CVS finds new way to deny care under their Silver Scripts PDP Medicare Part D.

Community CCRx - 2012 Part D OptionsCommunity CCRx Part D no longer offering Part D plans

There are literally dozens of Part D plans offered in most States and although no single plan is the best for everyone, some plans will be a huge benefit for Medicare beneficiaries on certain Medications.

Community CCRx members were transitioned to SilverScript Part D plans in January 2013. SiverScript has been offering Part D Plans since 2006 and have over 4 million members.

It would seem that either employees of CVS Health/Silver Scripts have not been trained well enough to find anything in their computer system… or CVS Health has DUMPED a large portion of important forms/paperwork that was part of the CCRx database.

I called Silver Scripts today, to get a vacation over-ride for two medication for my wife (Barb)… I was first told that there was no POA form on file for me to speak to them.. although that form was submitted and always been found since Jan 2006.

After letting them talk to Barb to give them permission to talk to me about her medications.. they told me would only OK a 30 day supply as a vacation over-ride.. while they provided a 90 days supply over-ride last year.. keep in mind the Rx would be due to be refilled in abt a week.. and she has been taking it since 2006/2007.

I asked to speak to a supervisor… got off this conversation with seemingly the vacation over-ride in placed.. called the pharmacy and one was authorized but the second – a expensive generic – DENIED… the Pharmacist tried billing three difference NDC numbers.. including the one that they paid for 3 weeks ago for a 30 day supply.

Another call to Silver Scripts… the person this time tells me that the generic is not on the formulary but the brand name was .. so I called the Pharmacists back and he tried to bill for the brand name… DENIED….

Another call to Silver Scripts… of course different person this time.. she is confused why my wife has been prescribed the same medication TWICE – brand name and generic.. another long explanation as to why that was .. and to ignore the attempt to charge the brand name..

Then she told me that the generic needed a PRIOR AUTHORIZATION… and there was none on record… but.. couldn’t explain why they had been paying for it since I got the PA for back in 2006 or 2007 and why I was told when CCRx converted to Silver Scripts I verified that the PA would follow and was assured that it was good for TEN YEARS …

Simple solution – per her – just get your doctor to fill out a new PA.. keep in might this all started over a vacation over-ride request and Monday is a holiday and before we could get an appt and Barb would be out of medication… we would be hundreds of miles away.. This is for a controlled med and everyone knows how happy Pharmacists are about filling out of state Rxs for controlled substances..

This woman had no idea that Silver Scripts had acquired CCRx years ago… she claimed that the PA was probably with a different PDP..

So has CVS Health/Silver Scripts indiscriminately purged necessary forms from their system from the pts they acquired from CCRx .. or is this just another “save a buck” ploy to help make sure that Merlo gets his bonus or help make sure that they have the 10 billion to buy Omnicare ?

I ran into another problem with Silver Scripts last year in getting a vacation over-ride on this same medication for Barb and the Silver Scripts employee told me at the time… that “I would have to get it filled at CVS.. IF THEY APPROVED IT “..  We don’t use CVS..!!  After I convinced her that she was wrong and I got the approval and verified with the pharmacy that they got a authorization to fill and get paid…

I went to www.cms.gov and file a complaint about Silver Scripts attempting to violate my wife’s freedom of choice… as provided for in Medicare… within a hour a got a response from CMS and shortly their after I got a call from a supervisor from Silver Scripts.. who gave me her direct phone number… which I have in my trusty IPhone … and who I will be talking to on Tues …  If she can’t get this situation resolved..

To sum it up… a disabled Medicare pt… covered by ADA…. being denied medication she has been on for years… that without it will adversely affect her quality of life…  how many emails/complaints/phone calls… let me count the ways ….

 

2 Responses

  1. My Hero !

  2. It is sickening to read this. I hope when you call the person whose phone # you have to call next tuesday, I hope there still employed there.

Leave a Reply

%d bloggers like this: