Comments on: Caremark strikes again…

By: reply

reply — Fri, 27 Oct 2006 00:27:07 +0000

Actually this package they are paying for is years and years of countless research a pbm does to make the most cost effective plan for their client as possible…tons of data…and youre right…we are a claims processor. Its our job to process the claims and administor the benefits your plan wants you to have. We do get deals and such for particular medication, but youre missing the point in that. If we get 20 mg of lipitor at a contracted rate with cvs at 150 bucks for 30 pills, and zocor for 200, then we make that a “preferred” medication that saves your plan (our client) money, and what does that do?..it allows them a more friendly and larger budget to cover other medicaitons. Its your plan that tells us to deny and do what we do…thats what we get paid to do. It;s good business, and if it was your idea, then you would have done it too

By: drumsnwhistles

drumsnwhistles — Tue, 26 Sep 2006 20:25:05 +0000

So basically in an era where health insurance premiums have outpaced inflation by more than 200% you’re saying that part of the expense is for our insurance company to hire Caremark to essentially be the benefit denier with no real medical review of the claim?

I don’t buy that. And that’s not what the pharmacy benefits contract says either.

But let’s suppose that’s true. Is Caremark basically selling their service by saying “Hey, we can deny claims more efficiently than Medco down the street?”

I don’t think so.

The facts are that this medication has been denied with no factual basis for doing so.

The facts are that one of the “various other ways” that Caremark makes money is through pharma rebates for promoting one medication over another.

Is the health insurer a part of the problem? Absolutely. But they’re not all of it — Caremark has at least as much responsibility.

When you all start denying claims for Viagra I might take you a bit more seriously.

By: get real

get real — Tue, 26 Sep 2006 20:02:51 +0000

I work for Caremark, and I can tell you that this “service” is the same for any pbm. Caremark does not truly “deny” your coverage. Caremark is contracted on by your health insurance company or your benefits office to adminsiter their plan. Does Caremark get the blame? of course..thats part of the reason as to why we get paid to handle their plan. Caremark doesnt pay for your drugs…your insurance or benefits office does. We make our money in the contract with that client (and various other ways) So when your appeal is denied..keep in mind we are going off the guidlines that either A. your benefits office or insurance company created or B. your insurance company or benefits office adopted these guidelines as a sort of “package” Caremark creates and offers our clients. Caremark only refuses coverage because ultimately thats what we’re told to do. We just look like the bad guys and take the blame.

By: Joy

Joy — Fri, 05 May 2006 19:31:51 +0000

My physician told me yesturday to contact Caremark and ask for a medical refiew with a physician reviewer. That review would need a response in writing to myself and my doctors. This physician reviewer should state what his reccommendations and reason for denial are. He said that this put the physician reviewer and Caremark on the spot to come up with a solution. He said that ‘by law’ they have to respond to this particular request.

Perhaps, you too can do this.

My prayers go out to your son, also.
Joy