Caremark PHC, LLC

This is in response to your inquiry dated August 11, 2016 regarding the member’s mail order prescriptions.We spoke with the member on August 16, 2016 and verified the medication name. At this time, we advised the member we would do additional research as she had refused the packages for two orders of the brand name medication.We verified the member had been provided incorrect information by a Customer Care Representative and was not aware additional orders would be sent to her. In addition, for the third order of the brand name, an override was completed which should not have occurred.We have approved an authorized return of both orders. Once the orders are received back, the member’s mail order account will be credited in the amount of $210 for both orders.We spoke with the member today and advised of this information. The prescriptions for the brand name medication have been discontinued as they are written to only allow the brand name to be dispensed. We have also placed notes on file to only fill the generic form of the medication. The member stated she will speak with her physician to obtain a new prescription to allow for generic substitution. The member was satisfied at this time and did not require any further assistance.

April 15, 2016
Revdex.com
[redacted]
[redacted]
Complainant ID: [redacted] / [redacted]
To Whom It May Concern:
This letter is in response to the correspondence we received from your office on April 4, 2016. Thank you for the...

opportunity to address Mrs. [redacted]’s concerns regarding being charged for diabetic supplies.
Mrs. [redacted]’s plan benefit includes a diabetic kit or diabetic bundling rule. As long as supplies are filled within the same 24 hour window as the insulin, the bundling will apply. Insulin must process before the supplies. Insulin is charged a standard copayment and the remaining items are charged a $0 copayment including a second insulin. If Mrs. [redacted] orders supply items without insulin, she will be charged a copayment for each diabetic supply item.
On August 23, 2015 Mrs. [redacted] was charged $240.00 for insulin and lancets. The test strips were processed before the insulin therefore the diabetic bundling rule did not apply.  On November 14, 2015 Mrs. [redacted] was charged $164.47 for her order of insulin and lancets. Mr. [redacted] was charged $120.00 for the insulin and $44.47 for lancets. The Lancets were processed before the insulin therefore the diabetic bundling rule once again did not apply.  In an effort to resolve this issue in Mrs. [redacted]’s favor we have reimbursed her $164.07 as a courtesy. As of April 7, 2016 Mrs. [redacted] was reimbursed $120.00 for her August 23, 2015 order of test strips and $44.07 for her November 14, 2015 order for Lancets.
We value Mrs. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mrs. [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted]  My office hours are Monday thru Friday from 9:00 a.m. to 5:30 p.m. Central Standard Time.
Sincerely,
[redacted]
Member Advocate

Dear Ms. [redacted],
The Plan allows one vacation override per medication, per year, up to a maximum 30-day supply. Unfortunately, there are no exceptions to this rule. 
SilverScript Insurance Company

June 16, 2016
 
Revdex.com
[redacted]
 
Complainant ID: [redacted] / [redacted]
 
To Whom It May Concern:
 
This letter is in response to the correspondence we received from your office on June...

9, 2016. Thank you for the opportunity to address Mr. [redacted] concerns regarding receiving an unauthorized order of medication.
 
Upon review of this concern, CVS/caremark mail order received a prescription from Dr. [redacted] office for processing. The prescription was received electronically and was filled automatically per our process. The prescription request was not initiated by CVS/caremark and there were no instructions dictating to hold the prescription on file. Mr. [redacted]’s order was processed and shipped on June 4, 2016. At the time this order was shipped, Mr. [redacted] was unaware that the medication in question was being filled via mail order. Due to the inconvenience, as a one-time courtesy, packaging has been sent to Mr. [redacted] to retrieve the order for a reimbursement. Once the medication is returned Mr. [redacted] will be credited $65.40.
 
We value Mr. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted].  My office hours are Monday thru Friday from 9:00 a.m. to 5:30 p.m. Central Time.
 
Sincerely,
 
 
[redacted]
Member Advocate

Revdex.com:
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 # [redacted].  
 I've paid for this medication TWICE! and not gotten it ONCE! The payment was automatically deducted from my debit card WITHOUT my consent and authorization. I was told that medication was mailed out, I never received it. There was a problem with mail deliveries for a little while. A notice came out for anybody that was missing mail to call the Postal Service. Apparently individuals working for the Post Ofc were hijacking mail. A $1500.00 rent check to my landlord went missing, as well as some other stuff. I've called 3 different times about it. One said it was sent, the second, she said she'd get it right out to me, and the third freakin jerk, told me I RECEIVED it, and told me I NEVER called about it. YES I did. It was supposed to be refilled and sent the last time the [redacted] was sent to me. Then I got a msg that prescription wouldn't be refilled until Nov 24th. I've been without it for weeks now, but it's been paid for TWICE! I've taken additional steps with the local Post Master and the local Police Dept. But that last mn I spoke with at CVS, is a total [redacted] He sucks at customer service and could use some remedial training. Contrary to public opinion and vicious rumor, the customer is NOT always right. But in this case, I DID make the calls, the medication, I don't dispute that it was mailed, is MIA, and has been PAID FOR! Get what I paid for without any additional grief. I've been without it for weeks, my numbers on my bloodwork are going to be all kinds of whacked. The date and price on the next page aren't correct, I do not have that information sitting in front of me.
Regards,
[redacted]

Tell us why here...
June 3, 2016
 
Revdex.com
[redacted]
[redacted]
 
Complainant ID: [redacted] / [redacted]
 
To Whom It May Concern:
 
This letter is in response to the correspondence we received from your...

office on May16, 2016. Thank you for the opportunity to address Ms. [redacted] concerns regarding receiving and unauthorized order of medication.
 
On May 10, 2016 Ms. [redacted] doctor’s office faxed in two new prescriptions to be filled via mail order. Ms. [redacted]’ order was later processed and shipped on May 11, 2016. As a new prescription is received, it will automatically go into processing. If there aren’t any rejections or concerns with the medication the order will ship shortly after completing processing. Ms. [redacted] was provided this information on May 16, 2016 and was also told she would be responsible for the order balance of $131.42. Due to the frustration and inconvenience this issue has caused, a mail tag was mailed on May, 17, 2016 for Ms. [redacted] to return the order.
 
When speaking with Ms. [redacted] to inform her that the mail tag was on its way, she then informed me that she had already threw away the medications. Ms. [redacted] was previously told that no credit would be given and chose to discard the medications sent in the order. Since the medications were no longer in Ms. [redacted]’ possession, the mail tag process was unable to be completed. In an effort to rectify this issue, a courtesy credit of $131.42 was given. Ms. [redacted]’ mail order account now reflects a zero balance as the credit has been applied.
 
We value Ms. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Ms. [redacted] have any additional questions or concerns, please do not hesitate to contact me at [redacted]  My office hours are Monday thru Friday from 9:00 a.m. to 5:30 p.m. Central Standard Time.
 
Sincerely,
 
 
[redacted]
Member Advocate

July 28, 2015  Complaint ID: [redacted] To whom it may concern: CVS/[redacted] administers the prescription benefits portion of the health plan for the [redacted] of which Mr.  [redacted] is a member. This letter is in response to the...

correspondence we received from your office on July 21, 2015. Thank you for the opportunity to address Mr. [redacted]’s concerns as expressed in Complaint ID [redacted]. We verified that there were instructions in a previous account requesting that the mail order benefit not be utilized if any prescriptions requests were received for Mr. and Mrs. [redacted]. When the order in question was received for processing there were no instructions which would have stopped the order. We have confirmed that when the plan was renewed, the previous notated request did not transfer to the new file. For this reason, the order was shipped.  We have contacted Mr. [redacted] and confirmed that there are now instructions on the mail order account to prevent future orders from processing via the mail order benefit.  Additionally, a credit of $13.87 has been issued to the account as of July 22, 2015.  We sincerely apologize for any frustration or inconvenience that Mr. and Mrs. [redacted] experienced. We value Mr. and Mrs. [redacted] as a member and we remain fully committed to our purpose of “helping people on their path to better health”. Should you or Mrs. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at ###-###-####. Sincerely,  [redacted]

Dear Sir or Madam,  Thank you for giving us the opportunity to address the beneficiary’s concerns regarding the cost of BD Ultrafine Pen Needles through her Medicare Part D Prescription Drug Plan. The attached letter is in response to your correspondence received on May 4, 2015.Please feel...

free to contact me directly with any questions or concerns regarding this response.  Sincerely,  [redacted] Senior Consultant, Medicare Part D GrievancesPhone ###-###-#### Fax ###-###-####

May 6, 2015 [redacted]  To whom it may concern: CVS/ caremark administers the prescription benefits portion of the health plan for [redacted], of which...

Mr. [redacted] is a member. This letter is in response to the correspondence we received from your office on April 21, 2015. Thank you for the opportunity to address Mr. [redacted]’ concerns as expressed in Complaint ID [redacted].  Upon review of this concern, we confirmed that the order [redacted] in question shows to have been delivered on April 10, 2015 at per UPS Mail Innovations tracking number [redacted]. Our records reflect that Mr. [redacted] called CVS/caremark care team April 15, 2015 to report this order as lost. A request was submitted to our account team and an exception was granted authorizing a reshipment to be sent at no cost to the member.    On April 23, 2015 a new order was shipped and was delivered via UPS [redacted] on April 24, 2015.. Additionally, upon review of Mr. [redacted]’ interaction with our customer care team; we recognize that there were several opportunities for additional training and coaching for our staff.  Feedback has been provided to each member of the customer care team with whom Mr. [redacted] interacted with.  Please note that our goal is to ensure that our valued customers receive only the highest level of customer care.    We sincerely apologize for any frustration or inconvenience that Mr. [redacted] experienced. We value Mr. [redacted] as a member and we remain fully committed to our purpose of “helping people on their path to better health”. Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted]. Sincerely,  [redacted]Member Advocate

The previous response was not correct we should have responded with the below information.
In order to properly investigate your concerns, we are in need of additional information.  Please provide us with the following information: Member ID number, Date of Birth, and the medication in question.  
Prior to speaking with Ms. [redacted] we are in need of the above information so that we can look into the concern.

Revdex.com of Eastern MA, ME, RI, & VT[redacted]Phone: [redacted] | Fax: [redacted]
Complaint # [redacted] / [redacted]
To whom it may concern:
CVS/caremark administers the prescription benefits portion of many health plans as well as...

offer services through our Specialty Pharmacies. This letter is in response to the correspondence we received from your office on July 5, 2016. Thank you for the opportunity to address Mr. [redacted]'s concern as expressed in Complaint ID: [redacted].
Upon review of Mr. [redacted] concern we verified that his claims in question were submitted to the assistance program and denied for the dates of service. The dates of service were prior to coverage being effective.  A member of our Specialty Pharmacy has reached out to Mr.  [redacted] and addressed his concerns. As a courtesy to Mr. [redacted] the account has been cancelled with the collection agency and the balance has been adjusted.  Mr. [redacted] was provided direct contact information should he have any questions or concerns in the future. 
We value Mr. [redacted] as a member and we are confident that future service will consistently reflect our commitment to our purpose, “helping people on their path to better health.” Should you or Mr. [redacted] have any additional questions or concerns, please do not hesitate in contacting me at [redacted]
Sincerely,
[redacted]Member Advocate

Revdex.com:
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 #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]