In October my doctor at the cancer hospital called CVS Caremark PBM for a prior authorization and was told until I am denied coverage for the rx one can not be requested. On 12/5 I was informed by my local pharmacy that I was formally denied coverage for my doctor’s rx by CVS Caremark PBM . I asked for the price difference and the pharmacist totally flipped out on me. I was told with venom based negative affect that he would not dispense any rx for me that was not consistent with the CVS Caremark PBM rx for me. I told him that CVS Caremark PBM is not my doctor has never even seen me and that their rx for me was an unauthorized reduction in my rx. He became even more angry reiterated that he will not dispense any rx that differs from what CVS Caremark would cover and that what I was trying to do was have him fill two different rx and he was not filling two different rx like that for me that he would only dispense the CVS Caremark PBM rx or I would need to find another pharmacy and hung up on me.
Steve, I don’t think I have ever been treated like such garbage in my life and for sure the entire pharmacy staff and customer base in that small apothcary heard it the entire tirade. Big issue too is that I no longer even have physical access to my rx bc it is e-scripted to the pharmacy. I also had a very bad reaction to fillers in varied pharmco brands of my liquid medication so can only tolerate vistapharm liquid bc I become deathly ill from Edetate Disodium. So my rx even reads vistaapharm brand only which is a special order.
I am being denied legitimate access to pharmaceutical care and benefits for valid medical needs and I doubt anyone cares or will help even if it is illegal. The ADA is no help. I am not on medicaid and although I sent an email complaint to CT Commission of Pharmacy Drug Control regarding CVS Caremark PBM over reach,patient profiling,practicing medicine without a license and making unauthorized reductions to my medication resulting in a denial of access to needed care I do not hold high hopes of any regulatory response. It is now acceptable to treat anyone on pain medication like a third class citizen with no rights in this country. This situation has become very out of control and very abusive. The cancer hospital will again try to obtain an authorization however this entire situation is egregious and they said unless patients are receiving direct chemo or radiation they are frequently being denied access to prescription pain medication on a daily basis now since CVS Caremark PBM has been allowed to operate this way with immunity. According to them none of the regulatory oversight is commenting or wanting to be involved. I am very concerned that significant medical issues and pain management related issues that are now somewhat controlled allowing me some semblance of quality of life are at grave risk to resurface and do not think that I should become a victim to a “Customer Care” Team that is unlicensed to practice medicine, patient profiling and allowed to remain anonymous. Its all pretty awful…
Just imagine if this is how CVS Health is functioning as JUST a Pharmacy/PBM… just imagine what is to come if the FEDS approve them to buy Aetna and they also become the HEALTH INSURER..
Is it just me… or has CVS quietly dropped their tag line “Where HEALTH is EVERYTHING”… maybe they need to start using the tag line “It is OUR WAY or the HIGHWAY “
One thing that any pt having a C-II prescribed is to INSIST on getting a paper prescription.. because if the pharmacy receiving the electronic order can’t/won’t fill it .. it becomes DOA.
The DEA now allows the receiving pharmacy to transfer the C-II to a different pharmacy… states have to change their state laws to conform to what the DEA allows and all the pharmacy’s Rx dept software has to be modified to conform… the last time that such a DEA change was made – allowing C-II to be electronically submitted… it took YEARS for states and software companies to “get in line” and it became legal to do.
The same is in limbo right now with DEA allowing pts to get less that the full quantity prescribed and are now entitled – by the DEA – to get “refills” up to the total quantity originally prescribed… but until the states and software companies get their act together… many pharmacies will not be able to do it.
Filed under: General Problems
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