescription will be filled at a later date. On October 24, 2022, a notice was sent to ************** advising this order will now begin processing. The doctor also specified no generic substitutions for this medication. This order shipped on November 3, 2022.

The charge to Mr. ****** credit card on November 2, 2022 was for a medication that was shipped on November 3, 2022; an email was sent advising the order shipped and the tracking number was provided. This order was placed by ************** on the website on October 31, 2022.

On November 1, 2022. ************** called CVS Caremark and spoke with a ************* Representative who conferenced him with a Pharmacy Technician, ******, who advised that it was his plan that requests the prescriber be contacted to see if they can change from a brand name medication to a generic medication for savings opportunity. ************** also requested his credit card be removed from his account and will call ************* to pay for his medications. ************** was also advised he can request an invoice.
Initial Complaint
Date:11/01/2022
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.
Received a letter on 10/31/2022 stating they are trying to save me money by switching to their pharmacy instead of a competitor. I can fill out the forms , call them to opt out or they will not cover my prescriptions. This is putting my health at **** and a ploy to get me to call so they can convince me to switch to their pharmacy instead of using my cheaper more competitive pharmacy.
Business Response
Date: 11/09/2022
November 9, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the *** Grande health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 1,2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we determined effective January 1, 2023 the beneficiarys plan sponsor will adopt a new program. Should the beneficiary wish to opt-out, he should call the number on the back of his ID card to make the request. Opting out of the program must be done yearly.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:10/31/2022
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.
This about CVS Caremark ,our prescription insurance not providing the services we pay for. A medication called Nucala has been prescribed by my ENT ************************************* I've been suffering for 15 years of rhino-sinusitis with nasal polyps. I had a polyp operation few years ago that didn't work. I'v been in the vicious circle of antibiotics and steroids that don't work and worsen the situation. ******************* prescribed Nucala, and CVS Caremark approved the prescription under our insurance plan. Recently Caremark announced that the prescription had to be reapplied for since their annual cycle of approval expired. I have been taking this medicine for 6 months now with absolute success: My polyps reduced, my breathing is normal, smell and taste returned. Presently Caremark has been placing delays and obstacles to renew the medicine. My doctor has provided all the information they required about the success of this medicine but still Caremark delays the refill. It is unacceptable that after having approved it in the beginning now they deny it with no explanation and it with the threat for me to go back to all kind of respiratory problems not solved by palliatives like antibiotics and steroids when there is this medicine Nucala that in my case works wonderfully. I am seeking form Caremark reversal of this unjustified denial approval of the refill and allow me to continue my treatment.Thank you,*******************
Business Response
Date: 11/16/2022
November 16, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug 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 October 31, 2022. Thank you for the opportunity to address the beneficiarys concerns.

Upon review, we determined the medication in question requires a prior authorization. The previous prior authorization expired on August 9, 2022 and therefore a new approval was needed. A prior authorization request was denied on August 24, 2022 because the clinical documentation clarifying the members positive response to the medication was required and was not submitted with the request. The beneficiarys doctor can submit most recent chart notes, medical record documentation, and medical necessity letter to ************ to complete the first level clinical appeal.

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

Sincerely,

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

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