Follow-up from CVS/caremark Platform Upgrade – NRECA Employee Benefits Weekly

CVS/caremark upgraded their claims system platform on August 1. Despite extensive testing performed both by NRECA and CVS/caremark, some participants are experiencing claims issues as a result of this system change. We are working with CVS/caremark to identify and resolve the root cause and if needed, issue refund check(s) to participants.

The issues participants have reported include:

Copayment or coinsurance being applied in error after deductible has been met
Preventive drugs purchased at non-Exclusive Choice pharmacies receiving Exclusive Choice pharmacy benefits when a copay should be charged
Generic drugs filled via mail order being charged incorrect copay (e.g. $5 instead of $0)

We continue to communicate daily with CVS/caremark on the resolution of these issues and are working to get the best possible experience for our participants going forward for their pharmacy benefits.

Generally, most pharmacy claims are adjudicating as expected, however if a member has a question regarding their payment please contact the Member Contact Center at 866.673.2299 or contactcenter@nreca.coop. Representatives are available Monday through Friday, 7am to 7pm CT.