Received a Letter from CVS Caremark

RxGetter wrote:

Why is a retailer allowed to decide what medicines I should be allowed to take? Isn't that they realm of my doctor?

It's not like I am going without insurance. I have good insurance and I am always careful to select the most inclusive policies each year at enrollment time. This letter just rubbed me the wrong way.

Your doc did decide what you should take and for how long. The prescription plan you have, however, decided they don't have to pay for it. You can still follow your docs treatment plan. No one is stopping you. You just have to pay for it yourself, that's all.

And this is proof that you don't have "good insurance" as you say. If you were willing to pay more for a better plan then it probably would have been covered.

Insurance is meant to protect you from major financial ruin when big expensive things happen. I blew my knee out and only paid $3k for a $12k operation. That's what insurance is for. It's not going to ruin you financially to pony up for a two week supply of anti-fungal cream.

I want to clarify what you said: You stated you were prescribed 2 weeks of terbinafine by your doctor. You did not specify what form (oral, etc.) this came in. You then told us you got a letter stating you were approved for 2 months of terbinafine, again not stating the the form (some cream forms are rx, and some are not; tablet forms are rx). I assume you're talking about oral terbinafine, since that usually what is prescribed, and the usual course for toe fungus is 3 months. However, this still doesn't clear up why your doctor would prescribe two weeks of terbinafine, unless it's just him or her telling you to take the cream and see what happens. I think your initial post could use some clarification.

pardon any grammar or spelling errors/written in haste

Sorry for the confusion. Let me clarify.

I was prescribed a two-week cycle of oral Terbinafine. This is a pill that I take once a day for 14 days. The Rx was approved and I picked it up. It was $0.24 in total, which is crazy cheap.

I was surprised at the letter, which despite my approval basically just told me "we approved your claim but we don't have to if we don't want to." Seems like an odd letter to send to someone that you just approved for a two-week prescription.

Am I wrong to think this letter was weird, unnecessary, and a little threatening? I understand the initial response saying it is not going to break the bank to buy this pill for two-weeks, but what if it was for a cancer drug? Do I really want someone at CVS deciding whether I get my cancer meds?

This is more of a question than anything. I am curious whether this is the new normal.

To clarify further, my doctor said the two-weeks should clear up the athletes foot since it had not spread into nails. If I had it in the nails, it would be ore like 90 days of treatment.

So yes, the two-month limit stated by CVS also caught my attention because what if I did need it for 90 days...?

Regarding my insurance: I do pay for the max coverage allowed. I work for a large company that is generally acknowledged to have good benefits. I have no issues with the provider side of my insurance. Actually, my deductible is $2,300 for the family and my wife hit this on a shoulder surgery last year. So I understand what "Doc Did, Bro" is saying.

CVS Caremark is a prescription drug benefit manager that insurance companies hire to administer their prescription drug benefits. CVS Caremark is a subsidiary of CVS, which owns the retail drug store chain. CVS is trying to merge with Aetna in order to vertically integrate health insurance with health care services.

The letter you got was not from the retailer. It was from the benefit manager. It is silly CYA language that is all over the health insurance industry. If you read everything in your health insurance policy and all the boilerplate that comes with your benefits statements, you would be scratching your head at 80% of what is in there. But in the for profit health system, everyone jumps in between you and your health care to try to squeeze out a few more bucks for investors.

Precious Roy wrote:

CVS Caremark is a prescription drug benefit manager that insurance companies hire to administer their prescription drug benefits. CVS Caremark is a subsidiary of CVS, which owns the retail drug store chain. CVS is trying to merge with Aetna in order to vertically integrate health insurance with health care services.

The letter you got was not from the retailer. It was from the benefit manager. It is silly CYA language that is all over the health insurance industry. If you read everything in your health insurance policy and all the boilerplate that comes with your benefits statements, you would be scratching your head at 80% of what is in there. But in the for profit health system, everyone jumps in between you and your health care to try to squeeze out a few more bucks for investors.

Thank you. This makes sense. I should be thankful that this letter was for athlete's foot and not for something life threatening. And the fact that I was approved makes it a moot point, but - you're right - the language seemed a bit CYA.

I'm on a treatment for a life threatening issue.

The pharmacy calls me to confirm I am taking my pills and am fine with therapy. Its part of a counseling legislation that retail has agreed to as part of their remit.

The only time I'd worry is if they said they had not approved for the drug.

Some drugs are best not taken long term. A lot of antifungals are limit in time.

Lets hope it clears up.