I submitted for Prescription reimbursement from the past year (2016-2017) I was denied by mail June 26th. First set of deniaIs was bogus.
I submitted all necessary info. I even called ahead of time to be sure I did it correctly. Was told to attach UCF. Which I did.
contacted the CSR by phone on June 29 2017 . I wanted specifics as to why a legitimate, common drug prescribed by a medical doctor is not approved. He (Jaime) CSR could not give the specifics. He tried.
He was diligent. He put me on hold. He spoke with an ES pharmacist; who apparently, is not allowed to speak directly with me. I want to know that a medical professional is denying these claims, and why?
Not some minimum wage, high school kid, who just looks for "codes", and has no medical background. My doctor thinks it's safe, who is the insurance to decide that it isn't an approved ingredient? The final answer(s) for my denial: -the ingredient(s) isn't approved, -or it contains an over-the -counter ingredient. example given was "methocel", "siliacgel" & microcrystalline -ingredients not covered.
You cannot tell me that there are no over- the- counter products in their "approved" prescriptions. Example, if there is sugar, or flavoring (not healthy) in children's cough syrup. That sugar is an over- the -counter product. Not medicine.
Here is an article which may explain their lack of integrity: Conflict of interest here? Express Scripts has their own mail - order prescription service.
Are compound pharmacies cutting into their profits? https://www.bizjournals.com/stlouis/blog/2016/01/express-scripts-in-new-fight-with-compounding.html
Product or Service Mentioned: Express Scripts Claim.
Reason of review: Problems with payment.
Monetary Loss: $1500.
Preferred solution: Full refund.
I didn't like: Denying compound med reimbursement possible conflict of interest.