CalPERS members report widespread problems after switch to SilverScript; board rep. pledges follow‑up
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Summary
Retirees told CalPERS at a Jan. 31 town hall that a January switch from Optum to SilverScript (CVS) left prescriptions missing, prior authorizations lost and customer service unresponsive. Yvonne Walker said CalPERS will route cases to its health team and that staff are working to resolve glitches.
Yvonne Walker, the CalPERS board representative for the webinar, acknowledged at the Jan. 31 town hall that the systemwide switch of CalPERS’ pharmacy benefit manager from Optum to SilverScript/CVS has produced member complaints and operational "glitches" and said CalPERS staff will route specific cases to its health team for follow‑up.
"We have switched over our pharmacy benefit provider from Optum to, CVS, the SilverScripts," Walker said, and she urged members experiencing problems to provide details so the health team can respond directly. "I'm going to refer all of the questions and the comments about what's happening to our healthcare team so that they can get in touch with you directly," she added.
Multiple callers described similar problems. Michael said customer service misdirected him and that some routine generic drugs now require prior authorization; he called the experience "awful." Lisa, who said she is a type‑1 diabetic, told Walker, "The insulin I use is not on the formulary," and described receiving form letters and automated communications that she said left her unsure how to get necessary care.
Other callers reported prescriptions and prior authorizations that did not transfer after the change. Pat said "none of the prescriptions transferred from Optum to to Caremark," leaving patients and physicians to "start all over again," and Ronnie described difficulty getting small providers recognized in the network and problems scheduling behavioral‑health appointments through Included Health and Quartet.
Callers also pressed CalPERS on oversight of vendor communications. Lisa said the earliest letters she received bore no CalPERS logo and complained members "had no voice" during the vendor change process. Walker said CalPERS added a team dedicated to SilverScript/CVS and that staff have been assigned to oversee member issues; she said CalPERS will post FAQs and links with follow‑up information and urged members to use the CalPERS contact center at (888) 225‑7377 for case intake.
A caller asked whether penalties in the SilverScript contract would create incentives for the company to deny coverage; Walker said penalties and benchmarks are intended as accountability measures and that any financial remedies would be returned to the program to lower member costs, not held by the vendor.
Walker and CalPERS staff repeatedly apologized for members’ experiences, said they expected many issues to smooth out after the first month of operations, and pledged continued attention and direct outreach. Several callers asked for callbacks; Walker said the health team would follow up on individual cases.
The town hall provided no binding policy changes or votes; it was a member Q&A and information session and CalPERS staff said formal remediation steps are being handled through the health‑team case intake process.