Express Scripts complaints

By way of background, Express Scripts administers prescription drug benefit plans on behalf of plan sponsors, in this case, . Express Scripts provides plan sponsors with "core" pharmacy benefit management services, including third-party claims processing, formulary administration, benefit plan communications, and other similar activities. In this capacity, Express Scripts is not acting as a health care provider or insurer but serves to administer benefit plan designs and formularies in accordance with rules provided by the plan. Ms. Gaubatz expressed difficulty obtaining a medication using her prescription benefits. In review of Ms. Gaubatz prescription history, the controlled medication in question required Prior Authorization (PA) to allow for coverage through her primary insurance plan. A coverage review was conducted yet denied for not meeting clinical criteria. Ms. Gaubatz requested that her secondary insurance be billed instead; however, she was informed that her primary insurance could not be bypassed in order to bill her secondary plan. Express Scripts discussed all concerns with Ms. Gaubatz who voiced understanding.

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