ComplaintsforMaxor National Pharmacy Services, Corp.

• Initial Complaint

  03/22/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Dear BBB/Sir/Madam, Good morning to you. My name is ******* ******* and I am writing to seek your help with a denial of medication from my insurance company, a Texas based company called Maxor Plus. I am retired military from the U.S. Army and after I retired, I developed a condition in my esophagus called ********* Esophagus. Essentially, pre-cancer in my esophagus. A condition that places me at risk for cancer in my esophagus which has a 13% survival rate. I have tried multiple medications to control my symptoms over the years (over 6) and the only one that works for me is ******** 30MG x 2. I have a specialist that routinely scans and biopsies my esophagus to ensure it does not develop into cancer. I provided this very compelling letter of medical necessity from my physician and was denied this critical medication from my insurance company. They cited medical literature that suggests that one medicine for this purpose is not better than the other. Completely ignored the fact that I am a patient and not all patients nest or fall into categorical studies used to produce medical literature. If I had a wart on my hand and was seeking cosmetic cream, I would understand. Maxor Plus should be ashamed of themselves. I would like some assistance addressing this company for this shameful decision. I am hopeful you can help. I am happy to provide their decision and the letter from my doctor, a renowned physician who practiced at ** ******** for many years. Thank you in advance for any help. Sincerely Yours, *******

  Business response

  04/15/2024

  Thank you for the opportunity to respond to this member’s complaint. We understand his frustration and hope this response will offer additional insight to help him understand the coverage decision.

  MaxorPlus administers this member’s prescription drug benefit in accordance with the rules determined by his health plan.  MaxorPlus does not control the health plan’s drug coverage and is not authorized to change the health plan’s drug coverage. In this situation, the member requested a drug that is not covered by his health plan. The drug sought by the member is part of a class of medications wholly excluded under his health plan.

  The member requested a prior authorization to obtain the prescription drug. The prior authorization was denied because his health plan does not cover the drug.  MaxorPlus informed the member of his appeal rights. The member submitted his first appeal and an independent review organization upheld the denial. The member then appealed a second time and a different independent review organization also upheld the denial based on the documentation provided by the prescriber. Importantly, appeals are reviewed by physicians with the same or similar specialty as prescriber.

  Therefore, MaxorPlus, as a benefit administrator, is unable to authorize payment for the requested drug by the member’s health plan.  

• Initial Complaint

  02/12/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  They are the most horrible pharmacy ever on the face of the Earth. They cannot seem to get it together and get my prescriptions to me. It has already caused me to have an eye surgery and I still cannot get the prescriptions I need for the other eye which is going to cause me to have to have another eye surgery because they refuse to let me fill my prescriptions at any other pharmacy through my insurance. I don't even get my diabetes medication through them because because I can't get it timely it is costing me out-of-pocket every month to get my prescription for my diabetes filled and not through my insurance so it doesn't go to go towards my high deductible at all. I have been fighting with them for over 3 years now and I am sick and tired of their ***. I want to be free to fill my prescriptions at the pharmacy of my choice and not be forced like a Communist to order through them.

  Business response

  02/19/2024

  Thank you for the opportunity to respond to Ms. ******** complaint and general dissatisfaction with MaxorPlus and MXP Pharmacy.  I certainly understand her frustration with the delay in getting her prescriptions. 
  
  From our research into the situation it appears that Ms. ******** physician was sending the prescriptions electronically to Maxor Specialty Pharmacy and they were not valid specialty medication prescriptions so Maxor Specialty could not fill them.  Messages were sent back to the physician electronically indicating they were being sent to the wrong pharmacy.  The member contacted us on 2/5/2024 and we informed her that we did not have the prescriptions.  We made contact on her behalf to the provider to make sure they are sending them to MXP Pharmacy and received the prescriptions on the same day.  The member received text notifications that new prescriptions were received that day. 
  
  On 2/6/2025 we sent notifications that there was a delay with her order and to please call us for more information.  The notifications were sent to get approval for the short day supply (less than a 90 day supply) prescribed by the physician and the high copays associated with them. 
  
  We received a contact us email from the member on 2/11/2024.  It was evident from the email that Ms. ****** was very unhappy so the supervisor working that day called the member directly.  She discussed the short day supply and the high copays with Ms. ****** and Ms. ****** approved both.  We confirmed during that call that we had the correct number for the notifications and she had received the them.   The prescriptions were released to be shipped.  The shipment went out on 2/12/2024 and received by the member on 2/13/2024. 
  
  I’m sorry that Ms. ****** has elected to go outside her pharmacy benefit for her diabetic medication.  The last fill for diabetic medication through our pharmacy was in February 2022.  We could find no history of issues with the orders that were sent to her then or prior. 
  
  Ms. ******** prescription benefit plan sponsor requires that maintenance medications, which these are, be dispensed through home delivery.  I understand Ms. ******** frustration with this requirement, however we, as the benefit administrator, are unable to make the decision to allow her to fill her prescriptions locally.  As a URAC accredited pharmacy benefit manager and home delivery pharmacy we are required to inform Ms. ****** that she has the right to appeal any dissatisfaction with the resolution to a complaint to her plan sponsor.  

  Customer response

  02/20/2024

  I agree that the prescriptions did finally get sent to me however I still feel like I should be able to fill my prescriptions at any pharmacy of my choosing this is ridiculous requirement for this stupid insurance plan that I have no control over. I refuse to get my diabetic medications through them they are ridiculously expensive and I cannot guarantee I get them on time so I will continue to go outside of their dumb pharmacy to get my diabetic medication field at my own expense.   I am hoping with all the other complaints that my co-workers are sending to the VI p's of the company that soon we will not have to deal with them anymore.

• Initial Complaint

  12/14/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  11/08/23: a prescription was filled for generic *******, the out of pocket cost I ended up having to pay amounted to $111.94. I was told that my insurance would not pay for the prescription so I was offered the use of a manufacturer’s coupon to help cover the cost. I accepted and it brought the price down for me. 11/15/23: on this day I filled another prescription for generic *******, the out of pocket cost amounting to a price of $122.94. I was again told my insurance didn’t cover it and offered a manufacturer’s coupon to help cover some of the expenses. 12/08/23: on this day I filled a prescription for generic *******. I was under the impression that this payment would have me meet my deductible and finally start to cover costs leaving me with only a copay. The price ended up amounting to $140.70 after the manufacturer coupon. That weekend I checked my insurance benefits to make sure I’d chosen the correct plan. It said I had but my prescriptions weren’t in my deductible costs. I called my insurance to inquire why that was and they forwarded me to this company. This company proceeded to tell me I had met my deductible and should start only paying the copay, then backtracked and said that my claims were reversed and that they didn’t know why. They said the pharmacy did it, when I asked for the number so I could contact them and ask why, they gave me a random number that was forwarded to a strangers cell phone. He knew nothing about what I was talking about. I called back and told them i was going to the pharmacy on break and putting them on speaker so we could get to the bottom of this. Twenty minutes later they magically found the correct number to my pharmacy and spoke to “Brooke” who told them that my claims were reversed because of the copay accumulator program. This company lies about why they won’t meet your deductible and gives you fraudulent generated numbers to call to send you on wild goose chases. I’m calling them everyday until I’m reimbursed.

  Business response

  12/20/2023

  We appreciate the opportunity to respond to this complaint.  I’m so sorry to hear of the issues that Ms. ***** had with her pharmacy.  This is not uncommon when members use a discount service like ****** or **********.  One of our supervisors has spoken with Ms. ***** and I believe she understands the situation and how these discount programs do not go through the prescription benefit, and no out of pocket expenditures will accumulate toward deductibles or out-of-pocket maximums as determined by the plan.  Our supervisor also spoke with the pharmacy and they stated that they inform the patient when using these discount programs that they are not processing through the prescription benefit and nothing will go toward the deductibles or out-of-pocket maximums, but of course, we have no way of knowing if that was the case here or not. 

  About the incorrect phone number for the pharmacy being given to Ms. *****, we apologize.  The agent Ms. ***** spoke with followed our standard process and gave her the phone number that was listed on the pharmacy record within our adjudication system.  This information is updated electronically on a regular basis based on NPI and NABP information fed to us through NCPDP (National Council for Prescription Drug Programs).  The phone number for the pharmacy evidently changed at some point and it was probably never updated with these agencies – that is not uncommon either. 

  It is our responsibility as a URAC accredited pharmacy benefit manager to inform any member that if they are not satisfied with the resolution of a complaint they have the right to appeal to their plan sponsor.  Please let us know if we can be of any further assistance with resolving this complaint.  

• Initial Complaint

  06/05/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Maxor Committed to ship priority over night, they failed to do so and refused to refund me the charges to ship priority. This has happened three times and I think it is time to make them accountable. I want an explanation.

  Business response

  06/09/2023

  We also received a written complaint from Mr. ******** late on 6/3/2023.  With reduced staff and reduced hours over the weekend we were able to start the research into his complaint on Sunday 6/4/2023.  Our supervisor on duty contacted Mr. Heitmann on 6/4 and discussed with him our shipping policy, processing timeframes and circumstances of his specific situation.  The processing time of the order was within our standard policy.  The overnight shipping charge was waived by the pharmacy; the ********** were not charged the overnight shipping charge.  We reviewed multiple calls and did not find any other issues around shipping charges.  After discussion with our supervisor, Mr. ******** was satisfied with the resolution of no overnight shipping charge.

• Initial Complaint

  01/09/2023

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  Maxor plus has repeatedly given me incorrect information regarding my medication and prices. I am still waiting for compensation from July/august where I was told I was receiving a full 3 month supply of medication and was only sent one and to date nothing has been done. I try to fill my insulin repeatedly and I’m told it’s all set but never comes then I call several times more and still they didn’t ship. I went 3 weeks without insulin. This is a constant with them. I again ordered my insulin Thursday and was told it would ship. I had not received shipping text so I called and they said oh it needed prior authorization but this is incorrect as my dr called it in and then I was hung up on. I have diabetes and need a trustworthy company to provide my medication in a timely manner. I will sit here again with out my diabetes medications. Not one but two this time. I want them to release my medication and let me pick up at a competent pharmacy where my health will not be in jeapordy every order and over charged. I’d like my money that was taken returned.

  Business response

  01/30/2023

  Response sent to BBB 1/27/2023
  Re: Complaint #********
  Ms. ******* is a member of a plan that requires all brand medication go through MXP Pharmacy (mail order) after two retail pharmacy fills.  In June 2022 Ms. ******* requested an additional retail fill beyond what was allowed by her plan.  The approval was given by the plan account executive for an additional retail fill for a 15-day supply and she was informed that no additional retail fills would be allowed.  We requested that Ms. ******* get with her doctor and request a 90-day prescription be sent to MXP Pharmacy.   It is our understanding that Ms. ******* was then referred to a specialist but still needed a fill for her current medication while waiting on the specialist appointment.  Our team went above and beyond to work with the retail pharmacy that still had an active prescription on file to transfer the prescription over to MXP Pharmacy.  The prescription that was transferred was a 30-day prescription so the maximum that could be filled for the member was for a 30 day supply.   The plan specifics state that copayment for a preferred brand maintenance medication for up to a 90 day supply is $70.  We confirmed with Ms. ******* that she was aware of the copayment and she confirmed she was aware.  As a courtesy, MXP Pharmacy agreed to waive the overnight shipping charge since she was almost out of medication.  It is my understanding that Ms. ******* believes she is due a refund because she paid a higher copay for the 30-day supply and the new doctor decided to change her medication to something else.  It is standard policy across the industry that copays are not refundable if a physician changes the prescription to something else.  If the new doctor had sent a 90-day prescription for the same medication with same dosage and strength we would have considered filling the remaining 60-day supply with the copay already paid by Ms. *******. 

  
  It appears that over the course of the last several months that Ms. *******’s medication has been changed and adjusted by her physician.  Some of these medications, especially the preferred brands require a prior authorization.  There was at least one instance where the physician never responded to our request for information so the prior authorization could proceed.  Also, there are certain medications that require shipping arrangements due to refrigeration and these are only shipped on certain days of the week.  We notify Ms. ******* via text message when the order is ready for shipping and she will call in to let us know when she would like to receive the medication.  All of these are shipped overnight as part of the overall cost of the medication that is covered by her plan.  There is no indication in our claims history for Ms. ******* that she has been without medication for any extended length of time, especially approaching 3 weeks.  Her last shipments of medication were on 1/11 (received on 1/13 non-refrigerated) and 1/16 (received 1/17 refrigerated).   Our standard turnaround time for shipments is 5 business days from fill request to delivery if no intervention (i.e prior authorization) is required.    

  
  All pharmacy benefit plans are set up differently and make different requirements of their participants.  In this particular instance Ms. ******* is required to get her preferred brand medication filled through MXP Pharmacy.  Prior authorizations for medications in certain classes, and particularly those that require additional clinical oversight, are not uncommon and is a process that usually takes 1-2 business days if physicians are responsive to our requests for information.  I would suggest that if her physician is trying out or adjusting her medication that she take advantage of the two retail fills her plan allows before requesting a 90-day prescription be sent to MXP Pharmacy.  As long as the medication, dosage or strength is different it should go through with no problem until the mandatory mail order requirement kicks in after the first two retail fills. 

  
  Please let me know if there are any questions or need to discuss further. 

  Customer response

  01/31/2023

  
  Complaint: ********
  
  I am rejecting this response because:
  This is a long explanation but does not address the issue. I specifically asked representative twice if this was for a 3 month supply and twice I was told yes  I did not receive what I paid for and made sure to ask repeatedly  a manager confirmed she listened to call and she did hear this as well  had I known this was for a 15 day supply I would not have moved forward with purchase again that is why I asked twice   I am asking to be refunded since I was lied to about my prescription and was given incorrect information regarding my medication and cost  again I asked for confirmation twice  the call was recorded and you do have it so maybe you should listen again and send a copy here as well if you are going to refuse to take responsibility for your repeated errors  I made an informed decision on the false information your company gave me and for that I am not responsible  like any company or person when you make a mistake on your part you need to take responsibility and make it right  I am only requesting what you stole me  

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

• Initial Complaint

  01/21/2022

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have been trying for a week or more to get my prescription from my pharmacy for my sever asthma. This company Maxor, refuses to allow me to have my medicine because it isnt through Mailorder. I dont do mail order because of people who steal packages and will steal my items. This company has 1 of three choices. remove this feature from my phone, drive my medicine to me immediately or pay my medical bills when I end up in the hospital. I am done with this run around.

  Business response

  02/25/2022

  Business Response /* (1000, 10, 2022/02/17) */ Contact Name and Title: Lori ******** Contact Phone: XXXXXXXXXX Contact Email: *********@maxor.com Ms. *******' prescription benefit plan requires that all brand maintenance medication is ordered for a 90-day supply and dispensed through MXP (Maxor Mail Order) Pharmacy. Ms. ******* joined her employer-provided prescription benefit plan effective 9/1/2021. She has received the maximum number of retail fills allowed by her plan prior to brand maintenance medications being required to go through Mail Order. This issue has been escalated to the Account Executive and Ms. *******' employer. It is the employer's decision whether or not they approve a long-term exception to the requirement and allow Ms. ******* to receive the brand maintenance medications from a local retail pharmacy.

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