ComplaintsforCVS Caremark

Health Insurance

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Initial Complaint
11/19/2021
Complaint Type:
Product Issues
Status:
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.
The pharmacy has refused to call me regarding my prescription. I have called them every other day since October 7th and they continue to lie about withholding my medication. they mailed me a letter with full approval on November 15 but deny it over the phone. My health is at risk due to their negligence and they refuse to escalate my request.
Business response
12/08/2021

December 8, 2021

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

Complaint # ********

To whom it may concern:

CVS Specialty Pharmacy was the dispensing pharmacy for the prescription benefits portion of the members health plan. This letter is in response to the correspondence we received from your office on November 13,2021. Thank you for the opportunity to address the members concern.

Upon review, a coverage determination was updated on November 23, 2021 to allow claims to process properly going forward. Prior to the update the pharmacy shipped medication with the following *** tracking numbers 1Z0R544VNW49787326 and 1Z76824WP268122089 to the member and each was delivered on November 23, 2021. The member was contacted on November 30, 2021 to setup an order for supplies to be delivered on December 1, 2021. The supplies for home infusion were shipped on November 30, 2021 via *** tracking numbers 1Z77V750NW73696323, 1Z977203NW10302314,and 1Z265561NW07992758 and each was delivered on December 1, 2021.

We value our members and remain committed to our purpose,bringing our heart to every moment of your health. Should you have any additional questions or concerns, please do not hesitate in contacting me at **************.

Sincerely,

***** Ledbetter
Member Advocate
Initial Complaint
11/17/2021
Complaint Type:
Product Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
On 9/7/21, I purchased two medications from a ******************** in *********, ** out-of-pocket for $38.86 because the administrator of my COBRA plan didn't file my prescription coverage verification in a timely way. Once it was verified, I sought to be reimbursed by CVS Caremark. (CVS Caremark is contracted with MetroHealth to administer prescription benefits for their employee's insurance). I filled out the requisite paperwork and provided the original receipt. All the requested information that does not appear on the receipt, I wrote out by hand and included with my forms. I received a rejection letter on 11/1 stating that I did not have all the necessary information on the original receipt. List of all required items are as follows: patient name, prescription number, date filled, dispensing pharmacy name and address, drug name, NDC #, strength/form, quantity, ingredient cost, gross amount due, days supply, and price. Other information is required including Pharmacy NABP/address/phone #, prescriber NPI, and others, but the initial list must be contained in the original receipt. It is not MH's practice to include every one of these elements in their pharmacy receipt, only some. The requirements of the prescription benefits company should be in concordance with the routine practice of the company with which they have a contract. It is also unreasonable to expect the lay person to find the cost of the ingredients colloidal silicon dioxide, croscarmellose sodium, magnesium stearate, polyethylene glycol ****, polyethylene glycol ****, polyvinyl alcohol, talc, titanium dioxide, and iron oxide yellow in Keppra 500 mg. If "ingredient cost" applies only to compounded meds, it should be explicit. Providing the original receipt from the company with whom they are contracted and information requested should be adequate for routine reimbursement of prescriptions. It is truly no wonder my patients can't go through this rigamarole and wind up not taking their medicines.
Customer response
11/28/2021
I have not heard from the business in response to my complaint. Please advise.

Thanks so much,
*****************************
Business response
12/08/2021
December 8,2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of ********************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 29, 2021. Thank you for the opportunity to address the beneficiarys additional concerns.

The claims were processed on November 30, 2021 and check number ********* in the amount of $16.81 was shipped on December 1, 2021. The check should arrive within **** business days.

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

Sincerely,

***********************************
Member Advocate
Customer response
12/08/2021
[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
11/12/2021
Complaint Type:
Billing Issues
Status:
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.
ON NOVEMBER 9, 2021 CAREMARK ILLEGALLY CHARGED MY CREDIT CARD AGAIN WITHOUT MY KNOWLEDGE OR PERMISSION. I KEEP FILING COMPLAINTS WITH THEM THROUGH THERE WEBSITE AND REQUESTING THAT AN ACTUAL PERSON CALL ME TO DISCUSS MY COMPLAINTS BUT THEY'RE ALL IGNORED. IF I DON'T GET A CALL FROM AN ACTUAL ENGLISH-SPEAKING PERSON IN REGARDS TO THIS COMPLAINT, I WILL TAKE LEGAL ACTION FOR REPEATED CREDIT CARD FRAUD. THIS IS ILLEGAL AND COMPLATELY UNACCEPTABLE. I SHOULD NEVER HAVE ANY UNAUTHORIZED CHARGES ON MY CREDIT CARD BUT THAT'S EXACTLY WHAT CAREMARK KEEPS DOING AND IT NEEDS TO STOP IMMEDIATELY!!!
Business response
11/16/2021
We were unable to locate a transaction in which your credit card was billed on November 9, 2021; however, we did locate a transaction in which your credit card was billed on November 13, 2021 as your credit card was designated as a default status which indicated it was to be billed for all orders. We have updated the credit card and removed the default status and it will require permission before being billed for future orders. We attempted to call you three times, but were unsuccessful. We did leave a voice message advising your credit card has been updated to require permission before being billed for future orders.
Initial Complaint
11/10/2021
Complaint Type:
Delivery Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
CVS caremark mail order prescription has not arrived, and it has gone over the promised timeframe of 5 to 7 days. I am very concerned about running out of this mental health medication, and I find it ridiculous that caremark would use such a unstable shipping service like **** to send out crucial medicines. My medication has always arrived within 1 to 2 days, until now. I have tried to remain in touch with Caremark regarding this, but they told me that even though the package is supposed to arrive no later than 5 to 7 days, they cannot do anything to help me until after 11 days have passed. I think that it is unacceptable that a package that only has to travel 25 miles, should take over 7 days. I would like a replacement order to be resent now, using an overnight company like *** or ****** I think i deserve that free of charge from paying for shipping. This problem happens to many people all the time with the us postal service, and I think caremark needs to use more responsible shipping methods.
Business response
11/17/2021
November 17,2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the Aetna Better Health ********** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 11, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review,we determined the beneficiary placed a refill request and the order shipped on November 3, 2021. It appears there was a delay with the United ********************* ******* The beneficiarys order was delivered on November 14, 2021 via **** (tracking **********************). A representative from our office spoke to the beneficiary on November 15, 2021 and he confirmed he received his medication.

Upon review of the interactions with the beneficiary, the beneficiary was educated on how to obtain a short-term supply of medication to ensure he was not without medication.

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

Sincerely,

***********************************
Member Advocate
Customer response
11/17/2021
[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
11/01/2021
Complaint Type:
Billing Issues
Status:
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.
I am filing a complaint about the ********************** in ***********, **, which is part of *** **** This is an ongoing situation, which began in 2019 and continues today.This pharmacy has billed me hundreds of dollars more than necessary, and I have no choice but to pay it if I want to keep receiving my life-saving medication. That is the pharmaceutical equivalent of putting a gun to my head and demanding money.I began using the *** Specialty Pharmacy after my transplant in 2016. My insurance company, Caremark, requires me to buy my transplant medication that pharmacy.All was well from 2016 through 2018. I had (and still have) two insurances, Caremark and ********* which they billed appropriately. Shipments were sent on time.In 2019, they stopped billing ********* In response to my numerous calls and messages, they repeatedly insisted that my ******** ended in 2016. I then had to pay cash for my drug copays that ******** should have paid. To save money, after repeatedly refusing to acknowledge my ******** account, I switched my prescriptions from 30-day (required by ********) to 90-day (cheaper copays) supplies.In 2021, my copy became $250 per prescription, whether 30-day or 90-day. Although my doctor wrote my prescriptions as 90-day supplies, *** changed them to 30-day supplies so they could charge me $250 a month, instead of $250 for three months. Then, they suddenly remembered I have ********* but began charging my regular health insurance instead of my prescription insurance. It's crazy.I've tried to understand their billing history, but it's not written in a logical fashion.Right now I have a balance of over $300 that should have been covered by insurance. And I have to pay it if I want to keep receiving my medication.
Customer response
11/14/2021
I have not heard from the business in response to my complaint.
Business response
11/17/2021
November 17, 2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the *********** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 2, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review of the concerns, we determined the beneficiary has prescription drug coverage with both CVS Caremark and ******** Part B. Each is listed as primary. As a result, the specialty pharmacy can only **** one prescription drug plan. For this reason, the beneficiary had a balance on her account from.

Additionally, the specialty pharmacy confirmed the beneficiarys ******** Part B plan only allows 30-day supplies; therefore,when the ******** Part B plan is used, the prescription is filled with a 30-day supply.

The specialty billing team has removed the account from collections. A one-time courtesy was approved, and the balance was removed from the beneficiarys account because she was not quoted the copay for the orders. The beneficiary has a $0.00 balance. The specialty billing team called the beneficiary to confirm which coverage should be primary, and which should be secondary; however, they have not been able to speak to her. Once this information is updated, the beneficiarys future orders will **** both prescription drug plans.

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

Sincerely,

***********************************
Member Advocate
Customer response
12/07/2021
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.
This response does not address the full problem. She mentioned the recent ****, but not the fact that CVS has been charging me instead of my insurance since 2019. And WHY do they think I have two primary insurances, when I already told them that ******** was secondary? They do NOT make real attempts to contact me. In fact, when there was an issue with a past prescription, I asked why they didn't contact me first. I was told that they just sent it without contacting me first because I had a credit card on file. That's why I no longer keep a credit card on file, hoping it would improve communication.
At this point, working with CVS has become so stressful that I get panic attacks when I try to refill my prescriptions.

Business response
12/16/2021
December 16, 2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the *********** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on December 7, 2021. Thank you for the opportunity to further address the beneficiarys additional concerns.

As previously advised, we determined the beneficiary has prescription drug coverage with both CVS Caremark and ******** Part B. Each is listed as primary. As a result, the specialty pharmacy can only **** one primary prescription drug plan.

Upon review we have confirmed that it is the beneficiarys responsibility to update both insurances to coordinate benefits. The specialty billing team advised they have had many exchanges with the beneficiary between February 2019 through November 2021, to confirm which coverage should be primary, and which should be secondary. While the beneficiary advised on September 6, 2021 her Caremark insurance was primary and ******** Part B was secondary, both were still listed as primary when billed. The most recent attempt to contact the beneficiary was November 2, 2021, however, the specialty pharmacy left a message. Once the beneficiary contacts both plans to have the coordination of benefits updated, her future orders will **** both prescription drug plans.

Additionally, a benefits verification for ******** Part B was done on February 17, 2020, the specialty pharmacy was advised that the coverage terminated on December 31, 2018.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
10/28/2021
Complaint Type:
Customer Service Issues
Status:
Resolved
The complainant verified the issue was resolved to their satisfaction.
CVS sent me a **** for my prescriptions and my wife's prescriptions. They send us all of the medicine at once and did not wait for us to ask for a refill. I sent them a letter telling them to stop automatically sending us our medicine. With that letter I sent a money order of $216 to pay for BOTH my portion and my wife's portion of the prescriptions. They are sending me bills saying I still owe my portion of the prescriptions, which would be $73. The money order covered both of us. I do not owe this money but they are insisting that I do. I want to stop getting double billed for something I already paid for.
Initial Complaint
10/27/2021
Complaint Type:
Service or Repair Issues
Status:
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.
CVS is by far the worst pharmacy on the planet. My doctor prescribed meds and my insurance approved the prescription exactly one month ago and yet you still refuse to send me my meds. I have made 6 phone calls, each call lasting at least an hour and NO RESULTS!WHY ARE YOU REFUSING TO SEND MY MEDS AND CAUSING ME TO SUFFER, NEEDLESSLY?
Business response
11/17/2021
November 17, 2021

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

Complaint # ********

To whom it may concern:

*** Specialty Pharmacy is the dispensing pharmacy for the prescription benefits portion of the beneficiarys health plan. This letter is in response to the correspondence we received from your office on October 28, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review of the concerns, the medication in question requires a prior authorization. The prior authorization requests for this plan are handled by the plan, not Caremark. The specialty pharmacy confirmed the prior authorization request for the medication was approved on September 28, 2021. However, this approval was for the maintenance dose, not the starter dose. The starter dose was approved on October 27, 2021.

The medication shipped October 27, 2021 and was delivered to the *** pharmacy on October 28, 2021 via *** (tracking number 1Z786FX92904731431) per the beneficiarys request.

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

Sincerely,

***********************************
Initial Complaint
10/26/2021
Complaint Type:
Product Issues
Status:
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.
I am a retired Connecticut State Trooper and Caremark is the prescription drug coverage supplied by the State Of Connecticut. I must purchase prescription drugs as needed and get reimbursement from Caremark after submitting a claim. I have three prescriptions that I fill every 90 days and have been doing so since approx 2014 the same prescriptions over and over. Caremark says it pays claims approx 90 days after receiving claims. But I have submitted approx 10 claims in 2021 and have received only ONE reimbursement for ALL OF 2021. Outstanding claims total approx $1,000. They used to pay claims a bit slowly but now I get NONE and they claim they never received approx 5 claims and I had to resubmit them AND STILL NO PAYMENTS.
Business response
11/17/2021

November 17,2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the ******************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on October 27, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review,we determined that the claims department has not received any claims since the previously processed claims on July 30, 2021. The claims team verified the beneficiary should send his claims form and the required receipts to:

CVS Caremark
PO ************************************************************************************** the beneficiary included his claims form and the receipt, the claims team advised there was only one receipt that was legible and showed the medication. The claim was processed on October 28, 2021 and check number ********* in the amount of $20.67 was shipped on October 29, 2021. The check should arrive within **** business days but could take longer since it was sent to a foreign country.

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

Sincerely,

***********************************
Member Advocate
Customer response
11/18/2021
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.
Their response is UNTRUE. All the 8 or so claim forms I sent, they told me they do not exist, so they were RE-SENT USING THE EXACT SAME CLAIM FORMS and they are perfectly legible. This is just an excuse.

If need be I can send the exact same claims to BBB and you can verify that they are legible.
Business response
11/29/2021
November 29,2021

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

Complaint # ********

To whom it may concern:

CVS Caremark administers the prescription drug benefits portion of the ******************** health plan, of which the beneficiary is a member. This letter is in response to the correspondence we received from your office on November 18, 2021. Thank you for the opportunity to address the beneficiarys additional concerns.

Upon review,we determined that the beneficiarys point of contact, *****, received paper claims on November 13, 2021 and November 16, 2021. The claims were processed on November 23, 2021 and check number ********* in the amount of $225.24 was shipped on November 24, 2021. The check should arrive within **** business days but could take longer since it was sent to a foreign country. Additionally, Manidipine/Madiplot is not available in *****************. The claims team used Nifedipine as the substitute. In the future, the beneficiary would need to provide ****** equivalent if it is not Nifedipine.

The beneficiary was enrolled in the Adopt a Member program on July 27, 2020. Typically, a member is enrolled in the program for six months; however, ***** will be the beneficiarys permanent point of contact. Therefore, the beneficiary can continue to send his paper claims to *****, and she will assist with getting them processed.

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

Sincerely,

***********************************
Member Advocate
Customer response
11/29/2021
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.

Those claims are correct. BUT they still have not processed claims from:

1-20-2021
1-29-2021
3-11-2021
4-23-2021
7-23-2021
08-20-2021
09-17-2021

5 of them were submitted FOR THE SECOND TIME 08-16-2021 to Laura @

****************************************
Initial Complaint
10/25/2021
Complaint Type:
Service or Repair Issues
Status:
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.
On july 29th my dermatoligist gave me a prescription for otezla. it went to CVS specialty pharmacy when i called them to ask questions they started taking all my information. i told them to hold on don't send me anything right now, i'm working with AMGEN corporation to get the price down. don't send me anything. then in september a package came via **** it was otezla and it was from CVS. i called them immediately and said" ah what happened i told you guys not to send me anything until i got a decision from AMGEN" they didn't know what to say. i said i can send it back. they said no they can't take it back. i said i told you not to send it to me. and now a few weeks later they send me the **** its $ *****. because this was their mistake i don't feel that i should have pay any of this. i feel bad for them someone made a big mistake but it was not my fault.
Business response
11/17/2021
November 17, 2021

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

Complaint # ********

To whom it may concern:

CVS Specialty Pharmacy is the dispensing pharmacy for the prescription benefits portion of the beneficiarys health plan. This letter is in response to the correspondence we received from your office on October 26, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review of the concerns, we confirmed the beneficiary has a balance of $4,234.77 on their account for an order filled on September 14, 2021 for the medication in question. The beneficiary was informed the order would not ship while he was working with Amgen regarding the copay assistance; however, the order shipped in error. The **************** the beneficiary received did not meet our level of expectations. We have asked management to review this matter for coaching, training, and process improvement opportunities.

The specialty pharmacy attempted to call the beneficiary on October 26, 2021, October 29, 2021, and November 1, 2021, to apologize for the shipping error and discuss the return of the medication; however,the specialty pharmacy was unsuccessful in reaching him. The beneficiary was also sent an email on November 2, 2021 requesting he contact the specialty pharmacy. The beneficiary would need to call the specialty pharmacy at ************** to return the medication for a credit, or he would be responsible for the balance on his account.

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

Sincerely,

***********************************
Member Advocate
Initial Complaint
10/21/2021
Complaint Type:
Service or Repair Issues
Status:
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.
My insurance only allows me to use CVS Speciality Pharmacy. In November 2020, I changed to the MS drug Vumerity. Biogen created a new copay number, but CVS used the old number from the other drug. CVS sent me the drug, and then tried to bill me for $1433.04. I am under a $0 copay program with Biogen. Now CVS has turned this bill over to collections, and will not send a presciption until I pay that bill. Myself and Biogen has tried many times to get this issue resolved. Please help get this issue resolved. I need this to get this critical medication to keep my MS from flaring up and causing relapse. Attached is from the web site where this issue had appeared to been resolved.
Business response
11/15/2021
November 15, 2021

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

Complaint # ********

To whom it may concern:

CVS Specialty Pharmacy is the dispensing pharmacy for the prescription benefits portion of the beneficiarys health plan. This letter is in response to the correspondence we received from your office on October 22, 2021. Thank you for the opportunity to address the beneficiarys concerns.

Upon review of the concerns, we confirmed the beneficiary has a balance of $1,433.04 on their account for an order from November 17, 2020. The beneficiarys copay assistance did not become effective until November 23, 2021 and therefore the claim rejected for filling before coverage became effective, when it was processed with the copay assistance. The specialty pharmacy called Biogen, the copay assistance, and they were advised the claim rejected correctly and they are unable to back date the start date. The specialty pharmacy also confirmed there were no errors with this order. Therefore, the balance from November 17,2020 is the beneficiarys responsibility.

Additionally,the beneficiary was contacted on October 25, 2021 and delivery of the medication was set for October 29, 2021. The beneficiarys medication was shipped October 28, 2021 and delivered on October 29, 2021 via *** (tracking number 1ZV826F6P224353092). The beneficiary had a $0.00 copay for this refill.

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

Sincerely,

***********************************
Member Advocate
Customer response
11/15/2021
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.
We would have waited until to copay assistance had started. We would not have accepted receiving these meds until the Copay issue was resolved.

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

FAQ

Regards,
*****

Business response
11/23/2021
November 23, 2021

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

Complaint # ********

To whom it may concern:

CVS Specialty Pharmacy is the dispensing pharmacy for the prescription benefits portion of the beneficiarys health plan. This letter is in response to the correspondence we received from your office on November 16, 2021. Thank you for the opportunity to address the beneficiarys additional concerns.

Upon review of the concerns, the specialty pharmacy verified the beneficiary was informed of the copay on November 17, 2020 and were advised she would call back to place the order. The beneficiary called on November 18, 2020 and stated she thought the medication was already ordered. The representative informed her the order was in process. The beneficiary asked if she needed to call the copay assistance and the specialty representative informed the beneficiary, she needed to call the copay assistance herself. The beneficiary confirmed she would call the copay assistance and did not dispute the order or shipment.

As previously stated, the specialty pharmacy called Biogen, the copay assistance,and were advised the claim rejected correctly and they are unable to back date the start date. The specialty pharmacy confirmed there were no errors with this order. Therefore, the balance from November 17, 2020 is the beneficiarys responsibility.

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

Sincerely,

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

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