CVS caremark is responsible for reviewing preauthorization claims for my insurance company (Blue Cross Blue Shield of Rhode Island) and they are completely inadequate and dysfunctional. I have recently switched jobs and this is a new policy for me. I have been taking a daily medication for over 4 months and have done very well on it with very few side effects. My doctor submitted a prior authorization request and that was also denied. He is board certified in his specialty and caremark has decided that he is incorrect with his prescribing practices because they think there is a "similar" medication that should be tried first. I have submitted an appeal about this because the medication they think is similar is not a generic for the medication being denied.in fact it is not even in the same medication class as the medication being denied.in addition it carries with it serious side effects such as suicidal ideation and depression. To make matters worse I have now received a letter from their appeals department saying they need a letter of medical necessity from my physician because they cannot make a decision without that. He has already submitted the necessary information. I also am unable to contact them to ask questions regarding the additional information because they only list a fax number and an address. If i call my insurance company I'm told that it is not in their hands, but is in the hands of caremark. Then I am given a number to caremark that tells me since I am a patient and not a physician I am not allowed to talk to anyone. This is absurd and very poor customer service as well as questionable ethics at best. This company, as well as BCBSRI should be ashamed of themselves. They are taking "cost effectiveness" to a disgraceful level. I always prefer a generic and/or more cost effective option when it is available, but the simple fact of the matter is that it is not available.
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