Medicare Part D Open Enrollment season is always challenging and this year is no exception with the discovery of pro-CVS bias in online plan listings at silverscript.com and pharmacy network status errors on two SilverScript plans at Medicare.gov.
An APRx member pharmacy has filed a complaint with CMS over its erroneous listing of the pharmacy as non-preferred in the SilverScript Plus and SilverScript Allure plans in Medicare Part D. After working with Norman's Pharmacy in Brenham, TX, to learn the details, we have confirmed that Norman's is indeed listed as "Standard" instead of "Preferred" in the online plan comparison tool at medicare.gov. In fact, our checking yesterday of a random sample of 20+ APRx member pharmacies from ZIP codes in seven different areas of the state showed that every APRx (Elevate) pharmacy is listed as "Standard Cost-Sharing" on medicare.gov instead of the correct "Preferred Cost-Sharing" for both the SilverScript Plus and SilverScript Allure plans.
American Pharmacies has notified Elevate and the National Community Pharmacists Association about the network status error. Elevate reported to us that CMS is working to resolve the problem, which reportedly was traced to data file exchanges between Caremark and CMS. Elevate reports that the federal agency is trying to resolve the problem by the end of this week.
Norman's also discovered that Caremark seems to be trying to to steer enrolling patients to a default CVS pharmacy at silverscript.com. APRx duplicated Norman's experience by testing the drug-pricing function for three Silverscript plans at the Silverscript.com website using 20 different addresses/ZIP codes from seven different parts of the state. I
n every instance, a CVS pharmacy came up as the default pharmacy and we had to click on the rather small, red "edit" link below it to choose another pharmacy (see top illustration at right).
Even if we selected a different pharmacy as the primary pharmacy, that choice was listed only for that plan and the other two SilverScript plans still defaulted to a CVS pharmacy (see second illustration at right).
This appears to be overt "steering" by Caremark to CVS pharmacies and is troubling in light of the firewall that is legally mandated to exist between Caremark and CVS since their 2007 merger.
We strongly encourage all member pharmacies to verify their provider status with Caremark's SilverScript Plus and SilverScript Allure plans at medicare.gov. Although the CMS website is in error, our checking yesterday for 20 different APRx pharmacies in 7 areas of the state showed that Silverscript.com correctly lists those pharmacies as "Preferred."
We also urge all our members to file a complaint with CMS over the CVS steering issue with Caremark's Silverscript plans.
Before submitting a complaint, please use the "Pharmacy Locator Tool" and the "Drug Price Quote Tool" at silverscript.com to verify that the site steers patients/enrollees to a default CVS pharmacy
and away from your independent pharmacy. (You can click here to see how Norman's Pharmacy went through this process).
If yes, then you should submit a formal complaint to CMS using this template as a guide. The subject line of your complaint email should read "Complaint Against Silverscript PDP by (insert name of your pharmacy/pharmacies)." You can send the complaint to: PartDComplaints_RO6@cms.hhs.gov. Please
send a copy of your CMS complaint to email@example.com so we can monitor the level of engagement on this issue.