Designated Diver AKA D.
Caremark Prior Authorization Experience…
Caremark Prior Authorization Experience – I am writing to document a distressing experience I encountered with Caremark’s prior authorization process for a longstanding medication. My medication, which I have taken for years, normally costs around $4 with a savings card, but this time the cost was unexpectedly close to $2000 due to a prior authorization requirement. The process became a nightmare due to multiple failures and communication issues: I was advised that my doctor needed to change the DAW (dispense as written) code to facilitate approval. Despite emailing the doctor’s office and offering to assist, no action was taken by the doctor’s office, and Caremark staff did not follow through. Caremark representatives initially claimed they could waive the need for a letter of medical necessity, but later insisted the letter was required. They marked the case as urgent and said it would be reviewed in a few days. Three days passed with no fax received by my doctor, and I was left without medication. Multiple calls revealed that Caremark failed to fax the necessary letter, and staff exhibited unprofessional behavior, including speaking over me, displaying irritation, and providing inconsistent information. The supervisor finally admitted that the fax was never sent, and I was told the waiver of the letter was due to a change in coding without informing my doctor or me. Throughout, I received no proactive communication from Caremark about these updates, leaving me in a vulnerable and distressing position without medication. This experience reflects poor communication, lack of accountability, and unprofessional conduct by Caremark staff, causing significant inconvenience and stress. I hope this summary can assist in addressing systemic issues within the prior authorization process.