ComplaintsforRightway

• Initial Complaint

  07/29/2024

  Complaint Type:

  Order Issues

  Status:

  Answered

  More info

  I am writing to file a formal complaint against Rightway Pharmacy regarding their handling of my significant other, *******'s, medication coverage. Below are the details of my complaint:My employer, ByteDance, switched our pharmacy benefit this year from Anthem BlueCross to Rightway Pharmacy without notifying employees before the start of the benefit year. This switch resulted in significant disruptions to my significant other, *******'s, medication regimen due to Rightway Pharmacy's different drug formulary and prior authorization requirements.1. Descovy for HIV Prevention:******* has been taking Descovy for HIV prevention since last year.From the start of this year, Rightway terminated coverage for Descovy, stating it is not in their formulary and requiring a prior authorization form.Despite our doctor submitting the necessary forms, Rightway claimed the materials were insufficient, resulting in delays in receiving the medication.2. Skyrizi for Psoriasis Treatment:******* is prescribed Skyrizi for psoriasis treatment.Rightway denied coverage multiple times and requested excessive amounts of documentation.After numerous phone calls and complaints, they finally approved the medication, but it was delayed for more than two months.3. Modafinil for Psychiatric Treatment:Rightway also rejected coverage for modafinil prescribed by *******'s psychiatrist.Rightway Pharmacy delayed and denied medication coverage without sufficient justification, potentially to save costs. These delays and denials have caused significant frustration and have negatively impacted *******'s health and well-being. They worked with ByteDance, who failed to notify employees of the switch in pharmacy benefits before the start of the benefit year, resulting in unexpected changes in medication coverage.Rightway has potential violations related to healthcare access and patient rights, particularly concerning the handling of prior authorizations and formulary changes.

  Business response

  08/16/2024

  Dear ***,

  
  Thank you for reaching out to us regarding the issues you have experienced with *******'s medication coverage. We understand how frustrating this situation must be and appreciate the opportunity to address your concerns. At Rightway, we are committed to ensuring our members receive the highest level of service and support.

  
  In response to your complaint, we will address the communication efforts regarding your benefit transition, the specific issues with medication coverage for Descovy, Skyrizi, and Modafinil, and our efforts to improve address verification for communication purposes.

  
  Communication Efforts by Your Employer and Rightway
  Your employer, in partnership with Rightway, took extensive measures to inform employees about the transition to Rightway. These efforts included:
  - A dedicated Wikipage for all employees describing the 2024 health benefits, including information about the transition to Rightway.
  - In-person open enrollment fairs held in ******** on November 7, *********** on November 8, and ************ on November 9, 2023, where Rightway representatives were available to answer questions.
  - *********************** in December 2023 by Rightway regarding formulary changes for existing prescriptions, including recommendations for alternative actions and offers to assist with the transition including the ability to connect live with our dedicated pharmacists.
  - Updates to the Sequoia app in January 2024 to reflect these changes.
  - An email sent to all ****** US employees on January 10, 2024, alerting them to the change in benefits.
  

  These efforts included a multimodal communication strategy across print, digital, and live options to support members through the transition, underscoring our emphasis on member support and satisfaction.

  
  Medication Coverage Issues
  Descovy for HIV Prevention: We confirm Descovy is a Tier 3 medication requiring prior authorization for usage. As part of our standard transition strategy, we provide a 90-day ***** period for members with existing prescriptions that will not be on Rightways formulary or require prior authorization to make the necessary adjustments. We communicated this transition via mail on December 18, 2023, prior to our official launch on January 1, 2024, and sent a reminder via mail on February 27, 2024, about the 3-month transition fill and the necessary actions required for the prescription. We provided information on next steps for either transitioning to a clinically appropriate alternative or how a provider can submit a prior authorization (PA) for the drug. When the prescription was attempted to be collected after the official transition period, we provided a one-time courtesy override to still allow access to the medication and worked with your provider to submit a prior authorization for the drug. The initial information submitted by the doctor for the prior authorization did not meet the clinical criteria required for coverage, and we then offered clinically appropriate alternative options, which were declined. The required information was communicated to the provider on several occasions to assist with the PA process.  Upon appeal and receipt of the necessary clinical information from the provider, we approved the prior authorization within 1 business day.

  
  Skyrizi for Psoriasis Treatment: Skyrizi was prescribed to ******* as a new therapy after the transition to Rightway on 4/16/24. Approval for this medication requires supporting documentation to ensure it aligns with the **************** of Dermatology's diagnosis and treatment guidelines. Rightway received the initial approval request approximately 10 days after ******* started on samples of Skyrizi provided by the doctors office. Within the request, the provider's chart notes indicated that first-line therapies had not been tried and failed - a requirement from the **************** of Dermatology - prompting us to request additional information from the provider within 2 business days. Despite making 18 attempts via phone and fax to obtain the necessary documentation, we did not receive a response from the provider until July 3. Once the information was received, Rightway approved the request within 2 business days. 

  
  Modafinil for Psychiatric Treatment: ********* was prescribed to ******* as a new therapy after the transition to Rightway and was attempted to fill on 4/16/24. As a new therapy, Modafinil requires prior authorization to confirm the diagnosis and adherence to standard care guidelines. Upon attempting to fill the prescription, we provided the pharmacy a claim notification indicating that prior authorization was needed. As a follow up, Rightway made three phone outreaches and three fax attempts to the providers office to initiate the PA process. In addition to our provider communications, Rightway leveraged our chat function to provide you with regular updates on the status of the prior authorization submission and even provided an alternative submission option through the patient portal to expedite the process. On 8/8/24 Rightway made an additional attempt to speak with your provider. We were successful in obtaining the information we needed verbally from the provider and were able to approve the request on the same day.   

  
  Conclusion
  We regret any inconvenience caused and assure you that we are taking steps to improve our processes. We recognize that your employer had an incorrect address on file for you. We leverage those provided addresses for our print communications. While we employ a multi-modal communication strategy to ensure there are several ways to connect with members about important benefits changes, we recognize the effectiveness of printed reminders. To prevent such issues in the future, we are making renewed efforts to remind employers to encourage their employees to keep their contact details current in payroll and ************ so that we have access to accurate information when contacting you. For life-qualifying events such as transitioning onto COBRA benefits, we will target reminders for employers to communicate these changes promptly. We have resent the copies of the approval and denials for the above medications via mail on 8/8/24, and also provided digital copies via the Rightway member app. 

  
  We understand that obtaining necessary medications for yourself and your family members is a top priority. We are committed to ensuring that you receive the support you need to be on the most clinically-appropriate medications for your needs, following the benefits design of your plan sponsor/employer, and Rightways evidence-based review process. Our goal is to provide seamless and efficient support to our members. If you have any further concerns or require additional assistance, please do not hesitate to reach out to our member services team.

  
  Thank you for your understanding and for allowing us the opportunity to address these issues.
  

  
  

• Initial Complaint

  01/16/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I called Rightway asking why I'm paying a copay for the same medication that I was not paying a copay last year; they said they don't know and they can't help me.

  Business response

  01/29/2024

  Dear **********,
  I trust this message finds you well. I'm reaching out to discuss your recent call on 1/15/23 regarding concerns about the copay for two medications totaling $10.89. During your conversation with our team, you mentioned that you had historically paid $0.00 for these medications and were confused about the change since joining Rightway in 2024. I want to personally address the issues raised in your complaint.

  Rightway configured our system in alignment with the approved benefits provided to us. Based on your concern, we regrouped with the plan sponsor who identified that we were not provided complete information. We are now actively working with the plan sponsor to understand the new requirements and will update our system to align with the new benefits. Your copay will now be $0. In the interim, Rightway will reach out to you to place a copay override as we update our systems.

  In terms of providing you satisfactory service, upon review, I acknowledge that there were missed opportunities during your conversation with our team that I would like to address, specifically as it relates to a comprehensive explanation of benefits. We recognize the need for a more detailed and comprehensive explanation of your overall benefits. We should have ensured that you fully understood the changes in your coverage and felt confident in navigating the copay structure.

  I sincerely apologize for any confusion or frustration caused by this missed opportunity. It is my commitment to continuously improve our customer service, and your feedback is invaluable in this process. To address this matter, I am implementing additional training for our team to ensure we are equipped to provide more thorough and informative responses to your inquiries. I appreciate your understanding and patience as we work towards enhancing our service.

  If you have any further questions or concerns, please feel free to reach out to your Rightway care pod directly at ************** or ***************************** so that we can provide the necessary assistance and clarification.Thank you for bringing this to my attention, and I appreciate your role in improving our services.

  Customer response

  05/09/2024

  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 and the matter has been resolved.
  
  Sincerely,
  
  *****************
  
  
  
   
  
  

• Initial Complaint

  02/27/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Rightway Healthcare advertises itself to be a personable and tech-based pharmacy benefits manager (PBM). As such, my employer contracted with Rightway for 2023 as a replacement to our previous PBM. It is now the end of February 2023, and the Rightway mobile app (which is the primary method we, as employees, are supposed to use to interact with the company) does not work as advertised. For example, Im supposed to be able to see the cost of prescription drugs (both those I have already filled and those that I might fill in the future), but instead I am shown error after error for most medications. Rightway, as a PBM, is also supposed to provide regular (at least weekly) updates to our main health insurance provider (Aetna) regarding our deductible spend. This vital information transfer function ensures that individuals do not spend more on healthcare than is required by our deductibles and out-of-pocket maximums. After reporting to Rightway that I couldnt see any of my deductible spend after filling a prescription back at the end of January, I have gotten no resolution to the issue four weeks later (its now the end of February). Rightway claims that theyre still working on the issue, but this technological function should have been live well before our plan year began. I cant seek new medical care until the deductible issue is fixed without risking paying significantly more than I am supposed to. In any case, its simply distressing that a healthcare/pharmacy benefit manager hasnt prioritized ensuring that their core product works before selling it. I just need my insurance to work as intended. Ive attached a screenshot that shows their error message when loading the cost of a specific drug, and Ive also attached a view of my main deductible spend from Aetna, which should show as over $500 as of today, but instead shows $0.

  Business response

  03/07/2023

  Dear ******,

  
  We sincerely apologize for the inconvenience these issues may have caused you. We know it can be distressing to not have clarity into your healthcare expenses including your deductible spend and prescription costs. At Rightway our goal is to create a high-tech, high-touch consumer experience that empowers members to make the best decisions for their health. We value our members and understand the need to access your benefits information, and this should not have happened.

  
  It appears you had difficulty viewing the cost on your medications. At the time you requested a price check, the medication had recently been filled, therefore the medication was flagged in our systems as too soon to refill which created an error message. We are working to (1) adjust our systems to surface medication pricing irrespective of medication refill status and (2) create tailored error messaging with clear next steps. 

  
  In regard to your deductible, based on the requirements from the insurance carrier, Rightway has been actively exchanging accumulator data with the carrier every two weeks as of 2/8/23. Rightway and the insurance carrier have been engaged in reviewing connectivity concerns that the carrier was experiencing which was ultimately resolved by the insurance carrier on 2/27/23. To ensure that the insurance carrier has updated information, two catch up files were provided which contained data from 1/1/23 through 2/5/23 and 2/5/23 through 2/19/23. Rightway is currently pending confirmation that the insurance carrier has processed the files successfully. 

  
  Again, we sincerely apologize for the inconveniences you have encountered and are dedicated to continuing to improve your experience with Rightway. Thank you for your feedback. Should you have further questions, please do not hesitate to contact us at *****************************************.

*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. ↩