New Cases Illustrate CVS Caremark Driving Up Costs for Patients, Health Plans

By Kevin Schweers

Since the 2007 merger of pharmacy retail giant CVS and pharmacy benefit manager (PBM) Caremark, community pharmacists have heard a drumbeat of complaints from patients accusing the combined company of deceptive practices, privacy violations and conduct resulting in higher health care costs. The problems led NCPA, the National Legislative Association on Prescription Drug Prices and the union-backed Change to Win coalition to seek a Federal Trade Commission investigation earlier this year.

Last month, CVS Caremark disclosed that it is currently the subject of an FTC inquiry. That same day, analysts separately expressed renewed skepticism about the viability of the combined PBM-retail pharmacy model.

NCPA recently shared with the FTC the following new, unfortunate patient stories. They are consistent with problems identified in a remarkable Houston TV news report that aired last month. Summarized below, these cases make clearer that these problems are no anomaly and remain a current concern.

Mailed medication arrives late; costly complications ensue; but you “save” $2!

A patient reports having to use CVS Caremark mail order for monthly deliveries of Enbrel, a pain medication.  Enbrel must be refrigerated immediately upon receipt.

Despite the patient’s best efforts, including taking time off from work to wait for deliveries, sometimes the deliveries are so late as to result in missed doses. When that happens the bills really start piling up for the patient’s insurance plan: $70 to visit the pain management doctor; $400 to receive a spinal injection and $1,200 for an MRI.

Previously, through the local community pharmacy, the patient paid a $164 co-payment and could conveniently refrigerate the drug. Through CVS Caremark mail order the co-payment is $162. That’s $2 of “savings” in exchange for a stressful monthly ritual, a mountain of medical bills to treat resulting complications and untold hours of lost time and productivity at work. In addition to the obvious health concerns, it’s some “deal” for the patient and taxpayers.

Medicine by Help Desk, part II

This next case is reminiscent of an earlier problem that The Dose covered here – Medicine by Help Desk.

In this case, a resident of a long-term care facility needed a refill from the community pharmacy servicing them, but the claim was rejected. The state requires that the resident’s medications come in unit-dosed blister packaging.  When the pharmacist called CVS Caremark to ask why the claim was rejected a phone representative explained that the patient had reached their third refill. Because there were no CVS locations nearby, mail order was suggested. But CVS Caremark mail order did not prepare unit-dose medications.

The phone rep suggested two solutions. Pay out-of-pocket and submit a receipt to get 50% of the cost reimbursed. Or ask the prescribing physician to change the dose of the drug every third refill!

Ultimately, the patient paid cash.

Taxpayers Pay Emergency Room Price for Routine Insulin Dose

After running out of Lantus (insulin), a Medicare Part D patient went to the community pharmacy for a refill. CVS Caremark refused to pay for it, saying the plan limitations were exceeded. 

After refusing an override, a company phone rep told the community pharmacist that the patient would need to use mail order. Obviously, that wasn’t an option, so CVS Caremark advised the patient to pay cash to get the drug now.

Because the patient could not afford the $95 out-of-pocket cost, the patient was forced to go to the emergency room to get the insulin in time.

This is just a sampling of the patient complaints that keep rolling in.

3 Responses to “New Cases Illustrate CVS Caremark Driving Up Costs for Patients, Health Plans”

  1. 1 Randy Armbruster December 18, 2009 at 6:07 pm

    These examples have happened to us many times. We are just trying to take care of our patients and because of Caremark/CVS’s
    greed, we are not allowed to fill for our patients, so as a result, we lose, the customer’s health suffers or both. It is an absolute joke. Pharmacy has been turned into a commoditized joke by Caremark, Medco, ESI and WALMART! It is time that pharmacists that work at these places start examining what they are doing to their profession (or what was a profession) and start either requiring changes or find a different job. Show some respect for yourself and your profession by putting healthcare and your patients back into the practice of pharmacy.

  2. 2 Larry December 18, 2009 at 6:47 pm

    Pharmacists that work for Wal-Mart, Target, and the mail-order operations are harming their own profession with consequences that last forever. No professional renders a service for $4. Wal-Mart is having a hard time retaining pharmacists in our part of the country, so maybe things are looking up. It’s hard for me to believe that pharmacists — trained healthcare professionals with doctorate-level education — are being demeaned by their employer every day and are putting up with it.

    It really would not hurt for NCPA to take an official position on this issue that spotlights the pharmacists who are helping erode the profession and make the delivery of prescription pharmaceuticals a simple commodity. And the pharmacy schools should follow that lead.

    I wonder how many people are choosing their doctor based on price? Bet it’s not a tenth of those choosing their pharmacist based on price.

  3. 3 Leke December 19, 2009 at 6:24 pm

    Independent pharmacies continue to provide excellent pharmaceutical service to patients unlike Walmart, Publix and Target that discount the professional inputs of their pharmacists. I wonder why they are not charging $4 for the services of the ARNPs employed at their mini-clinics. Any self-respecting pharmacist employed by these companies should re-evaluate their own credibility.
    Same goes for pharmacists that work for the PBMs and their mail-order outlets. For now you may have a “job”, but for how long, if you continue to devalue yourself ?
    Has anyone noticed recently the reimbursements ESI is now paying for Tricare prescriptions? For how long do we accept this ridiculous and disrepectfull treatments from the PBMs?

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