My employer just switched to CVS Caremark from Express Scripts and it has been the most horrible experience and we just started the plan this year! The prior authorization department needs a lot of work. I needed an Ovidrel prescription and I have been going back and forth with Caremark for over a week to get the prior authorization approved. When I first called CVS Caremark customer service advised the doctor's office needed to call in the prescription, when my doctor's office spoke with a rep at Caremark they advised that Ovidrel was not covered and Novarel was, so my doctor put in that prescription.
I was checking my caremark dashboard daily to confirm if the prescription was processed and it wasn't. I waited 2 days and called customer service back, one rep told me Ovidrel wasn't covered, I called again because the rep was super rude and short and would not elaborate. When I got another rep she said that I need to speak with the benefits department at *******556 and ext. *******. The rep on 1/15/20 said they did not have my insurance information so that is why my prescription was pending, which is odd since they are my insurance prescription provider. She said due to the holidays I would need to call on 1/19/20 to confirm that authorization was approved.
This is where things go from bad to worse because I need to have the prescription by 1/21/21, anyone who is trying to conceive knows the importance of getting the medications on time so all the preparation and other meds you endured beforehand doesn't go to waste.
I called back on 1/19 and was told that the Novarel was not covered under my policy, they do not have the previous Ovidrel prescription that was sent in and that the doctor must call the PA department at *******506 to get verbal approval for Ovidrel. I told my doctor's office this and they called and the PA department advised to speed things up they should put in the authorization on covermymeds.com. If a verbal authorization suffice why would they direct them to cover my meds?
I spoke with the benefits department who kept telling me that my doctor's office never called to put in the prior authorization, Fernando with the benefits department was extremely rude, super short and did not want to help or listen to what I was saying at all. I called back and spoke with Beth who was more helpful and then requested to speak with their manager Yessenia who called the PA department herself with me on the phone. They did confirm my doctor called them but said the doctor office called to get a key for covermymeds, which makes no sense, how would they even know about this website?
Either way I have been getting back and forth from the authorization department when all they needed to do was accept and put in the system that my doctor called and authorized the Ovidrel. I spent over 4 hours on the phone with them yesterday, ultimately Raj K. With the PA department advised to have my doctor's office to call back to the same number *******506 early in the morning and request a verbal authorization of the Ovidrel.
My doctor's office called and sent me an message stating they followed the directions given to me, I waited 2 hours, called the benefits department back, got Fernando on the phone again who proceeded to tell me my doctor's office never called, the authorization was still pending. I gave him my PA confirmation number, he then stated that someone was working on it and should reach out to me. I asked why he said that my doctor's office never called and he proceeded to get short, was rude and denied.
Right now I am still waiting on Caremark authorization. I need this prescription by Thursday (tomorrow). What really burns me up is how convoluted this process is, how so may reps give various information which delays the process, and how no one from the PA department can actually confirm whether someone calls them because they do not adequately document their file. I am left feeling defeated, angry, unheard, and disappointed that this is my new prescription provider (employer plan). I may have to skip this month in trying for a child because of the red tape in place by CVS.
I would hate for my fellow co-workers to go through the same thing if they need a medication on a deadline that requires prior authorization. If a verbal authorization is all that is needed then do not direct a doctors office to a website or send a fax, just take the verbal! Customer service needs better training and more compassion.