https://www.wsj.com/articles/cvs-exploits-pbm-role-and-taxpayers-pay-1529956036
https://insurancenewsnet.com/oarticle/pharmacy-middlemen-reap-millions-from-medicaid
My wife and I have Silver Scripts Part D health insurance… which the PBM is Caremark… which is part of CVS Health.. My wife has a lot of chronic health issues and one of the medications that she has been taking for over 10 yrs I was trying to get refilled and Silver Scripts wanted – once again – a prior authorization for something that they have been paying for … for over 10 yrs.. They told me that the copay – if they approved it – would be $600 and change… for a 90 days supply which is constantly increasing…
I asked the pharmacy that I patronized what they cash price was and was quoted the figure $300 and change… I went out to www.goodrx.com and found a local pharmacy that would charge $87 and change for the same prescription.
If I had the pharmacy that I normally go to fill the prescription and billed Silver Script… I would have been charged $600 and change and they would have reimbursed the pharmacy for far less and claw back the difference http://www.pharmout.com/pharmacy-insights/pharmacy-clawback-issue
This prescription is a controlled substance C-IV medication… so now she is throwing a “RED FLAG” according to the DEA for paying cash for a controlled substance when she has insurance. Is Caremark putting Medicare Part D pts in a compromising position… pay their INFLATED COPAYS or run the risk of becoming a target of the DEA for throwing RED FLAGS ?
Silver Scripts is the 2nd or 3rd largest part D provider … for seniors and disabled on Medicare.
This year, apparently Silver Scripts decided to have “preferred pharmacies” which only they were able to charge the copays that Silver Script charged everyone last year… just so happens there is only 10 preferred pharmacies in Clark-Floyd-Harrison counties – 8 of them being CVS stores and one independent in Jeffersonville & Corydon. This year, our out of pocket expenses have jumped some 30%+ because the closest preferred pharmacy is over 9 miles away and the independent pharmacy that we use will deliver to us…. If we are not able to get out.
I don’t know if some/many at HHS, CMS or members of Congress are asleep at the switch or just turning a blind eye to what is going on.
I have taken my own advice that I regularly handout and have filed a grievance/complaint with CMS (800-MEDICARE) and I have just begun.. When these entities have screwed with others… I can only make a recommendation as to what they can/should do… but now I HAVE SKIN IN THE GAME…
steve
Filed under: General Problems
Here is a number for Pamela Kent, Resolution Dept. Caremark, for anyone who has that coverage. She was very helpful in the past with my issues with CVS Caremark. I’m not sure about Silverscripts although they were my benefit provider at one time when I had a Medicare D plan with them.
Pamela Kent, Caremark
844-353-5604
Ext. 1751530
Silverscrip has screwed me too. For 17 straight months they reimbursed my pain med without any interruption. Then in January at the height of the bogus ‘opioid epidemic’ they denied coverage for this Rx. Back and fourth four appeals later and two calls with the judge and a peer to peer, HHS has provided notice denying me reimbursement for my medically necessary opioid. Then just recently, Silverscript said they would approve it but just through August (for just three months time). Then what? I pay cash?! No answers From SS. HHHs has issued a denial and SS has changed their decision to a three month approval. I don’t know if I’m coming or going….