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:10/29/2022
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.
Processing to receive Rxs are complex and ****** complicated for a Doctor prescribed medication. Prior authorizations to be specific are being required for Rxs that a board certified Doctor is Rxing. This has become more frequent in the last year. It is delaying treatment and care for family members. Thats members. More than one in my house. Please impress upon CVS Caremark that their business practices are degrading their policy holder and their policy members. This is tied to my *********** which is FedBCBS and I cannot choose another *********** They need to make this right and stop the games.
Business Response
Date: 10/31/2022
Thank you for your recent inquiry to the ********** and ******************* Benefit Plan Pharmacy Program. We appreciate your patience while we reviewed your inquiry regarding the Prior Approval Program.

Certain medications are in our Patient Safety and Quality Monitoring Program (****). **** is a special program to promote patient safety and monitor health care quality. The **** program features a set of closely aligned programs that are designed to promote the safe and appropriate use of medications. The Prior Approval Program is included in ****.

Please refer to the terms of your coverage as outlined in the ********** and ******************* Benefit Plan brochure (RI ******) Section 5(f), Prescription drug benefits:

Prior Approval

As part of our Patient Safety and Quality Monitoring Program, you must make sure that your physician obtains prior approval for certain prescription drugs and supplies in order to use your prescription drug coverage. Prior approval must be renewed periodically.

The Prior Approval Program is not intended to cause inconvenience, but rather to ensure our members receive the highest in safety and quality monitoring. We do this through:

Performing safety checks - Before your prescription is filled, we perform quality and safety checks for usage precautions, drug interactions, drug duplications, excessive use, and frequency of refills.

Setting quantity allowances Specific allowances for several medications are based on ****approved recommendations, clinical studies, and manufacturer guidelines.

We have also attached instructions on how to obtain prior approval.
Customer Answer
Date: 10/31/2022
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,
******
Initial Complaint
Date:10/11/2022
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 take a brand medication to control an illness that I have. I have a security breach. Every three months, I am told that I have to have a Prior Authorization. I keep getting hit with voice phsing which the person that is hacking me keep interfering with. This is my life that she is playing with.
Business Response
Date: 10/14/2022
October 14, 2022

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 October 3, 2022. Thank you for the opportunity to address the member's concerns
regarding their specialty pharmacy experience.

Upon review, we have verified that a prescription was received from the members prescriber on
September 19, 2022. The last refill was processed and delivered to the member on September 16, 2022
via *** (tracking #1Z77V750NW82718443). The specialty pharmacy contacted the member on October
3, 2022, to setup the delivery of her refill. The order shipped on October 3, 2022 and was delivered by
*** (tracking #1Z265561NP17162264).

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

Sincerely,
***********************************
Member Advocate
Business Response
Date: 11/07/2022
November 7, 2022

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

Complaint # ********

To whom it may concern:

*** Caremark administers the prescription benefits portion the Plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on October 12, 2022. Thank you for the opportunity to address the members concerns.

Upon review, we have verified that the members medication requires prior authorization in order to be covered by their plan. A prior authorization request was received and processed on October 10, 2022. The request was denied due to the prescriber not advising that the member has tried the required number of preferred alternatives. A second prior authorization request was received and approved on October 11, 2022. The prescriber indicated that the member had in fact tried the required number of formulary alternatives. The prior authorization was approved from October 11, 2022-October 11, 2023.

In regard to the phone calls the Member is receiving stating that her medication requires prior authorization, these calls are automatically placed each time the *** pharmacy processes a refill, and the medication is rejected for prior authorization being required. The local *** pharmacy attempts to fill this medication every 90 days or when a refill is schedule or phoned in. With the Members most recent prior authorization expiring September 29, 2022, the automatic calls were placed to advise that a prior authorization would be needed. The pharmacy attempted to process the refill for the Members medication every day from October ****, 2022. The Members prior authorization is approved for a one-year duration so these phone calls will stop. If the Member should continue to receive these phone calls, please can contact me at the phone number below. If the Member wishes to opt out of the phone calls, she may inform her local *** pharmacy.

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:10/06/2022
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 asthma and my doctor has prescribed a medicine for me. According to my insurance company, ********** Blue Shield of **, I have to get it filled at a specialty pharmacy. My doctor, my insurance company and myself have been on countless telephone calls and provided various approvals over the past several months to CVS specialty Pharmacy. They continue to block filling this prescription which is causing me harm because of the severe asthma I have. I need them to review my case, clearly state what is needed and provide a direct contact in order to expedite the resolution.
Business Response
Date: 10/19/2022
October 19, 2022

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

Complaint # ********

To whom it may concern:

This letter is in response to the correspondence we received from your office on October 6, 2022. Thank you for the opportunity to address the members concerns.

Upon review, on October 12, 2022, our Specialty Pharmacy team contacted the member. They explained the steps that needed to be taken in order for her prescription to be filled by CVS Specialty pharmacy. The member was pleased with the assistance.

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:10/06/2022
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.
For almost a MONTH I have been trying to get a prior authorization approved for a medicine that I've taken for a few years. Last year I went through the SAME thing with CVS Caremark denying the prior authorization for my Saxenda medicine only to file an appeal to have it approved. Here I am almost a month later and my prior authorization is still not APPROVED. I meet all the requirements. When I first emailed asking why and asked for the appeal I was told because the forms submitted by the doctor did not include the weight (Which I started at 170 currently at 130). However, was this not the case? Because the letter I received in the mail yesterday states something different. My doctor's ****** is telling me CVS Caremark keeps telling them they are needing different things. Why isn't CVS Caremark picking up the phone and just calling the doctor's ****** if it's going back and forth? I realize you get a lot of prior authorization HOWEVER a month is a long time. I have now run out of my medication I can't have filled which means WHEN it's approved I will have to go through the side effects again. Oh by the way the weight loss have decreased my migraines. BUT if the medicine is NOT approved and I gain the weight back chances are it will cause more migraines like before. SO PLEASE escalate since every thing I have tried is NOT working.
Business Response
Date: 10/27/2022
October 27, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark (CVS) administers the prescription benefits portion of the Plan, of which the consumer
is a member. This letter is in response to the correspondence we received from your office on October
6, 2022. Thank you for the opportunity to address the member's concerns.

The prescription the member was attempting to fill requires approval of prior authorization from the
Plan. The members approved prior authorization expired on September 7, 2022. A prior authorization
request was received on September 8, 2022 without supporting clinical documentation describing the
need for continuation of the medication. On September 8, 2022, CVS attempted to call the prescriber to
request the necessary clinical information. CVS did not receive a call back from the prescriber, so we
refaxed the prior authorization to the prescriber with instructions requesting the clinical documentation.
On September 9, 2022, CVS placed another unsuccessful call to the prescriber and again refaxed the
prior authorization form. Since no clinical information was received from the prescriber, the prior
authorization was denied on September 9, 2022. A second prior authorization was received on
September 15, 2022, again without the appropriate supporting clinical documentation. On September
20, 2022, CVS again placed another unsuccessful call to the prescriber. The second prior authorization
was denied on September 29, 2022 due to lack of clinical information. On October 11, 2022, our appeals
team received a request to appeal for coverage of the members medication from her prescriber. This
request was submitted with the appropriate clinical information. The appeal was processed and
approved on October 20, 2022. The medication is now approved for coverage from October 20, 2022
through October 20, 2023.

Should you or have any additional questions or concerns, please do not hesitate in contacting me at 1-
************.

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:10/05/2022
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.
On Monday October 3, 2022 950 Am for approx 24 mins i called CVS Caremark customer service line with questions and to cancel 2 prescriptions that were wrong. I spoke to **** and asked to cancel 2 prescriptions prior to them being filled as 1 dexcom transmitter was supposed to goto the local pharmacy and the other the ** needles was wrong NDC #. I asked him again to confirm these was canceled and he said yes and that it may not show on the web on my side but assured me that it was. Now 2 days later im getting an email that these items still shipped and i called and asked why and he didnt which now i need to send back and wont credit me back the $137.82 for a minimum of 8 days depending on shipping. Rep ************************ that this was their mistake and asked supervisor if there is a way to refund now but was told no. I will need to pay for the correct prescription without getting my refund prior which money is tight already and they refuse to work with me.
Business Response
Date: 10/19/2022
October 19, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the ***** Medicine health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on October 5, 2022. Thank you for the opportunity to address the members concerns.

Upon review, the member requested an immediate refund for the order they received. A request for same day refund was sent to our finance team. A refund in the amount $137.32 was issued to the members credit card on file on October 6, 2022.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:10/04/2022
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.
I was prescribed HIV preventive medication to begin taking within 72 hours of exposure. My prescription was sent a local CVS but they could not process the claim. The prescription was required to be delivered and delivery was unavailable until after the time limit for medicine to be effective. The medicine was available at the local pharmacy the whole time. I was unable to begin the full regiment before the time required. I spoke with over 20 people over the two days and nobody could help.
Business Response
Date: 10/19/2022
October 19, 2022

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 October 6, 2022. Thank you for the opportunity to address the members concerns.

Upon review, we have verified that a prescription was received on October 2, 2022 for processing. The order encountered delays at both an internal and external level. The internal delay was due to the medication needing to be shipped on October 3, 2022 for delivery on October 5, 2022 when the member needed the medication on October 4, 2022. The order was delivered on October 4, 2022. Another prescription was received and was transferred out to local pharmacy then being transferred due to the local pharmacy not being able to fill the medication. Both medications were subsequently delivered on October 4, 2022 under tracking #s CVS6570000010616 and CVS6570000010595. The member was provided the resolution to his concerns on October 6, 2022.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
Date:10/03/2022
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.
I'm diagnosed with multiple chronic autoimmune diseases: Ankylosing Spondylitis and Psoriatic Arthritis by rheumatologist *********************************************. Immuno suppress drugs help control symptoms. IMPERATIVE TO KEEP ON TRACK WITH INJECTIONS. MANY probs with CVS Specialty Pharm sending my meds on time last few years, NOT due to insurance or doctor. Due to issues within the company. Recent issue: began Cosentyx in 7/22 . ************************ doubled my dose from 150mg to 300mg every 4 weeks to help alleviate my back/neck/hip pain and fatigue on 9/16/22. Pain greatly affects my daily life and ability to work, and function. I met with rep from St ********* ****************** Team, *********************, on 9/19/22. She sent insurance-approved script with increased dose of 300mg to CVS Spec. Pharm. She noted my last dose of 150mg on 8/22, and next dose due 9/25.To PREVENT probs like in the past/ensure receiving med on time, I sent chat messages to CVS reps from my accnt. I have screenshots of this communication beginning Sept 20. Reps state I could fill my new increased script. But other reps state they did not have script. After repeatedly explaining that their pharmacy was only giving me option to order ONE 150mg syringe, CVS reps either argued or REPEATEDLY IGNORED me. All this in writing.On 9/28, the *** MAN TEAM called CVS. St Eliz Med Man told me that CVS said all was well with my new 300 script. When I tried to order, the 300mg was STILL NOT AVAIL for me. I CALLED CVS MYSELF on 9/28. Female answered and explained there was a disconnect between CVS and their online department. She saw the approved 300 script, but it hadn't been sent to online ***** She reassured me she would expedite my meds, now very late. Promised I would receive two 150mg shots on 9/30/22.I reiterated my needs online when rep asked if I needed further assistance following this call. No shot has been sent! It's 10/2. CVS had sent message 9/28 saying no 300mg script avail for me!!!HELP!
Business Response
Date: 10/19/2022
October 14, 2022
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 October 3, 2022. Thank you for the opportunity to address the member's concerns
regarding their specialty pharmacy experience.

Upon review, we have verified that a prescription was received from the members prescriber on
September 19, 2022. The last refill was processed and delivered to the member on September 16, 2022
via *** (tracking #1Z77V750NW82718443). The specialty pharmacy contacted the member on October
3, 2022, to setup the delivery of her refill. The order shipped on October 3, 2022 and was delivered by
*** (tracking #1Z265561NP17162264).

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:09/27/2022
Type:Sales and Advertising Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
** Monday, 9/19/22, I received email confirmation from CVS Caremark of a routine refill request I had placed for a prescription called Metronidazole Lotion ****%. The confirmation email from Caremark stated the "estimated delivery" for this RX was ***** 21, 2022 - Sep. 26, 2022" and (correctly) listed the quantity of a 90-day supply as prescribed by my doctor, as "***** / 90-day supply." For reference, the "*****" refers to the quantity in milliliters. Each individual bottle is 59 ml, so 59 x 12 bottles = 708 ml. Again, this is CORRECT and is what my DOCTOR ********** for me. During the window designated as "estimated delivery," I observed that my order seemed to be staying in "processing" status longer than the normal ***** hour window before shipping. I called Caremark **************** twice on 9/22/22 and once on 9/24/22. ** 9/22/22 I was told to check back in ***** hours. In the meantime, the medication shipped, but the quantity had been changed from ***** ml (12 bottles for 90 days) to ***** ml (3 bottles for 88 days) --- changed by Caremark, **NOT BY MY DOCTOR.** ** 9/24/22 I stated to the rep that I was aware Caremark was "shorting" me the med and that I was owed 531 ml (or 9 bottles) besides the mere 3 they had opted to ship. ** 9/24/22, I was told I would receive a call back from a pharmacist on or about 9/25/22. ** Monday, 9/26/22, I received a voicemail from someone named ***** who acknowledged that Caremark had indeed shorted me and that I was owed the remaining medication. I followed up with calls to ***** (on 9/26/22) and "***" (on 9/27/22) and was told by *** that "***** put notes in the computer this morning." However, I have yet to see, on the customer-facing side of the website, a change in the status of my RX, a correction to the quantity Caremark incorrectly changed, or any information about when the remaining 9 bottles I am owed will ship.
Business Response
Date: 10/07/2022
**************************************************** | ***********, ** | T: **************
October 7, 2022
BBB serving Eastern *************, *****, ************, and *******
290 *********************************************, Suite 102
***********, ** 01752-4705
Complaint # ********
To whom it may concern:
CVS Caremark administers the prescription benefits portion of the *****************- **** General
******* health plan, of which the beneficiary is a member. This letter is in response to the
correspondence we received from your office on September 27, 2022. Thank you for the opportunity to
address the member's concerns regarding their mail order prescription quantity being shorted.
Upon review, we have verified that a prescription refill request was received via our web portal. On
September 24, 2022, the member contacted our customer care team and requested additional
information for the change in quantity and day supply that had been shipped. Upon confirming that an
error had occurred, the prescription was retranslated on September 29, 2022 and the remaining 9
bottles were shipped to the member on October 3, 2022 and delivered on October 4, 2022 **** tracking
number 1Z74W0A61306776118).
Finally, we understand the level of service the member received did not meet with their or our
expectations, and we sincerely apologize for any frustration or 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 1-
************.
Sincerely,
***********************************
Member Advocate
Customer Answer
Date: 10/07/2022
[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:09/23/2022
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've been fighting with CVS Caremark since December 2021. I was prescribed a liquid medicine that only one pharmacy in my city could make. I paid $127. When the pharmacy sent in the claim form for reimbursement CVS Caremark said the form was missing the *** number and to resend the form. By this time I had already refilled in January. I made sure to send in all the information for both times. Then I got told I used the wrong form. They sent the right form so I got it filled out. In April I refilled again. I sent in paperwork again. I got denied. I called on May 24 and in that phone call I got told both that my pharmacy was out of network AND that I needed prior authorization. They told me exactly how to tell my doctor to fill it out including my diagnosis and the reason for the medicine starting from December 2021. I was also recommended to get my medicine filled in ********** and mailed to me. I've done that ever since they told me. My doctor filled out the paperwork and sent it in. I got denied again. At this point the doctor keeps calling me in frustration that she has to keep filling out paperwork even though she's already sent the same info numerous times. I spoke with I believe a case manager named ***************She told me she would listen to the calls and get back to me. She told me that they DID tell me the wrong information and that they would send one final form to my doctor and once they get it back, it will be approved and I will get reimbursed. Got all of it done and I got denied again because some of the ingredients weren't covered. I called back and was told again it was because my pharmacy was out of network and it was my choice to keep filling it there. I reminded them AGAIN that I did exactly as they asked and they didn't tell me until MAY that it was out of network. That's not my fault. I should still be reimbursed. I have filled that medicine at my pharmacy three times for a total of $381.
Business Response
Date: 10/06/2022
October 6, 2022

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription benefits portion of the State of ***************** Blue shield
health plan, of which the beneficiary is a member. This letter is in response to the correspondence we
received from your office on September 26, 2022. Thank you for the opportunity to address the
members concerns regarding the denial of their paper claims submitted for reimbursement.
Upon review we confirmed that effective January 1, 2017, the plan implemented a firm policy that
compounded drugs would only be covered at in-network pharmacies. The plan reserves the right to
review all compounded claims and exclude any excessive charges including but not limited to charges for
bases and bulk compounding powders. The plans policy is determined by the State of Kansas. This
information is available to the member on the State of Kansas website and the Benefit Description that is
provided to the member every year.
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: 10/07/2022
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.]
I understand that the compound medicine needs to be filled in network but I didn't know that pharmacy wasn't in network until months after first filling my prescription. No one can expect me to know that if no one tells me. The moment they told me I had to fill it at another pharmacy (in **********) I proceeded to do so. Also, if you listen to the phone calls I had with CVS Caremark, you will hear that 1) they gave me misinformation many times and 2) I was promised that once my doctor filled out paperwork, I would be reimbursed. This is the complaint I have. Thank you for your time.

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,
Sydnee

Business Response
Date: 10/21/2022
October 21, 2022

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

Complaint #********
To whom it may concern:
We apologize for the inconvenience. The summary plan benefits provided to you upon enrollment state that you can contact customer care 24 hours a day to confirm a pharmacies network status.
Please let me know if you have any additional concerns.
Sincerely,
***********************************
Customer Answer
Date: 10/24/2022
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.]

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I will continue to argue this point. I had called SEVERAL times, yet no one told me this pharmacy was out of network or at which pharmacy I was allowed to fill. And my complaint goes beyond that as CVS Caremark employees promised me a reimbursement. I understand now that I can call anytime to check if a pharmacy is in network. I will be sure to do that next time. But when I am calling and being given misinformation time and time again, that is not fair to me. I did everything I was asked to do and yet I am still here out $381. I will not give up this fight.

FAQ

Regards,
Sydnee
Initial Complaint
Date:09/21/2022
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.
As a CVS employee we are forced to use Atena as our insurance provider which has a plan renewal in June. I have been getting a specialty medication from mail order for over 2 years with a manufacturer **mpany assistance card. When the plan renewed in June I should have been charged my ******** yearly out of pocket ** pay for my first months medication then the **pay assist card the $100 **pay charge for that medication moving forward. However CVS charged the **pay assist card $1,500.00 which doesnt apply to the deductible and they charged this same amount 3 months in a row until they depleted the card of funds only then did they **ntact me for my payment. I **ntacted them and told them of the error and that the claim needed to be refunded back to the card and me billed for the $******** they said because I didnt call them ahead of time and per ***** in billing the deal was done and they got paid they wouldnt re process the claim to fix the issue. I asked to speak to a supervisor after an 1hr32 min with ***** was given to ****** a lead billing **** rep who said that it is CVSspecialty Policy that even if they are notified of a billing error if there wasnt notation in an acct beforehand they would not **rrect it. Even tho both reps said had thier been notes it still would have processed the same exact way but that then they would **rrect it. I work as a pharmacist for CVS in the retail setting and we re process claims all the time after being notified by the customer there was an issue afterwards. I spent over 2 hrs on the phone with them yesterday as well. It would have taken maybe 5 minutes to reprocess the claim but as per ***** once CVS got thier money thats it they are done. So even tho they would still be paid for the medication just by me instead of the card they wont reprocess it. Very disappointed with CVSspecialty. I will be looking elsewhere for my medication and I will be filing **mplaints with other regulatory oversight agencies.
Business Response
Date: 10/03/2022
October 3, 2022

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

Complaint # ********

To whom it may concern:

*** Caremark administers the prescription benefits portion of the *** Caremark Corporation health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on September 21, 2022. Thank you for the opportunity to address the member's concerns regarding the billing concerns with our Specialty pharmacy.

We have contacted the member and made the exception to refund the copay assistance card and reprocess for the copay only. The member added a credit card to their account to bill the deductible. Further, all specialty claims from June 8, 2022 to August 26, 2022 have been reversed and reprocessed. The member can contact their Specialty Pharmacy single point of contact, *************************, at ************** should they have any additional concerns with this matter.

Finally, we understand the level of service the member received did not meet with their or our expectations, and we 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 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

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