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.

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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.

23 thoughts on “Why doesn’t Caremark care about my insulin pump?

  1. I previously had a Medicare Part D policy that used Caremark. They constantly delayed one of the expensive drugs I take, although through repeated phone calls I approved the co-pay charge to my credit card. The insurer was of no assistance. I changed insurers at the next open enrollment period.

  2. I haven’t found Caremark to be any more or less soulless than the other big insurance companies, but the ability to pick up Rx’s at the local CVS instead of having to mail-order all long-term meds is convenient. (I’d always been terrified that if one of my wife’s meds got lost or stolen, there’d be all sorts of hassle in replacing the more-expensive ones.)

    1. As a general rule, you’re allowed 2 “exceptions” per year where the pharmacy can force through insurance early. Sometimes the insurance company makes the pharmacy call and jump through a few hoops – don’t let a lazy tech tell you they can’t do it. Things happen, people go out of the country, purses get stolen. I know this because I had a long conversation about it when my husband was going to Europe and I had to get early refills for him.

      I use a small local pharmacy instead of a big chain, and I highly recommend. They’re extremely kind and will work with you/go out of their way to help when big chain places usually won’t. Most of them offer free delivery too.

      1. I know this because I had a long conversation about it when my husband
        was going to Europe and I had to get early refills for him.

        I had something similar on a trip to Asia. Except the insurance company didn’t approved the extra medication until the day before the trip — and the local pharmacies did not stock the medication. I had to set up a doctor’s appointment in Hong Kong to get the prescription — and they prescribed something different, that cured my allergy instead of just treating it.

        1. “and they prescribed something different, that cured my allergy instead of just treating it.”

          Undoubtedly one of those compounds that only Asians and Europeans can have because your regular pharma manufacturer has pressured the FDA to drag its feet on approving it.

      2. I currently work at a small pharmacy and my Pharmacists will bend over backwards to straighten these issues out for a customer, so they don’t have to fight with the insurer. He even goes through the Medicare plans to make sure oour customers has the best plan for their budget and med profile… And Yes, we do offer delivery. The only bigg chain store in the are to offer delivery is Rite Aid…

  3. I used to have Caremark and they’re awful. They kept wanting me to switch to mail order. I didn’t want to, because it was a medication you can’t skip, and every single person I know with mail order has had problems: getting it on time, getting the wrong dosage/amount, being billed full price randomly 4 months later, you name it.

    So I’d go to the pharmacy and pay more – they let you pay a higher copay and pick it up at a CVS. Then at my annual appointment, my doctor’s office insisted on sending the prescription to the mail order. And of course, I didn’t receive it on time by several days and they charged me the in-store copay instead of the cheaper mail order copay. So I ended up having to pay cash out of pocket, and it was expensive, a little over $100.

    I spent over 6 months trying to get reimbursed for the out of pocket payment (because it was their fault I hadn’t received it – it wasn’t the shipping company) and the extra copay amount I’d been charged twice. I received one of the copay amounts and that’s it. I finally gave up.

    In short, don’t let them talk you into mail order. They really talk it up and call and leave messages about it, I’m 99% sure they have a quota. Don’t do it.

  4. Unfortunately we had to be involved with Caremark last year and this year as our insurance contracted with them to manage its prescription drug program. Of course, they do like you to use the mail order program as it saves the insurance company some money. But, it is not mandatory.
    We have experienced issued with Caremark mail order in the past, as we have had with Express Scripts who was the prescription drug program manager for our insurance before Caremark won the contract.
    I always recommend that one go to their local pharmacy to get their medications and refills; unless you can get them cheaper by mail order (which can make a real difference for those who are on fixed or limited incomes). Of course, these managers always want you to use generics in order to tave the insurance companies money (understandable with the continual price increases of drugs).
    I have always had success is getting any problems we have had with Express Scripts or Caremark, but sometimes it has been a real pain in doing so. Still one has ot have his/her medications.

    1. Add to the single payer system some government controls on the cost of medications. There are people needlessly suffering or dying every day because they can’t afford medications that would relieve their pain or keep them alive. The pharmaceutical industry needs to be reined in. A good start would be legalizing the re-importation of American drugs from Canada and other countries where they are retailed at a fraction of their price in America.

      1. Pharma does need to be reined in, but before we impose price controls and rationing panels, let’s try opening up the market to some competition. We should be able to get our prescriptions filled at Amazon, which should be able to make bulk purchases on the global market to save money, just as Dell does when it buys chips for its computers, rather than being bound by the domestic monopoly. Let Medicare and other government payers buy in bulk too, as their Canadian counterparts do, and everyone will save.

        In fact, the biggest savings will be on the generics that most of us are prescribed. The world market price for pyrimethamine, the generic that Martin Shkreli wants to charge us $750 per pill for, is a long-standing generic that sells for literally pennies on the world market.

        1. Alan, it is my understanding that it is currently against the law to re-import drugs manufactured in the United States and sold in foreign nations.

          Drugs manufactured in foreign nations must have FDA approval to enter the US. Foreign manufacturers don’t want to go through the lengthy, rigorous and expensive process of securing approval. There’s a whole big world that they can sell their products to without needing approval from the FDA.

          1. To change the law, we need to elect a Congress that does not worship the campaign contributions and other perks that Big Pharma provides. That won’t happen until the public becomes somewhat aware about the way that their Representatives and Senators are voting. In a society where most people can’t even name their Congressperson or ONE of their US Senators, the awareness level is very low and there is little chance of getting rid of those elected representatives who are profiting from selling their votes.

          2. Exactly, and this is what has to change. First, we need to eliminate the sweetheart legislation that prevents us from buying US-manufactured drugs sold in other markets. New products like Harvoni for hepatitis C cost less everywhere else in the world than here.

            Second, we need to allow our doctors to prescribe and have imported drugs that have been approved by FDA-like testing organizations in places like Switzerland and Japan. Testing the same drug more than once is a waste of money.

            The FDA should be cut back to its basic function of testing, rather than controlling markets. Any power to restrict the sale of compounds it has already approved is a power that gets abused to rig markets. That is how Shkreli gets to charge $750 for his ten-cent pill. I would strip the FDA of any power to control markets.

          3. While I agree in part, I would only accept drugs from a limited number of countries. Many drugs, regardless of which country has approved them, are made elsewhere. And some of them, in particular generics, have issues with production. In the last 2 years, 5 fairly common generics in countries other than the US, had to be pulled because there was not enough of the actual drug in each pill.

  5. It’s amazing that Caremark had such an issue over diabetic meds and supplies. It’s one of the most common mail order items,b since the reimbursement process is routine. I don’t condone problems, but I could understand it more had this been a rare drug. Any mail order worth using should be on top of diabetic supplies since a mixup can have dire consequences for a person.

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