CVS review: rx not processed in timely and correct manner

Christian, Karen Manley
Female, 83 year old, 5/19/1937

Our office, UCSD Medicine for Seniors/Geriatrics, sent an E-Rx for pt's Lunesta on 3/24/2021. Pt was getting denied claim and our office was trying to do Prior Auth. We were having difficulty processing PAR online despite given insurance info. I called Evolve pharmacy 4/16/2021, approx 5pm, pt's pharm insurance, to do verbal PAR or ask where to fax the printed PAR. Shawne, Evolve pharmacist, stated that pt's Lunesta did not need PAR, it was being processed incorrectly by CVS pharmacy. CVS was processing Lunesta claim as #30 for 15 day and correct Rx is #30 for 30 day. Confirmed with Shawne that we have Rx written as 1 tab at bedtime as needed for 30 day supply. Shawne placed me on hold and wanted to speak to CVS pharmacy herself. Shawne informed me that she spoke to pharmacist and informed how to process claim correctly, she can see all the rejected claims on the insurance side. I informed pt of what happened and it should be cleared since the insurance pharmacist called herself.
Pt called again 4/19/2021 and stated that she could not get Tia, CVS pharmacist, to get her Rx over the weekend. Pt stated that the refill has been delayed 11 days now. Pt informed me that Tia continuously told pt that she did not receive auth from the doctor's office and she did not see error on their end. I called and spoke to Tuyet, CVS pharmacist, to ask why Rx has not been processed when Evolve pharmacist, Shawne, cleared up processing issue on 4/16/2021. I explained that E-Rx was sent from our office on 3/24/2021. I could hear typing, Tuyet informed me that she would process pt's Rx.
Pharmacy

CVS/pharmacy #9963 - San Diego, CA - 5644 Mission Center Rd
5644 Mission Center Rd Suite 201, San Diego CA 92108
Phone: [protected]  Fax: [protected]
DEA #: FL1169538
Outpatient Medication Detail

eszopiclone (LUNESTA) 2 MG tablet
Sig - Route: Take 1 tablet (2 mg) by mouth At bedtime as needed (insomnia). - Oral
Sent to pharmacy as: eszopiclone (LUNESTA) 2 MG tablet
Class: ePrescribe
Date/Time Signed: 3/24/2021 18:04
E-Prescribing Status: Receipt confirmed by pharmacy (3/24/2021  6:04 PM PDT)

Michelle, LVN
UCSD Medicine for Seniors
[protected] phone
[protected] fax