My CVS Caremark plan and a T1D friend's CVS Caremark plan from a different company both list DEXCOM as excluded from coverage starting this year 2022. This was covered the last several years under the same plans, but was specifically excluded starting this year.
Anyone else can confirm that they are also having this issue?
My alternative is to contact the medical insurance to get it pre-authorized as a necessary DME (durable medical equipment) which means paying the deductible in full with the first Dexcom supply each year. Very costly since the deductibles aren't that low.
Hi, I got a letter in the mail from CVS Caremark saying my prescription is “notice of adverse determination”. I have been on medication for about 6 months and have had no issues filling at local pharmacies. My psychiatrist has also not mentioned any issue with my health insurance. For reference I’m in NC with blue cross and blue shield with great coverage. I’m anxiety the letter says I will need to appeal the decision? Is this just a scam or legit? My office doesn’t open until tomorrow and I’m just very worked up about it. Has anyone else received this letter?
Anyone have the bin n group numbers for the new cvs card. The rejections with check new card and inactivate this old cvs plan one.
I have tried from patients card. Doesn’t go thru. I called insurance n got hung up twice and don’t have time to deal with this
Hi all, I got prescribed 2 medicine yesterday and when I logged into my CVS Caremark account, I only see 1 of 2 prescriptions. Does this mean there was some kind of error?
Thanks in advance.
Yesterday I called CVS Caremark for the first time in years. I called from a Google Voice number.
Within a couple of hours of the call I received a phishing text message to an entirely different phone number, my regular cell phone number - (the one in the CVS Caremark database) saying I had a significant balance in my rewards account and to check the balance by clicking on a link. This was obviously a problem because I had never signed up for their rewards program.
The text message said it was from CVS and had a link to a completely different website domain that resolved to a server in Turkey.
I did try to report this to CVS but couldn't get to someone who understood the problem.
Be careful if you receive anything from CVS or CVS Caremark, their servers may have been compromised.
Hi any independent having problem getting 28 $ from cvs caremark, while other pay 40 $
Literally almost just got outed because he was asking about something involving cvs Caremark that was sent to his house. He read off the clinic dr name and I panicked. I got up and said it was just a cvs Caremark coverage denial letter. He is not good with technology, technical, paperwork or medical terms and I’m not out to him. I got lucky.
But like I have been paying for my own clinic visits, testosterone, and bloodwork costs over a year. I don’t even think they said anything to me about trying to get my prescription covered through cvs Caremark. Last clinic visit I felt like I was pressured into using my dads insurance to cover it but I can’t be out to my family. I really don’t want them just sending shit like that to my dad to get it covered under his insurance. I’m gonna tell them I just want to continue to pay for it instead of using insurance like they have tried to get me to do.
Desperate to become more independent and at least get myself off his insurance. I want to legally change my name. I am sick of having something over my head like being on his insurance. Also I want to get the testosterone pellets in the near future so I don’t have to worry about this. I have to get out of here soon
Edit: he was then like “you know you can talk to me about anything. I ain’t ever raised my voice at you. A lot worse parents than me” ok I just got a letter notifying me that cvs Caremark coverage doesn’t cover the clinic so I think that’s what he meant. Still though I’m not about to talk to him about that because I have heard him say some very transphobic shit about all gender bathrooms, makeup commercials with trans people, and this one time there was a trans person on tv who didn’t pass well. I swear to God the IRS needs to give me my taxes so I can have some money to get some new equipment for or and make money so I can get out of here
Summary: almost got outed by paperwork my clinic sent to my dads house of a failure to get cvs Caremark coverage that I did not apply for, despite me paying for my testosterone for over a year and a half now
So I’ve been thinking of applying to the Caremark near me because I’m sick of retail. I currently work as a lead technician and was wondering if someone could tell me about certain positions within Caremark. I want to try and stay in a leadership role because of my experience and because I’d really like to not have a decrease in pay. I saw they have an opening for a Sr. Tech Member services as well at Sr. Tech Dispensing. Qualifications as far as I can tell don’t include working in a prior position at Caremark, but do you think I’d be overlooked because I’m coming from retail and would need training? Has anyone worked in these roles or similar ones that can give me a little more insight on them? Please and thanks!
Well, I posted yesterday about CVS CAREMARK Not approving our epi pen dose for our daughter. I really was hoping to never use it.
I’ve been back and forth with doctors all day, making phone calls trying to figure out what’s wrong with our daughter. Last stop was an opthamologist who took one look at us and said she needed an allergist but it was a three month wait. I told him I need to get in NOW
Got home and within ten minutes her face swelled up, tongue fell out of her mouth, rash, and couldn’t swallow. We called 911 and luckily they had the right amount of epi. We are in hospital.
Parents, listen to your gut, no one will fight for your kids like you will.
We are not giving up but so grateful she’s alive
CVS CAREMARK CAN GO FUCK THEMSELVES
EDIT:THANK YOU! After harassing the manufacturer we got them to over night us the meds for $25, I’m really not sure how it goes from 5k at a pharmacy who can’t even order it to $25 but I’ll never understand big pharma.
Despite blood work that showed an extremely mild intolerance to dairy along with a delayed postive patch test result for soy/Casien- which they all said was irrelevant. Turns out that she “may” have a pretty severe allergy to dairy even though it’s “unusual” and they said it “doesn’t make sense”.
Medical professionals need to stop focusing solely on numbers and look at their patients. If it quacks like a duck, walks likes a duck, then it’s a duck.
Anyway, I’m not stopping until I get some real Answers
✊
CVS Caremark has fought with me all year. I take Stelara every 4 weeks instead of every 8 due to the severity of my disease. My doctor made this dosing decision with my best interests and health in mind. 8 weeks didn't work. Caremark, who makes decisions based on profit, is trying to suggest that I take my medication every 6 weeks and see how sick I get before approving 4 week dosages, which I don't see them doing because my pain and quality of life isn't their issue.
I've already maxed out the yearly Jansen Carepath card benefits by April of this year because of the way this slimy insurance company changed their policy to leave me responsible for a 30% copay. They work with PrudentRx to cover the remainder after the manufacturer benefits, but they won't cover anything before CVS pays.
I just hate this shit. It's evil. For the June 2021 QUARTER, CVS Health Corp made 72.33 BILLION dollars in revenue (up 11%) with a 3.85 net profit margin (almost 3 billion dollars). For one quarter.
Why are American companies and CEOs allowed to profit from making decisions that affect our lives negatively? How is anyone ok with this? How can so much money going to a few people top be seen as good for the economy? If EVERYONE could have affordable healthcare they would have more money to spend. Isn't money flowing in the economy more important than hoarded savings and investments in a CEO's portfolio? Don't the masses of people and their quality of lives matter more than excessive wealth for few? Why is America so damn greedy?
Fuck Caremark. Fuck America.
/end rant
Six month old is having allergic reactions which are progressively getting worse , do not know the cause, Doesn’t seem food related- had some tests done . We need an epi-pen and the only brand who sells her dose is called AUVI-Q.
“Walgreens” (huge drug store chain in USA) is the only one who can get our dose, our insurance company who uses CVS Caremark does not contract with Walgreens so we can’t get her the EPI-PEN. No other pharmacy but Walgreens can order it, this drug is over $5k USD (by drug I mean two- one time use syringes that expire). CVS refuses to help us and will not coordinate with their competitor (Walgreens) to help us, normally I get that BUT is that worth the life of my 6 month old ?!?!?
This is literally fucking insanity, what do parents do ?!?????!?!?!?!?
I’m losing my mind.
We had to get an epi pen that’s nearly double - triple her dose 😳
Wtaf
Anyone getting claims kicking back/timing out?
Well. Two weeks ago, my derm prescribed skyrizi. I recently received a letter from CVS saying it was approved. I then got an email that says:
Your prescription order for SK is categorized as self-pay, meaning that you pay for it out-of-pocket. We are confirming this with your doctor and will contact you if there is a problem.
Am I screwed here? I have contacted my health insurance (anthem bcbs) and they had advised it would fall under my “injectable benefit” but then my RX coverage is not through anthem.
Self pay seems like it’s going to be expensive. Does that mean I have to pay the full cost? I’ve enrolled in the Skyrizi Complete program and I guess I’m waiting the the introductory call from the ambassador. Maybe my worry is premature, but now I’m nervous and it’s after business hours.
I guess I’m posting this to see if anyone in here has gone through this process with CVS Caremark and skyrizi and can describe to me what I should expect and a ballpark of the cost?
Is the skyrizi complete program income based? I’ve looked high and low online and it seems too easy for it to be $5/dose. There’s got to be some sort of eligibility requirements?? I’m scared we make “too” much for any type of assistance (even though household income is <100k)
TLDR: help. How much is this going to cost? And the US healthcare system sucks.
So today I had a patient call in saying that they usually have a discount if they have a 90 day supply of their meds. I checked their profile and their past 90 day supply of the certain med did seem to be a lower price than the newly filled one. I checked the past scripts as well and I'm not seeing anything else applied besides their insurance which is the same. Just out of curiosity is there really such a thing like a discount if you get a 90 day supply?
Throwaway in case coworkers see. I’ve been offered a new job with better pay. The new job would offer CVS Caremark for the prescription drug coverage. I did the drug look up for Humira on the cvs website and it came back over $1600 a month. Wondering if anyone has that insurance and if it’s really that expensive? My current insurance only charges $50 a month for Humira so that would be huge increase.
Hi all, quick question for those who have used CVS Caremark specialty pharmacy. My insurance is extremely picky about what pharmacy they’ll cover prescriptions at, and I usually go through Encompass Rx in Atlanta. My insurance company informed me my insurance wouldn’t cover Menopur with Encompass but would at Alliance Rx or CVS Caremark; I called Encompass and they forwarded my Menopur prescription to CVS. (My other medications were able to be filled at Encompass and Freedom Fertility.) I touched base with CVS this past Monday and they said they were still trying to verify my insurance before they could set up delivery. I haven’t heard anything since and I’m getting pretty anxious because we start stimming at the end of next week! Thankfully the other three will be here Monday and Tuesday. How long did it take to fill your prescriptions and set up delivery at CVS?? Thank you so much and wishing everyone precious miracle babies soon 🙏🏼
Hi - I have Aetna insurance and they work exclusively with CVS Speciality Pharmacy (sometimes called Caremark I believe). They won't provide a quote unless I actually file a prescription with them. Has anyone with Aetna been able to get pricing on their injection medicines from CVS and approximately what did it cost going through insurance (as opposed to cash/out of pocket)? Thanks!
I have a pretty vague question:
Any tips on how to reduce DIR fees/ Network Variable Rates from CVS Caremark Part D? So far we have tried MTM/CMR/TIPS. Other ideas I'm considering are: improving 90 day fills, formulary complianec, generic dispensing rates, offer free shipping for statins/RASAs to improve adherence, autofill and med sync improvements.
Also any thoughts on Amplicare?
Thank you for your help.
Why do so many people come into CVS with Caremark papers and RXs? What should I be telling these guys?
I just received two letters from CVS Caremark as they are the pharmacy benefit manager for my spouse's health plan. I'm looking for a little advice at how to handle these issues.
- My son suffers from eczema and uses Derma-Smooth Body Oil 0.01%. He previously used the generic version, but there was a large price hike, and the BRAND was cheaper than the generic. The letter that we received says that the Derma-Smooth will no longer be covered, and instead, he can use a generic topical corticosteroids. This seems ridiculous to me as the cost of the bottle of generic Fluocinolone Acetonide 0.01% is $123.86. Conversely, the Derma-Smooth was $36.20. Is there a way that I can appeal this?
- My husband had thyroid cancer and had a thyroidectomy. Afterward, his endocrinologist mandated that he take Synthroid vs. generic, and I have seen research suggesting that those who have had thyroid cancer should not take generic levothyroxine due to fluctuating TSH. The Synthroid will also no longer be covered.
I am hoping that you also know what steps that person could possibly take to get the prescriptions covered.
As far as the body oil goes, I know that I could use GoodRX or just pay out of pocket, but then I don't think it would count toward our deductible. Our insurance includes medications as counting toward the deductible.
Thanks in advance for any help you can provide!
My insurance changed, and they’re now trying to force me to go through CVS Caremark for my daily medications (trintellix and lamotrigine ER).
The call center just sucks to deal with, I got read the riot act because one of my meds is expensive and there is no generic yet. :/ I then said I needed the numbers so I can go to a local pharmacy instead, and they tried to convince me mail order is cheaper. Except I did the math, and for 10$ less a month I could go to CVS to pick them up, or 20$ less to have them mailed (and probably stolen). Thing is, 20$ off of 700$ a month isn’t worth it for me.
I’ve never been in and out of CVS, even for just a refill that was ready, in under 30 minutes. CVS also has issues ordering in my meds.
I’m concerned about mail order because token mail is a regular occurrence around here.
Am I just being paranoid for wanting to just stay with my local pharmacy? The cost is something I plan on every year, I hit the out of pocket max before may due to just meds. The worst they could do is move my meds to the “out of network” deductible and costs.
I'm hoping someone can advise me on an issue I'm having with CVS Caremark:
I have been on a name brand medication for over ten years. Because I am a light weight I have to take children's doses of this medication. The child doses are considerably more expensive than the adult doses, and insurance companies always fight paying for it, but agree to do so in the end because it is medically necessary. I have attempted to move up into an adult dose, but this has resulted in serious side effects (this particular medication has a potentially lethal side effect, so great care has to be taken). I have also attempted generics, resulting in allergic reactions and hair loss. In short, it is not safe for me to experiment further with generic formulations, and it is not safe to increase the amount of medication taken to make it cheaper for the insurance company.
My husband's new-ish employer uses CVS Caremark for prescriptions. I have spent many hours on the phone with the people at CVS Caremark appealing rejections and working through their labyrinthine system. While the tier exemption process is still ongoing, they are currently on board with paying for the medication in name brand in some form - we are just haggling as to how much they will cover it at this point.
I received a letter a week ago informing me that CVS Caremark would no longer cover any medication if ordered in a 30 day supply. I was told I needed to contact my doctor and get a 90 day prescription. I did so, and had it forwarded to my usual pharmacy, a Walgreens. The Walgreens told me that Caremark refused to cover any part of it. I called Caremark to see what this was about, and was informed that I am now required to have the prescription filled at a CVS pharmacy, or they will not cover it. I arranged to have the new, 90 day script transferred to the CVS.
The CVS pharmacy called this afternoon to tell me that their supplier can only provide them with one bottle a month, which works out to a 3 week supply for me. I live in a large metropolitan area. The pharmacist kindly called a number of much larger CVS pharmacies with larger suppliers, and was told the same thing - only one bottle per month is available. She then called Caremark back. The Caremark representative said that I would be billed the full, non-covered price of this partial refill because they only cover 90 day orders. The pharmacist explained the supply issue. The Caremark representative said that he recognized the pr
... keep reading on reddit ➡
Does anyone know why I would be getting repeated calls/messages from CVS Caremark out of Phoenix? I live on the opposite side of the country and don't fill prescriptions at CVS. Is this a scam or trying to sell me something? They call like every other week.
Getting my Rx filled for NuCynta ER (extended release) and ... Well, drug insurance spins the wheel of "How Can We Fuck Up Your Life" and... they'll only pay for 54 every month. Not the 60 my doc Rx'd - 1 pill every 12 hours for 30 days... It's an extended release, yo, to keep me level and not let my system be ruled by the you'd and downs of heavier things I have to take right now.
54 pills, by giddammit over their dead bodies it was not going to be 60. It was just so random and Brazilanesque. God forbid those last three days help me maintain steady pain management... Such a fucking facepalm.
Long story made short. Won a state appeal which overturns insurance company denial for Spravato.
Have a psychiatrist which I see regularly but he does not administer Spravato. So I have to use another practice.
Insurance company states Spravato is a medically necessary drug and refers practice to CVS Specialty Pharmacy to obtain drug. A medically necessary drug is paid for in full. A pharmacy drug has a copay...that's the only difference from MY perspective. I am fairly certain CVS specialty is part of the REMS certified plan to certify Spravato. I also know that they demand a some measure of improvement to continue treatment.
Now I hit another obstacle.
When I approached the practice, their RN Jenni stated to me. "We dont work with CVS. They require people to show an improvement with the Hamilton assessment and then they cancel everybody."
Efforts to clarify this have failed...practice wont return phone calls or suggest a solution.
Anyone have a similar experience or a way to contact manufacturer of Spravato?
For now I am just keeping good notes...nothing is going to be open until the pandemic resolves. Sounds like I may have to work with a other practice or talk to the state again but I wanted to see if anyone had more info to share.
So currently I work for cvs retail and I’ve been there for 7+ years. I have 2 years under my belt as being a CPhT and a Lead Technician and I currently make over $18 an hour. I like the store I work for, we really have a good team and a good flow of things but the stress and business and the fact that some customers just treat us like complete shit has really been bringing be down lately. Also on top of that a new pharmacist started that I’ve worked with in the past when she was still a technician, has me down too. She is just not a people person and always has an attitude and just doesn’t treat some of us technicians like we are competent enough to do our job sometimes. Is there anyone out there that is a certified tech that works for Caremark mail order and enjoy it? Will my certification get me far? What’s the starting pay like since I’m already making over $18 an hour. Basically just wondering if it’s worth it. Will also add that the mail order would be a shorter drive for me as well since moving in with my significant other. Any feedback would be greatly appreciated!!
Long report, the executive summery is only a few pages. Pretty much shows everything we have known about the sketchy vertical integration of pharmacy and PBMs. Looks like the health insurance industry is getting into the specialty Rx game as well.
We constantly get rejections in the pharmacy from caremark insurance. Everything from "not contracted with this plan" to "will not reimburse for immunizations". Now, caremark has decided not to cover onetouch diabetic supplies, only accucheck. Why would you not cover, I don't know, CVS's own truemetrix supplies?
Are you admitting the truemetrix is lower quality/higher price? Or are you not making enough money on your own brand to bother forcing people to use it? Then you complain that our 'beetus supply sales are down, and what are we going to do to fix it?
Recredentialed our store with CVS Health. Had to list SSNs for every staff pharmacist. So I assume they have every chain pharmacist's SSN as well. First, I don't know why they could possibly feel this is something they need, and second, if they get data breached, we're all screwed. Seems like there should be some sort of privacy law about this, although of course I'm sure the law says "PBMs are allowed to do whatever the hell they want"
Literally almost just got outed because he was asking about something involving cvs Caremark that was sent to his house. He read off the clinic dr name and I panicked. I got up and said it was just a cvs Caremark coverage denial letter. He is not good with technology, technical, paperwork or medical terms and I’m not out to him. I got lucky.
But like I have been paying for my own clinic visits, testosterone, and bloodwork costs over a year. I don’t even think they said anything to me about trying to get my prescription covered through cvs Caremark. Last clinic visit I felt like I was pressured into using my dads insurance to cover it but I can’t be out to my family. I really don’t want them just sending shit like that to my dad to get it covered under his insurance. I’m gonna tell them I just want to continue to pay for it instead of using insurance like they have tried to get me to do.
Desperate to become more independent and at least get myself off his insurance. I want to legally change my name. I am sick of having something over my head like being on his insurance. Also I want to get the testosterone pellets in the near future so I don’t have to worry about this. I have to get out of here soon
Edit: he was then like “you know you can talk to me about anything. I ain’t ever raised my voice at you. A lot worse parents than me” ok I just got a letter notifying me that cvs Caremark coverage doesn’t cover the clinic so I think that’s what he meant. Still though I’m not about to talk to him about that because I have heard him say some very transphobic shit about all gender bathrooms, makeup commercials with trans people, and this one time there was a trans person on tv who didn’t pass well. I swear to God the IRS needs to give me my taxes so I can have some money to get some new equipment for or and make money so I can get out of here
Summary: almost got outed by paperwork my clinic sent to my dads house of a failure to get cvs Caremark coverage that I did not apply for, despite me paying for my testosterone for over a year and a half now
