By Bob Witanek 908-881-5275
How many CVS customers have had the experience of having their insurance coverage denied for their medicine purchases from the pharmacies in CVS stores? In my case, as a “power of attorney” representative of a 90 year old CVS customer, this has happened 3 times out of 3 purchases for my ‘client’ at the CVS Carteret location in the past year. I can only conclude that the practice is systemic and store policy – possibly company wide policy. It is an act of fraud by CVS as well. In this case it is also an act of elder abuse.
In my first experience, attempting to pick up medicine at the drive up window – they attempted to bill $74 for a medicine purchase. When asked why the cost was so high with the insurance coverage of my client, they stated that the coverage was denied. They tried to tell me to come into the store to discuss it (so they could keep the drive-up queue moving) but I stayed put by the service window. After an extensive argument they admitted that the medicine *is* covered for my client and the price tag was around $24.
The second time – a couple weeks back – my client’s doctor had ordered two short runs of medicine. It was the doctor’s choice – not the patient’s. This time Carteret CVS only covered one – citing some sort of self imposed insurance rule that if the number of doses is low- it is not covered. It has been since learned from Express Scripts that the purpose of this policy is to limit shorter run orders from patients at patient’s request – possibly due to the criminal situation where impoverished patients can not afford a bigger supply. [ The entire way prescription drugs are profited from in the USA is sheer depraved indifference mass murder – and in this case Express Scripts is willingly participating. ] But I also learned that there is an override code that the pharmacy supposed to use if the short order was due to the doctor’s decision and not the patient’s
The third time – February 11, 2022, the coverage of my 90 year old client was straight up denied by the Carteret CVS pharmacist. Even though their records showed that recent purchases had been covered, the pharmacist was claiming – in multiple phone conversations that the coverage was being rejected. It was clearly something that the pharmacist is supposed to investigate – with the “Pharmacist Help” phone number that they are provided by Express Scripts rejection screen. However instead the pharmacist suggested for me to call Medicare which my client is enrolled in, to try and resolve the issue.
It’s Not Just CVS – The Whole System is Rotten to the Core!
When I called Medicare, they at first told me that my client’s coverage had lapsed in June 2020 – based on what her inquiry screen told her. I suggested she look into her file to see the approved coverage since then -which she confirmed I asked her to submit a complaint on my behalf about their system totally misleading that my client did not have coverage – and that since that system is deployed as the first line of call service for millions of American Medicare users. I suggested she take the screen shots and send them to senior management of her work group. The assistant agreed and stated she would do that.
They ended up telling me that I should call Aetna (CVS owned) next since my client’s Medicare Advantage plan is with Aetna. From them it was made clear that prescription drugs coverage was managed for my client by Express Scripts.
The Express Scripts call was informative. The associate put through the coverage request that had been submitted by Carterert CVS – they had a record of it – and she was able to get it approved when she put it into the system. She stated that CVS “must have” entered something incorrectly. She initially stated that the prescription might get rejected because it was just providing a one month supply of the medicine but when I told her that was not the patient’s fault but what the doctor decided she stated there is an override code for that!
The recent visit when one of two prescriptions was rejected – the same Carteret CVS store for that reason – they did not mention an override code. And in that case also it was the doctor that ordered a smaller number – not a patient decision. CVS could easily had entered an override code but made a fraudulent decision not to – thus increasing their sales revenue. Multiply that by millions of customers and the additional revenue piles up.
The Express Scripts representative stated “I worked for CVS. The rejection screen for coverage states that they are supposed to call the number to see if they can resolve it. The number is not for customers to use but for the pharmacists.”
She referred to it as a pharmacy “help line” service of Express Scripts. She gave me the number and stated I should give it to the CVS pharmacist and ask them to call it.
On the earlier call I told the Carteret CVS pharmacist that CVS is killing people by over charging for medicine and denying coverage – and “that medicine should be free.” She actually responded by telling me to “Go to Canada!”
When I called Carteret CVS yet again, the pharmacist on duty (on Friday February 11, 2021, around 4 pm) stated that it is not their job to call the Pharmacy Help line – but mine as the customer. That is the exact opposite of what the representative of Express Scripts, the company that administers the help line stated. She was clear that the number is NOT for customers but for pharmacy staff.
Indeed that the pharmacist on duty does not routinely call the number shows that the Carteret CVS facility is employing the fraudulent practice of refusing to research when coverage is initially denied.
In just my client’s case in recent months there were 3 denials- the first one after I argued with them – they were going to charge $76 since they stated the medicine was not covered – went down to $24 when they admitted it should be covered.
The second time there were two prescriptions of the same medicine, one they covered and the other they did not. They fraudulently proffered the excuse that it was for a small number of doses – which had been a doctor’s decision and not a patient decision. They did not mention nor did they use the override code.
The third time they got the rejection notice but they did not bother to call the number Express Scripts provides to research when coverage is rejected. It is obvious that the proper step would have been to call since they had been using the same exact information to approve medicine for this patient for years including within the last couple of weeks.
It is apparent that Carteret CVS workflow is to NOT call the number. It is a fraudulent practice that increases receipts and sales revenue. No doubt a significant number of CVS clients pay the full uncovered amount when coverage gets rejected.
It is likely that this fraudulent practice is in place at other CVS stores as well, given how matter-of-factly and how persistent the pharmacist was that it is not their job to investigate further and use the number when coverage is denied.
Following these fraudulent practices likely increases CVS revenue by millions.
US HEALTH (DON’T) CARE SYSTEM – DEPRAVED INDIFFERENCE MASS HOMICIDE
Above I mentioned that CVS is in the business of killing people since it profits from medicine which should be free. That might sound like hyperbole but it is true that in the USA over 50,000 die every year for being unable to afford their medicines and medical care. Prescription drug users try to stretch their medicines out by taking lower doses and particularly for diabetes sufferers, such decisions often prove fatal.
Indeed CVS is contributing funds to powerful political lobbies playing a critical role in undermining attempts by American people to improve the disaster of medical services in the US. In their stores pharmacists like the one in the Carteret store are telling customers – like me – to GO TO CANADA. Meanwhile with the profits – including those fraudulently raised by these sketchy insurance verification practices, they are funding powerful lobbyists to make sure that you will not be able to get free health care ever in the USA – that you would need to go to Canada or over 100 other nations where health care is either free or costs a minimal amount.
CVS is the largest pharmacy chain in the US. The following is an excerpt from an article about the CVS role in assuring that health care does not come to citizens and residents of the USA AND that the parade of unnecessary deaths – 50,000 Americans a year due to lack of affordable health care – will continue. In other words CVS is in the business of mass murder for profit. They told me to “Go to Canada” – they tell our people to go to the grave yard for their profits!
“IN A YEAR marked by a coronavirus pandemic that has killed millions, CVS Health financed a wave of political advocacy against measures to control health care costs and increase access.
The health care giant, which owns Aetna health insurance and operates thousands of pharmacies and walk-in clinics around the country, provided $5 million to the Partnership for America’s Health Care Future, or PAHCF.
The seven-figure donation from CVS is the largest known contribution to PAHCF, which was formed in 2018 to lobby and advocate against proposals such as Medicare for All, the public option, and similar reforms that have gained growing support in recent years. PAHCF is a 501(c)(4) and is not required to disclose donor information.”
It should be pointed out how deep the CVS cess pool goes – the above reference to CVS ownership of Aetna – making it profitable for CVS to conspire with its wholly owned subsidiary Aetna to deny coverage – increasing the profits of both! Add to that – their ownership of walk-in clinics – they are employing the frontline doctors – the stench of collusion of these doctors at CVS clinics to limit insurance costs and pump scripts is likely rich indeed. What a thorough cess pool, this business model!
A FEW IDEAS!
I hereby call for an investigation of the fraudulent practices of CVS. Customers at CVS need to speak out and call it out – right there on the floor of the pharmacy whenever staff trained in these deceptive policies carry out these fraudulent practices. We need to expose this criminal company that kills American patients with their fraudulent sales practices as well as their conspiring with the murderous health (don’t ) care industry in the USA.
LETS HELP THE CVS WORKERS ORGANIZE!
As for the workers in the CVS stores – they are treated worse than the customers. The pittance of CVS compensation barely exceeds the minimum and they play the same games of retail rotating and assuring that very few even get the benefits to be able to afford the lucrative prescription products so fraudulently proffered. Employees who work less than 32 hours per week cannot receive health insurance through the company or paid time off. And they have to do so for a year before they get the benefits. Meanwhile CNN routinely continues massive hiring even though its part time staff wants to make full time to get the benefits.
So CVS – as it denies insured from getting their medicines covered – charges the full price for medicine for its own workers – keeping them from having insurance, even though CVS owns AETNA insurance and even though they get medicine at wholesale.
Workers are subject to hazardous conditions given the role the company plays profiteering off of the pandemic through testing and vaccinations while offering a pittance for hazardous condition compensation.
About 5.5% of CVS’s 215,000 workers are unionized with unions delivering victories and pay hikes of up to $3 per hour and better safety protections. The union that has made the most head way for CVS workers is UFCW with much of its success in southern California. `
By aiding CVS workers in unionizing and working together in solidarity, CVS workers will gain a greater understanding in the struggles of their fellow workers. Hopefully that will guide some to ignore management pressure to fraudulently deny coverage to customers.
When we are forced to pick up scripts -lets always bring some union literature to share with the store staff. And be prepared to act in solidarity and join pickets when the union comes in!
LET THE BATTLES BE JOINED
(An attempt was made to send this article to the pharmacy staff of Carteret but the e-mail address provided did not function properly.)