Tip: If your patient's insurance is CVS Caremark, there's a reason why the drug prior authorization is taking forever.

I'm a prior auth specialist in a doctors office (previously did pharmacy for 4 years) and we've been having an upsurge in prior auth requests lately, specifically for CVS Caremark prescription benefit plans. Normally this wouldn't be an issue - a lot of insurances recently switched formularies so we're used it. Pretty much every interaction I've had with a customer service rep when I've called about a PA for any insurance has been totally fine.

Caremark though? Jesus Christ.

My coworker and I do rock paper scissors if we have to call them about an auth issue for a medication. I was the unlucky one and had to call three times in a row today. Each time, I got someone on the phone who was clearly talking to someone else in the background and not hearing me for the first minute, or when I was explaining the easily fixable issue I kept getting interrupted with "I don't have time for this!" and hung up on me, to a rep telling me that I was inconveniencing her because she was having a conversation with her son when I called, and that i was "very rude for doing so and that i should be ashamed of myself". Wtf?? It's like this EVERY time we call and we're both very nice people, we don't lose our tempers or blame reps for things that don't go our way.

We'll get notifications on Cover My Meds for prior auths generated by Caremark, but then half the time they'll tell me that there's no prior auth requests on their end.... while telling me the name of the drug that requires the prior auth when I never told them what it was, so obviously something is showing up on their end. Whether they just don't know where to find it or are lying to me to get me off the phone, I don't know, but I've never had this problem with other insurance companies.

So if it's taking forever for a prior auth to be answered and the patient has CVS Caremark, that's why. It is IMPOSSIBLE to get a rep who seems to genuinely want to help you, no matter how pleasant you are to them. PAs take twice as long to do with Caremark because of all of the runarounds they make us do. Us PA people are trying, we promise! I feel really horrible for you guys working in the stores because I've been in your shoes when I worked in pharmacy, with patients yelling at me because their insurance hasn't answered their PA request yet.