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Silverscript Insurance Suspended by Medicare Services

Posted: Jan 30, 2013 4:40 PM by Nick Chabarria
Updated: Jan 31, 2013 10:41 PM

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COLUMBIA - CVS Caremark Silverscript Insurance Company remains on probation after receiving sanctions from the Center for Medicare and Medicaid Services earlier this month.

According the notice that CMS sent out on Jan. 15, Silverscript faced "suspension of the enrollment Medicare beneficiaries and the suspension of all marketing actives to Medicare beneficiaries." These penalties are result from a system wide failure that Silverscript experienced at the start of the new year.

CMS reported they received 2,340 complaints from SSIC members between Jan. 1 and Jan. 14. When trying to pick their medication, members reported pharmacies receiving false error messages from SSIC. According to the report these messages said the SSIC member was not enrolled with SSIC, the member was enrolled in the wrong plan or the member was receiving low-income subsidy incorrectly.

The notice said that these errors caused some people to leave the pharmacy without the medication they needed.

When contacted, Silverscript had no comment on the issue. The Center for Medicare and Medicaid Services said that they are working closely with Silverscript on the matter. However, the CMS was unable to provide specific details as to how SSIC was fixing the problem.

D & H pharmacist and Missouri Pharmacy Association treasurer Erica Hopkins-Wadlow said issues with insurances come up a lot. She estimates that 30 to 40% of prescriptions that come through her Broadway store have some problem with insurance.

"Whether it's a day supply issue, or a drug not covered, or its non formulary so it's a really high co-pay, yeah 30-40 could be on the low side sometimes," said Hopkins-Wadlow.

She added that dealing with insurance companies can be difficult but encourages people keep calling if they experience a problem getting their prescriptions.

The CMS urges any Silverscript members having problems getting medications to call 1-800-Medicare or SSIC customer service.

SSIC-Sanction-Attachment-01_15_13.pdf

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