The system shouldn’t be this complicated: A reflection on CVS Specialty
I recently shared an extensive collection of my CVS Specialty Pharmacy experiences over the past several years of dealing with them. Within a month of writing about it, I already had more misadventures to add! It’s unbelievable how much they mess up. However, I’m currently writing to share my “expert” advice for dealing with them: just call and bother them! Unendingly. Until they do what they’re supposed to. Who knew it was so easy? (Sarcasm.)
Coordinating my own healthcare as someone with a chronic illness is an unending list of tasks that, if delayed or missed, can seriously harm my health. I’m lucky that my dad is able to help me. I’m also lucky that my family knows a lot about the healthcare system at this point. Many people aren’t so lucky.
The most recent incident I’m referencing is when the online system tried to tell me it couldn’t deliver my medication until after I was supposed to take it. I was placing the order on Tuesday when I needed the medicine the following Monday. They said the soonest they could deliver was the following Tuesday. The funniest part was that the order screen suggested I pick Tuesday as the delivery date in order to stay on schedule with my medicine (I had entered my next dose date in the form). That’s some poor coding.
So that’s where my expert strategy comes in. Call them! Suddenly my medicine was being air-shipped to me the following day.
Of course, for people who can’t call during their specific business hours, this is a major problem. For issues that require multiple calls, hour-long calls, and more, this is a major problem. As I mentioned before, it once took 2 months of multiple calls per week for me to get my medicine.
The system is so inefficient, this is frequently the only fix for people who need their medicine. For people who are sick, disabled, elderly, or even simply employed, the amount of time it takes to fix problems is more than they have to spare. Especially for people facing chronic illnesses, where energy, time, and money are often carefully managed, this is completely unacceptable.
The amount of work that goes into coordinating prescriptions, insurance, appointments, referrals, and more makes itself into a job for many people with chronic illness—in fact, being a personal healthcare assistant is reasonable employment. Those with chronic illness are left to either do the work to become experts themselves, hire someone, or get lost or left behind in the system. It’s frequently the latter, and this shouldn’t be the case.
The system shouldn’t be so complicated that it takes years of experience to understand. It’s used by everyone in the country in one way or another, often at a person’s most vulnerable time. That is not the moment you want to realize how little you understand, how little guidance you have, and how little recourse you have for issues that arise.
The healthcare system doesn’t have to be complicated and opaque. So why is it? It certainly works out for the insurance companies and the hospitals, but what about the people it’s supposed to serve? The United States ranks poorly in many different health metrics compared to similarly developed countries, including life span, maternal and infant mortality, and more. I’ve heard people argue that our system is better for this reason or that reason, but the numbers prove this isn’t true.
We can do better. We need to do better, for the future of this country. So please, let’s talk about change. Let’s keep it in the national conversation. Let’s make it a priority.
There isn’t only one solution. I certainly have my ideas, but my purpose here isn’t to solve things or champion a fix. We need to solve things as a country, together. This affects everyone who lives in the United States.
So regardless of what we decide the solution is, let’s do something!
-Bri
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9 Comments
Rick Phillips
I have one word for you !!!
INFUSION !! Stop the confusion start infusing. 🙂
Bri
What infusion do you get?
Tennessee Mommy
I just googled “CVS Specialty Reviews” as I sit here on hold with them for over 56 minutes now. My God, this outfit is a joke. God forbid you ever need to call their billing department. They shuffle you around from person to person and put you on hold forever. People who are sick should not be subjected to this kind of torture.
Deeds
Yes, CVS Specialty is the worst. My husband and I are both physicians with experience in the pharmaceutical industry so we understand the critical importance of adhering to proper and timely administration of biologic drugs for serious chronic diseases. My mother has needed biologics delivered on a strict timetable for many years now and we are forced to deal with CVS Specialty with every new prescription because of her prescription drug insurer — Caremark, which is under the CVS/Caremark/Aetna umbrella. Their automated phone system keeps no record of why they are calling you so you have to start from the very beginning again and again. Every step along the way toward getting medication delivered takes another phone call to confirm and reconfirm that what they said happened actually did happen. They “claim” they contact my mother’s physician with an issue, but they lie. They use the same automated system to call the office as they do to call the patient — there is no live person who is familiar with the history of the issue who can communicate what CVS Specialty is missing. The CVS Specialty representatives are reluctant to get their own pharmacist or insurer (Caremark!) to resolve an issue — they push it onto the patient or the Dr. to do this busywork. The supervisors are equally clueless. Yesterday evening, we were on the phone with them for 2 hours and today I was on the phone with them for 2 calls of an hour each and still no progress! How much money are CVS/Caremark/Aetna executives making to botch delivery of critical biologics to patients? This is shameful — and borders on criminal negligence.
S
I’m sorry for what you’ve experienced, but appreciate your sharing – it makes me feel less alone as someone on biologics who cannot stand CVS Specialty Pharmacy. Every time they call, they want me to reconfirm all of the details of my diagnosis, when I was first diagnosed, why I stopped my current medication for a time (which relates to a painful and private situation), weight, height, etc., etc. I can understand why a pharmacy would want to make sure nothing has changed for a patient in terms of prescribed or OTC medication, but the additional rounds of questioning are unnecessary, intrusive, and a complete waste of time.
It boggles my mind that they will waste (literally) hours on the phone reconfirming details regarding a medication prescribed by a physician directly treating the patient, and are then completely lackadaisical about delivery – for instance, it’s not standard to have to sign for a delivery of $2000 medication, and patients must opt for this. I’ve had experience with missed and delayed deliveries as well.
Sorry you are going through this. If it’s helpful to hear, it is not just you. They are The Worst.
MH
Yes CVS Specialty Pharmacy is totally incompetent. Today I spent 5 hours on the phone on a critical medication delivery my wife needs. I can not even start to mention the twists snd turns during this conversation and the end result is that I still don’t know when the medication will be shipped. At the end of the conversation the pharmacist from CVS needed to get involved but the last one had left for the day. No pharmacist on call for the weekend so I will need to continue my saga on Monday while my wife is running out of medication. Supervisors for which I asked several times are equally incompetent/ powerless. Extremely frustrating.
Annoyed Patient
CVS Specialty is completely incompetent. I also take biologics for my Crohn’s disease and it’s nothing short of a nightmare every time I get a refill, often leading to my having to take my medication at longer intervals than I’m supposed to. One of my favorite issues was when it took over a month for them to sort out a prior authorization. Why? The script read take every 6 weeks, the prior authorization also said take every 6 weeks. After over a month of the doctor and insurance company repeatedly saying they sent it and sent it correctly, they determined someone on CVS Specialty’s end entered the prescription in their system as “every 42 days”. First off, the fact that this was even being contended as last I checked my math 7 (days) X 6 (weeks) equals 42 days was ridiculous, but the fact they caused the issue and blamed everyone else was absurd. To top it off after they fixed it, I STILL needed to call back to have it shipped and several of the dates were already maxed out. Apparently they only allow a certain amount of scripts per delivery day? Hours upon hours upon hours on the phone with these guys.
Groundhog Day
I just got off the phone with them after being on hold for 40 minutes. This is the second time in a week. Same story. Your doctor wrote the prescription for 8 weeks when the insurance will only provide reimbursement for a 30 or 90 days supply. I point out once again there is no 90 day supply — only a 4 week or 8 week injection. When she protests, I tell her to look at the pharma’s website. In the middle of the hold, I get another text informing me my prescription is ready to be refilled. Which prescription, you ask. Yes the one that has expired. This is, of course, the same information that I received 10 days ago. After 40 minutes I was losing my sh**. The agent says, I understand you’re frustrated. You’re damned right I’m frustrated. The same exact thing happened 10 days ago, and 10 days before that. It’s like Groundhog Day in an endless loop folding back on itself. Although I will say, one time I had the most wonderful experience with an agent. She said, I have to ask you the same questions at least 8 times. So be patient. By the fourth time I was answering the same questions, we both started laughing hysterically. It took a long time but only because we were having a great time.
I’ve also found that my meds are on automatic refill and delivery for two months and then suddenly they aren’t. One day I receive a text asking me to provide the shipping date (now overdue by three days) and two days later I call again and get the same story I got 10 days before. it is a completely altered reality dealing with the company. It would be one thing if we weren’t dealing with health and survival issues
Mike
I actually have stopped taking my medication since my insurance was switched to CVS Specialty. My RA symptoms at the moment are minor enough that I am usually functional at least. All of the things you list have happened with me: changed delivery dates without notification, out of stock constantly, long hold times, no call back, etc. etc. I would get so upset every time I had to deal with them. It’s more trouble than it’s worth. Suposedly untreated RA can shorten your life expectancy. That’s a fair trade not having to deal with them anymore.