CVS Caremark mail order forcing 30 day vs. 90 day suppies?

[c78]

Last month, when my doctor submitted my first refill of 2016, Caremark's specialty mail order pharmacy rejected the 90 day supply, and said my policy now only authorizes a 30-day supply.

I can't find anything in any of the documents on my employer's web site specifically calling out my medications for 30 days, everything talks about mail order 90-day copays.

This is incredibly frustrating, and definitely seems like a reduction in quality of care for financial reasons.

Has this happened to anyone else? Is there a patient advocate number at Caremark that anyone knows about to try and appeal this?

Thanks!

[Wade]

Hi, Was it a controlled substance ?

[AusShep]

Different plan, but I've been on 30 day refills forever.  Specialty meds often aren't covered in the 90 day supply quantities quite often from I've seen due to cost, or additional losses if you switch meds.  You can still refill early and build up a surplus.  It's never bothered me either mail order or from the pharmacy and hasn't impacted quality of care.
 
The 90 day supplies of most meds are to save the insurance company money, not to improve your quality of care...

[bocker3]

The 90 day supplies of most meds are to save the insurance company money, not to improve your quality of care...

It can save you money, depending on how your co-pays work.  I make the same co-pay for a 30 or 90 day supply.  So, it saves me hundreds of dollars a year. 
I have Caremark and am still doing my refills at 90 days.

[AusShep]

It can save you money, depending on how your co-pays work.  I make the same co-pay for a 30 or 90 day supply.  So, it saves me hundreds of dollars a year. 
I have Caremark and am still doing my refills at 90 days.

Wasn't trying to say the subscriber couldn't/wouldn't save too, they do give you incentives to use their mail order provider for maintenance drugs, but the reason they do it is for them to make more money, not for you to save.  You're using their provider and they retain the markup a third party pharmacy would receive. 

[bocker3]

Wasn't trying to say the subscriber couldn't/wouldn't save too, they do give you incentives to use their mail order provider for maintenance drugs, but the reason they do it is for them to make more money, not for you to save.  You're using their provider and they retain the markup a third party pharmacy would receive.

Somehow I doubt that this is as cut and dry as you make it (not to mention that you DID totally ignore any savings to the patient).  I suspect that my company, which is large enough to self-insure and only pays insurance company to administer the plan, pays less for the drugs in this scenario.

Personally -- I much prefer a 90 day supply, as it means less trips to the pharmacy (I pick up all my Specialty drugs at my local CVS), less copay, less chances to run low, etc. 

I DO agree that it would be ideal for people to be able to decide the 30 or 90 day on their own (I am NOT allowed to do 30 for any maintenance drugs, Specialty or not), but if it is helping to keep the cost of health care down, even a little, I'm OK.

M

[AusShep]

We're talking about different things, I was referring to quality of care on 30 vs 90 days, being a non-issue IMO, and insurance company policies are based on profit.

It is exactly that cut and dried as far as why insurance companies want you to use their owned providers.   From published numbers from the only spec pharmacy that breaks it down by Rx.  Profit is 6% / $167 on average, which works out to about my med cost.  So for a 90 day supply they either retain $500 in expenses, or pay that to a competitor, so giving you $100 incentive to use CVS to retain the other profit is why they do it, not to save you $100.

[bocker3]

We're talking about different things, I was referring to quality of care on 30 vs 90 days, being a non-issue IMO, and insurance company policies are based on profit.

It is exactly that cut and dried as far as why insurance companies want you to use their owned providers.   From published numbers from the only spec pharmacy that breaks it down by Rx.  Profit is 6% / $167 on average, which works out to about my med cost.  So for a 90 day supply they either retain $500 in expenses, or pay that to a competitor, so giving you $100 incentive to use CVS to retain the other profit is why they do it, not to save you $100.

Perhaps we are getting into minutiae here, but you are leaving out the power of negotiation.  I dare say that we all don't pay CVS/Caremark the same TOTAL price for a similar Rx.  They may "charge" the same, but they don't get paid the same.  Just like the negotiations that go into doctor's fees, hospital's fees, etc.  Bigger companies can (and do) demand better pricing for their employees (and their pockets, of course), so it would be impossible to breakdown a profit margin that applies across all.
Yes - pharmacies want to make a profit -- that is the system we are in, so I don't begrudge them their profit.  I don't like the system, but since it's the one we have, it works as it does.

[Dan0]

Last month, when my doctor submitted my first refill of 2016, Caremark's specialty mail order pharmacy rejected the 90 day supply, and said my policy now only authorizes a 30-day supply.

I can't find anything in any of the documents on my employer's web site specifically calling out my medications for 30 days, everything talks about mail order 90-day copays.

This is incredibly frustrating, and definitely seems like a reduction in quality of care for financial reasons.

Has this happened to anyone else? Is there a patient advocate number at Caremark that anyone knows about to try and appeal this?

Thanks!

In the past two months, I had a 90-day Stribild come through and last week was switched to Genvoya. Both 90 day and no mention of a change. I'll be on the watch for it, though! My opinion on CVS is less than positive.

[Corbett945]

I have been taking two HIV meds for a number of years and had mail order service from express scripts and myprime mail,  both of which filled 90 day supply. On January 1, 2016 I was forced to a new insurance company which uses CVS/Caremark and they would only provide me 34 day supply.  I wrote a letter to the CEO and copied various news/insurance fraud and state officials along with my pension company.  I was informed on May 13, 2016 that CVS is now providing 90 supply.  I was told CVS is training all representatives to comply with the 90 day refill for HIV.  I am on Medicare with a supplemental plan.  Try again and hope you are successful.  Corbett945

[xunil]

My insurance provider (United Health Care) will not authorize a 90-day supply of any medication unless it comes from their mail order pharmacy.