I needed a compound medication for the first time, which is a medication customzied by a pharmacist who combines multiple raw ingredients. Most pharmacies don’t do this and the one my prescriber send the prescription to didn’t work with any insurance, so I had to file for a reimbursement through Caremark.
Love that there’s an online option to submit a reimbursement claim. Don’t love that I have to manually list every single ingredient in the compound, including the NDC, quantity, and cost, especially when all of that information is already on the receipt I need to upload.
Love that a reimbursement decision was made within one business day. Don’t love that there’s no email or text notification when that decision is made. Don’t love that I can’t actually see the decision online and have to wait for a letter in the mail to find out whether my claim was approved or denied. Don’t love that it’s been thirty days since the claim was processed and the letter still hasn’t arrived.
I guess the system is working as intended. If the process takes long enough, maybe people just forget about it. I already paid three figures for the medication, so the only person losing out is me.
Update 1 (two weeks after submitting claim): Contacted online support and they said they don’t see anything on my account and it can take up to 30 days for an update.
Update 2 (a month after): Followed up with online support and after escalating to a senior team member, they said that with my plan, I should and can only submit for reimbursement via mail or fax…
Update 3 (a month and a week after): Called support to get a form to mail reimbursement. They can see the claim in my account but not in their backend system. Senior support said to just wait for the mail, but the initial support person filed a ticket to get their system checked and told me to call back in a week if I don’t hear from them. Thankful for people who are competent and care.
Update 4 (two months after): Insurance won’t pay for an out-of-network pharmacy LOL (yes, that LOL was sarcastic).