ComplaintsforExpress Scripts

• Initial Complaint

  08/08/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  Express scripts was given a prescription by my doctor for glucose test strips. Without notifying me, that rx was denied by insurance and express scripts got approval for a different order of test strips that require a new glucometer. They shipped those test strips to me without any notification and have billed me $50. I cant use these test strips and am not interested in buying a new glucometer. I have tried multiple times to have them refund the purchase (which was set up and delivered without my knowledge or consent). The box is unopened and I am happy to mail it back. They have horrible customer service through call centers that blow you off and put you on hold. Im currently on hold right now. ********************************************************************************************************************************************************** a rx we cannot use. This is a pattern. Theyve done this on previous calls.

  Customer response

  08/09/2024

  We were able to make resolution regarding the issue. We were finally able to speak to a manager and have them reset our balance. Thank you.

• Initial Complaint

  07/29/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I called Express scripts multiple times to cancel a Wegovy prescription, as my provider: ***************************** APRN had sent a order for a 1 month supply. I only wanted a 90 day supply since the cost for a 1 month supply is $200 and the cost for 3 month is $400. However my provider refused to give a 90 day supply claiming them medication need to be titrated each month increasing doses from 0.25 mg month 1, to 0.5 mg month 2 to 1 mg on month 3. So I decided to cancel the mediation entirely and no longer wanted the Wegovy from Express scripts at all. I then called Express scripts multiple times and requested that my credit card auto ship be removed, that all Wegovy orders be cancelled that I do not want the medication at this time due to the financial amount. I was informed that my auto pay would not be removed but that all orders for ****** would be canceled and additionally they would add a safety ship to my account that would pend any medication purchase this would stop auto pay until I personally called into Express scripts to verbally authorized that I wanted the medication to be filled and would then released, changed, and shipped. Please see Invoice# **********-65 for Wegovy 0.25mg, 1 qty, 28 day supply canceled. Then please invoice #*********-65 for Wegovy 0.25mg, 90-day supply canceled. I called Express scripts greater than 5 times with to ensure my orders were all canceled with the last two calls on 07/22/2024 and 07/24/2024. Again I requested to PLEASE remove the auto pay and cancel all ****** ordered. Today 7/29/25 Express scripts changed me $400 for Wegovy 0.25mg, 2 qty, 56 day supply!! You can imagine my surprise 1st. Ive canceled multiple times and 2nd My provider order changed to bypass. Express Case# RTL4283767 I am requesting a refund of $400. I did not authorize this transaction nor did I want it filled. Additionally I think it is unethical to change the health care providers order of a Rx so they can push through the medication that I canceled.

  Business response

  08/02/2024

  
  
  August 2, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID:  ********
  Complainant: *********************
  
  
  Dear Sir/Madam:

  Express Scripts is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  
  **********************************
  Senior Manager, Executive Correspondence

  
  

  Customer response

  08/03/2024

  Better Business Bureau:

  I am grateful the BBB got involved. I would strongly caution anyone against using Express scripts. 
  
  I have reviewed the response made by the business in reference to complaint ID ********, ********************** and I are currently working towards a resolution and this is satisfactory to me.
  
  Sincerely,
  
  *********************

• Initial Complaint

  07/29/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My dr prescribed zepbound 2.5 mg 3 month supply in Jan 24' & Express Scripts approved it with no problem. I was then moved to 5.0 mg 3 mth supply & received it with no issues. When it was time for me to move up to 7.5 mg the shortage was happening & I understood. I called apprx every 5 days to check on supply. Finally I got a rept that said "we don't have 7.5 in stock. We do however have 5.0 mg. Would you like to get a 3 mth of it?" I told her yes & ******* dr did whatever needed behind the ********** received another 3 mth supply, however I was charged ***** for the 1st 2 Scripts I received & that was ****** with ES saying the coupon no longer applies. I just paid it & was happy I was atleast able to get that supply. Yet again, when it was time to refill it I called 8 different times until finally calling BCBS Of MN & having run interference for me doing a 3 way call with ES. They again said 5.0 mg & approved a 3 mth supply. I paid ****** again. ES sent a letter saying they didn't have PLA from my dr & denied the 7.5. My dr called them & denied again with no explanation. After digging on the internet finally finding on reddit the reason. Doses 2.5, 7.5, 12.5 are transitional doses & allowed a 1 mth per 365 calendar year. My plan after finally finding the info on ES states 5.0, 10.0 & 15.0 are ************************************ can only be a 63 day supply. I have proof ES has given me the 5.0 mg in a 3 mth script twice now. 1st, why couldn't ES explain this to my dr when she called saving everyone ALOT of time? 2nd, why is the info hidden by ES as if it's the Holy Grail & refusing to tell people what each dosage is & what they need so people can have the medicine they require? Not only am i, but a unbelievable # of people paying outrageous amounts for medicine they need & still dealing with medicine being taken off the covered list. IE; I require thyroid medicine luckily I'm already on unithyroid since they removed synthroid. If we didn't need it our dr wouldn't give it. FED UP

  Business response

  08/02/2024

  
  August 2, 2024
  
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID:  ********
  Complainant: ***********************
  
  
  Dear Sir/Madam:
  
  This is to advise you that ******************* concern related to medication coverage has been resolved.
  
  A new prescription was received from Mrs. ****** provider for an 84-day supply, but we were not able to send the medication because plan limits have reduced the fill to a 28-day supply and for mail order we are not able to fill if less than a 35-day supply. This medication is covered for a maximum quantity of 2ml within a rolling 365-day period.  For the 28-day supply fill of the medication in question, *************** must fill at an in-network retail pharmacy.
  
  Under Mrs. ****** prescription plan coverage, the medication prescribed requires a Prior Authorization (PA) to be covered and she has an approved PA on file effective thru September 21, 2024.  This medication also has a quantity limit; therefore, an additional Prior Authorization is required to allow *************** to fill the medication beyond that quantity limit for additional fills after the first 28-day supply.
  
  We contacted ***************; she appreciated the actions taken and this matter is considered resolved.
  
  Sincerely,
  
  
  
  **********************************
  Senior Manager, Executive Correspondence
  
  
  
  

  Customer response

  08/05/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  07/29/2024

  Complaint Type:

  Delivery Issues

  Status:

  Resolved

  More info

  I have health insurance through my employer. My health insurance provider is ********** of ******. I must utilize their online pharmacy, Accredo, for certain (extremely expensive) prescriptions. My dr sent Accredo a new prescription the end of February, 2024. At first ********** denied the claim but immediately reversed their decision and approved the medication. I received a letter of denial and then the approval within a week of each one. I called Accredo around the middle of March to see if there was something I needed to do, so i would begin receiving the medication. I was informed they had received a denial on the prescription. i told them, i did but then i received an approval a week later. they claimed they had not received an approval. i asked them if i could email them the letter and was told it had to come directly from the insurance company. over the next several weeks, i called many more times and was finally told that they HAD received the approval back when i initially called them. the person could not tell me why it was taking so long for my mediation to be mailed out to me. I did not receive my first dose of medication until April 9, 2024. every month since then i have had excuse and lies told to me as to why i am not receiving my medication in a timely manner. I am at my wits end. i have called my insurance company numerous times to complain, last week, on July 24, 2024, was the final time i've called them to complain again about not getting my medication on time. i was told by ******, a CSR, that she would file a complaint with their pharmacy **** and a consumer complaint with the company. i received an automated message from Accredo on July 25, 2024, saying they were trying to reach me regarding the delayed shipment. i called them back and was disconnected twice, supposedly it was accidentally but after the 2nd time, i'm not wasting my time anymore trying to talk to them. Please HELP!

  Business response

  08/01/2024

  
  August 1, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: ***************************
  
  
  Dear Sir/Madam:
  Accredo is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  08/03/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.

  I received my medication today. Thank you for your assistance.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  07/25/2024

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  I use a medication that, for whatever reason, is to good to go to a normal pharmacy. I spoke with an Accredo agent over the phone to schedule my next delivery. They said they can get it delivered as early as 7/24. I told them I won't be home that day and it will sit on my porch all night so could be deliver it on 7/25? They said no problem. It ended up being delivered on 7/24. I tried calling them to change the delivery date. The agent didn't even listen to what I first said and started off with trying to sell me on something that had nothing to do with my concern. Then said "it looks like there's a delivery out for today. I can connect you with the delivery service". Accredo is the one that messed this up. What good is talking to the delivery service going to do? Accredo didn't even acknowledge my complaint. I need a new dose since it's supposed to be refrigerated and ended up sitting on my porch for more than 20 hours.

  Business response

  08/02/2024

  
  
  
  
  August 2, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  **************************************;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: *****************************
  
  Dear Sir/Madam:
  This is to advise you that ********************** concern related to his specialty medication being delivered when he was not home has been addressed.
  
  Mr. Hoffrages medication is temperature sensitive, and he is questioning the safety of the medication due to it being left outside for multiple hours.  Tracking confirms the order was delivered on July 24, 2024. Accredo has made multiple attempts to contact ******************** concerning this medication delivery, to confirm the medication must be returned and to schedule delivery for a replacement order. However, Accredo has not been able to reach him and has left voicemails advising for ******************** to contact Accredo at **************.
  
  We have also made multiple attempts to reach *******************; however, we have not been able to discuss this matter with him.  If ******************** has any questions regarding this matter, he can contact me directly at **************. 
  
  At this time, this matter is considered resolved.
  
  Sincerely,
  
  
  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  08/06/2024

  Complaint: 22043151
  
  I have reviewed the business' response and am rejecting it because:
  

  I emailed someone back. Emails work both ways. Not fault you choose to ignore it. As for the medication, keep it. Your company cannot follow simple instructions so therefore, I have no desire to work with you anymore. 
  
  
  Sincerely,
  
  *****************************

• Initial Complaint

  07/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  My Express Scripts application portal reflects coverage effective & Prior authorization on file, yet Express Scripts issues a denial to my pharmacy every time they submit. This has been going on for over a month. I have called Express Scripts and every rep tells me they do not understand why it is being denied and to have my pharmacy resubmit- only to be denied again. They keep stating there is not a current pre authorization - however my doctor has submitted several (and my portal states Pre auth is good) They had me join a weight loss support group. I have spoken to supervisors and my pharmacist and doctor have called. Each rep I speak to tells me something different. Sections and dates on my portal have also been deleted (no longer visible to me) and dates changed) I have screen shots to support this.

  Customer response

  07/26/2024

  Express Scripts notified me that they approved the pre-auth and would cover a month supply of Wegovy. I picked up this prescription from my pharmacy yesterday (July 25)

  It did take over one month of calls in order to get them to cover my RX. The customer service was terrible. I no longer need the BBB to contact Express Scripts concerning covering my medication, however, I would like my complaint noted and documented.

  The current policies and procedures of Express Scripts should be reviewed. They should not be managing prescriptions with the terrible customer service they currently provide 

  Thank you for promptly responding to my complaint. 

   

• Initial Complaint

  07/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  On July 15, 2024, I called Express Scripts to check if they had my prescription in-stock. They confirmed that they did and informed me to transfer my prescription asap in order to process the request as I was already out of my medicine. On subsequent calls on the 18th, 20th, and 22nd I was informed that my prescription was being escalated and that the medicine should be shipped on the 21st of July. After checking the app on 23rd of July, it still showed processing. I therefore called Express Scripts yet again and was informed that the medicine was out of stock as of the 17th of July. In no previous communication in the previous days did they inform me as such. The manager's response was that I should find a local pharmacy that has it in stock. I informed her that the reason I switched to Express Scripts was because they confirmed on the 15th of July that they had the medicine in stock and that they would expedite the request noting I was out of the medicine. The manager said her only solution was for me to find a local pharmacy that had the medicine in stock. The level of misinformation and lies told to me throughout this process has been unethical and truly unprofessional. This is prescription medicine that needs to be taken on a weekly basis, they cannot lie and mislead customers without any accountability. They assume absolutely no accountability.

  Business response

  07/24/2024

  
  July 24, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ************************************************************************************************;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: ***************************
  
  
  Dear Sir/Madam:
  Express Scripts is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  
  **********************************
  Senior Manager, Executive Correspondence
  

  Customer response

  07/25/2024

  Complaint: 22032524
  
  I am rejecting this response because I do not believe you will proactively contact me for a resolution. 
  
  
  
  Sincerely,
  
  ***************************

• Initial Complaint

  07/20/2024

  Complaint Type:

  Delivery Issues

  Status:

  Resolved

  More info

  I require diabetic insulin daily. Express Scripts refused to cover the medication at my local pharmacy. I placed an order for my refill on July 11 with approximately 8 days worth of medication remaining. The medication has now been "delayed" with no explanation as to why and the company now claims they have 30 days to ship a refrigeration required medication. They already took the money out of my bank account and still have not shipped the medication. I am now out of medication and my health is at risk and no one will give me an answer as to when the medication will arrive. The company suggested that I get a new prescription from my doctor and take it to my local pharmacy to pay out of pocket for it with no reimbursement while I wait for the medication I ordered to arrive. Not only is this unfair, it's detrimental to delay life sustaining medication and then suggest its my fault and penalize me for their issues.

  Business response

  07/24/2024

  
  July 24, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ************************************************************************************************;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: ***********************
  
  
  Dear Sir/Madam:
  Express Scripts is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  
  **********************************
  Senior Manager, Executive Correspondence
  

  Customer response

  07/26/2024

  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  07/18/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On my last prescription fill, I was charged a total out-of-pocket cost of $340.07 for a medication that normally costs $255.61.The details of the charges are as follows:* $112.62 was applied to meet my deductible.* This amount was subtracted from the total cost of the medication, which is $1022.42.* My plan then charged an additional 25% of the difference, amounting to $227.45.This calculation resulted in an out-of-pocket cost exceeding 33%, whereas my plan stipulates that I should only be responsible for 25% of the cost. This discrepancy has caused me significant financial strain.I kindly request a detailed review of my account and an explanation for this overcharge. Additionally, I request a refund of the excess amount charged.

  Business response

  07/24/2024

  July 24, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: *********************************
  
  
  Dear Sir/Madam:
  Express Scripts is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  
  **********************************
  Senior Manager, Executive Correspondence
  

  Customer response

  07/25/2024

  Complaint: 22012011
  
  I am rejecting this response because the matter has not been resolved. I intend to consult with an attorney as I believe multiple clients have been affected.
  
  
  Sincerely,
  
  *********************************

  Business response

  08/01/2024

  
  
  August 1, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: *********************************
  
  
  Dear Sir/Madam:
  
  This is to advise you that ********************************* concern related to the cost of a recent prescription claim has been resolved.
  
  In reviewing ********************** prescription plan coverage, her plan has a deductible.  While in the deductible phase, ********************** pays 25% of the medication cost.  Also, once the deductible is met and ********************* is in the copay phase, she will pay a 25% copay for this medication.

  On the date of service, July 16,2024, ********************** had a deductible amount of $112.62 remaining to satisfy her deductible.  The calculation of 25% of the medication cost exceeded the remaining deductible amount of $112.62,therefore the $112.62 only applied to the deductible.  The total medication cost was $1,022.42, the deductible amount was subtracted leaving a remaining amount of $909.80 to be calculated for the copay.  The plan copay is 25% for a preferred brand medication and 25 % of $909.80 is $227.45.  The deductible and the copay are added together for the total cost of $340.07.

  This increase is due to ********************** straddling between the deductible and copay portions of the benefit, which would apply a copay under both for this claim.

  We contacted ********************** and at this time, this matter is considered resolved.
  
  
  Sincerely,
  
  
  
  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  08/05/2024

  Complaint: 22012011
  
  I have reviewed the business' response and am rejecting it because:
  
  Straddle claims apply to ******** Part D, which my plan coverage is not. By that logic, not only is 25% applied to the deductible, but 25% would also be applied as a copay less the deductible. Regardless of deductible status, out-of-pocket costs should not exceed 25% as my plan is written.
  
  25% of the total cost of the medication is $255.61. 25% should not have been assessed on the balance of the total medication cost, less the deductible (once met). That simply is not how the plan has been written.

  I believe others have been impacted by the miscalculation and damages likely exceed millions of dollars. I will be pursuing full legal action.
  
  Sincerely,
  
  *********************************

• Initial Complaint

  07/18/2024

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  In an attempt for a prescription refill, a prior authorization was needed. My doctors ****** has been awaiting contact from Express Scripts as of July 12th through today July 18th. On July 18th at 3:16pm, I was notified via email that my prescription was denied due to no response from my prescriber. I contacted my insurance company (Express Scripts) to ask to have the *** sent again and was informed that without verifying the doctor's *** #, they will not send it again. I was informed that there is possibly a HIPPA violation if the *** # is invalid. After 56 minutes on the phone with *****, she then disclosed that another *** was sent at 4:36pm and that she called the doctors ****** (which was closed) and spoke with the answering service who do not have the *** # for the doctors ******. I attempted to confirm that the doctor's ****** *** # has not changed as I just spoke with them the previous day and was also in the ****** on Tuesday. Again, begging to please just send the *** again as this was a prescription that I need. ***** refused. I asked her why, does she just not want to? She took a deep breathe and said no. I asked for a supervisor and was transferred to ****** ***** shared that ***** shared that she called the doctor's ****** and was advised that the *** number she has was incorrect and that they did not have the doctor's *** number. I explained to ***** that this was not the case because the doctor's ****** was closed. I later spoke with ***** who shared that she would open the case again for me.

  Business response

  07/24/2024

  
  July 24, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******;63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: ***************************
  
  
  Dear Sir/Madam:
  Express Scripts is reviewing this matter and will be working directly with the complainant to resolve the inquiry.  We will notify your office, of the outcome, upon completion. 
  
  Sincerely,
  
  

  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  07/25/2024

  Complaint: 22011505
  
  I am rejecting this response because: 
  

  The contact person who called me spent time explaining the processes and procedures that the customer service representative should or should not have taken. The representative, ****** also shared that he would resolve getting my prescription sent urgently. Neither of these actions were needed. The supervisor that I finally spoke with resolved my concern before my call ended and before I submitted my claim of dissatisfactory service. If my initial complaint was not clear, I hope that this message helps. Policies and procedures in place have the need to be revisited by businesses and should be reviewed with a portion of factors around your customer's experience. I had to "fight" to get my prescription refilled. This was and typically is, entirely too much customer effort on my part. When I asked, what can I do differently to make this process smoother, I was given feedback on what I can do and what my doctor's ****** can do. What about what this company can do? Where is the ownership? Where the empathy for medical/patient need? 

  When I made my request for a refill (2 weeks in advance) and saw on the website that a prior authorization was needed, I called the doctor's ****** to let them know it was coming. They checked twice and could not locate any faxes. I asked my doctor's ****** to call and was told that I needed to call my prescription company again to ask for them to send the fax again or offer alternatives, thinking that maybe they did not send one because the drug was no longer approved. I did not call in hopes that the fax would eventually show up. A notification was received a few days later indicating no response from my doctor and I understood that it was not an issue of approval but rather a response to the fax. I in turn called your company to simply have the fax resent that turned into a 2-hour call of representatives in the prior authorization department who refused to simply resend the fax. 
  

  They may have been policy/process right, but what about morally/ethically right. I still needed my prescription and as of now, I was out - two weeks later. The supervisor, as a courtesy to me, sent the fax, my doctor got it the very next business day and now it is being delivered. A 2-hour phone call begging for someone to send a fax is entirely too much effort.
  

  In addition, ******, who called on behalf of this complaint shared that he would expedite my order and follow up with me when he called me on Tuesday afternoon. He also shared that my order was held after my doctor responded to the fax. I asked why is it on hold and not processing and he shared I have to call to take it off hold. How does a customer know they are supposed to do that? That again, is entirely too much effort for a consumer. If these are processes that we as consumers have to follow, can someone at least tell us that? There is nothing on the website that says, "hey customer,remember to call and have your order taken off hold after your prior authorization is received and approved?". I checked my order status yesterday, Wednesday morning, and the hold was removed, but not processing because I needed to process my payment, again. No one told me that my previous attempt to pay was cancelled/lost in the initial transaction. If I was not "stalking" the website for my order status, I would still be waiting for my prescription. And of course, I have not heard anything else from ****** who stated that he would "rush" my shipment out and call me back.
  

  As much as I appreciate the response, I would rather have one that is reasonable to my concern and with someone who values their consumers with the ability/intent of servicing customers as if it was one of their own family members. Most importantly, with someone who can make a difference. Hear this VOC! Value your customers and make a change that shows value to your consumers, within your allowed policies and procedures. Do what makes sense?

  Oh, and let me also add that the initial person who I spoke within the actual customer service department is the "only" person that ****** says needed to be coached because she was not "supposed" to transfer me to the prior authorization department in the first place.  Someone who has "helped" me and understood my need, showed empathy and searched for a resolve, is the one being coached?  Is that logical?

  Have this person call me: **********************************;Senior Manager, Executive Correspondence.
  

  Thank you for your time and consideration.
  

  Sincerely,
  
  ***************************

  Business response

  08/01/2024

  
  August 1, 2024
  
  
  
  Better Business Bureau Serving **************** and *****************
  ***************************
  ***********, *******; 63102
  Attn:  Dispute Resolution Department
  
  
  Tracking ID: ********
  Complainant: ***************************
  
  
  Dear Sir/Madam:
  
  This is to advise you that ***************************** concern related to medication coverage and challenges securing her medication has been resolved.
  
   In reviewing Mrs. ********* prescription plan coverage, the medication requires a prior authorization to allow for coverage as the one on file had expired.  The prior authorization renewal process is required to be completed by the provider.  There are multiple ways for the provider to contact us for a prior authorization, this can be requested by phone, fax or online.
  
  When the refill was first requested on July 12, 2024, there was no prior authorization on file and the prescription was placed on hold.  A fax was sent to Mrs. ********* provider, but we did not receive a response and the prior authorization was denied.  On July 18, 2024, a second prior authorization case was created, the provider was contacted and replied; the prior authorization was approved on July 23, 2024.  In an effort to assist, the prescription was released for processing and one day shipping was added to the order at no cost.  However, the payment method on file declined the charge and a notification was sent to *********************.  ********************* was advised of the approval, the payment method was updated, and the medication was delivered on July 25, 2024.
  
  We contacted ********************* and at this time, this matter is considered resolved.
  
  
  Sincerely,
  

   

  
  **********************************
  Senior Manager, Executive Correspondence

  Customer response

  08/05/2024

  Complaint: 22011505
  
  I have reviewed the business' response and am rejecting it because the business has yet to address the complaint around the LACK of customer service provided by the company.  The priori authorization is indeed required and was not an issue or what this complaint was about.  My prescriber did not respond in time and I agree that the request was closed as part of your business practice.  My complaint is related to my phone to Express Scripts to have the second prior authorization sent to my prescriber.  This phone call took 1 hour and 43 minutes, that involved a very lengthy conversation, BEGGING Express Scripts to please send it again.  This was entirely TOO MUCH EFFORT on my part.  The prior authorization representative refused to resend the fax for my prior authorization.  This was unprofessional, and when I requested a supervisor, he in turn advised me that she called my doctor's ****** to confirm the fax number and confirmed that it was incorrect.  My doctor's ****** was closed.  There was no one there to confirm the fax number, which was the reason I was calling to have the fax to be resent.  This person could not help me either and finally sent me to an actual supervisor who simply resent the fax, after 1 hour and 43 minutes.  

  There was not an issue or concern with the order after the fax was resent.  I was aware of the payment being declined with my OLD HSA card because I was watching my account online.  No alert was sent.  When I logged in, I changed the payment method and processed my order.  There is never a cost associated with my prescription.  It always ships overnight with no additional cost to me because it is a temperature controlled medicine.  Express Scripts did not do anything special to ship my order, however, I have no expectation for them to, but this is NOT what my complaint is about.  My complaint is about your poor customer service, research, follow up and ability to resolve matters for your customers.  

  I am assuming that the person working these claims are not able to address the customer service complaint but I do want it to be logged as this is what my concern is about.  I will also have this logged with my company as Express Scripts is our preferred vendor.  Maybe it is time we revisit this choice as we gather more VOC survey results.
  
  
  Sincerely,
  
  ***************************

*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. ↩