Why doesn’t Caremark care about my insulin pump?

First, Caremark agrees to cover Ben Schwartz’s insulin pump. Then it refuses. Is there anything he can do to make Caremark honor its word?

Question: Caremark is not properly applying my family’s prescription benefits, and customer service has not been able to resolve the issue. Between my wife and me, we have spoken to them three times and exchanged five secure messages.

Elliott Advocacy is underwritten by World Nomads
-- World Nomads travel insurance has been designed by travelers for travelers, to cover your trip essentials. Even if you run out of travel insurance or leave without it, World Nomads can cover you. We don't just keep you and your family protected, with us, you'll travel smarter and safer. Get more information at World Nomads.

My wife is diabetic and uses an insulin pump. We had been getting her prescriptions filled at the local CVS pharmacy except for insulin pump supplies, which are not available at the local pharmacy and so were ordered through Caremark mail order (CVS is owned by Caremark). Our prescription plan includes a diabetic kit benefit where certain prescriptions can be filled at the same time for a single copay. I was assured it would be processed correctly.

Late last year, my wife asked via Caremark.com Secure Message whether the insulin pump supplies qualified under the diabetes kit benefit. The customer service representative said that they did qualify and recommended that we transfer the prescriptions from the local pharmacy to the mail order pharmacy in order to take advantage of it, and we did so.

When the order was filled, the diabetic kit benefit was not applied to any of the items. I called Caremark customer service and they resubmitted the order to have the benefits properly applied. The benefit was then applied to her test strips, but not the insulin pump supplies. I followed up by phone, providing the specific prescription numbers when requested by the representative, and was assured that it would be processed correctly.

We have continued to follow up via Secure Message, each time reaching a different representative who is unfamiliar with the issue and doesn’t adequately address it. For example, several of the messages refer to the test strips, which have now been processed correctly, and not the insulin pump supplies.

It is very frustrating that this issue has consumed so much time with no resolution. Would you please fix this issue for this and future orders? — Ben Schwartz, Huntsville, Ala.

Answer: Caremark, a retail pharmacy and health care company, should have accurately described your benefits and fulfilled the order as promised. Calls like yours should be recorded for “quality assurance purposes,” and when there’s a question about what someone said, Caremark should produce a transcript. But, more to the point, since you used Caremark’s “secure” messenger for subsequent conversations, this should have all been in writing, and it should be an open-and-shut case.

Caremark is an enormous company, which is probably why your prescription got lost in the shuffle. That’s not an excuse; more like a call to action. If it can’t get the details of your order right, maybe it’s in the wrong line of work.

But perhaps in trying to reinvent the pharmacy, Caremark left a few important things out, like filling the order as promised. There is still time to fix the problem, and I won’t disagree that pharmacies need reinventing. Just maybe not like this.

I was ready to contact Caremark on your behalf. But before I did, you needed to produce a paper trail of correspondence between you and the company. Fortunately for you, my amazing research team had published the names, numbers and email addresses of the top executives at Caremark.

You contacted the company by email and copied me. Shortly after you sent the email, a “very understanding representative” from the Caremark executive resolution team got in touch with you. After a little research, he discovered that the issue stemmed from an “internal miscommunication about the appropriate benefits” at Caremark. Turns out the insulin pump supplies were not supposed to be included in your benefit.

Because Caremark made the mistake, they offered to cover the cost of these supplies for the rest of the year — a more than generous offer that you gratefully accepted.