CalPERS board member acknowledges problems after switch to CVS Caremark, pledges follow-up
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Summary
CalPERS trustee Yvonne Walker told retirees the move from OptumRx to CVS Caremark affected about 580,000 members, acknowledged rollout problems including higher co-pays and new prior-authorization rules, and promised staff follow-up and a direct contact for urgent cases.
Yvonne Walker, a member of the California Public Employees Retirement System board, acknowledged widespread problems after CalPERS switched its pharmacy benefits manager from OptumRx to CVS Caremark and urged affected retirees to document specific issues so staff can track and resolve them.
"The transition impacted about 580,000 members," Walker said, adding that while the change was intended to improve services, "it was the smoothest transition ever. It was not." She told callers to report exact drug names and problems to CalPERS and the dedicated CVS/SilverScript customer teams so the agency can create a paper trail.
Multiple callers described delayed shipments, higher out-of-pocket costs and new prior-authorization requirements for long-standing medications. One caller, Diana, said she had spent hundreds of hours on the phone and in emails and that CalPERS and CVS staff gave conflicting answers: "CVS Caremark is putting me through hell," she said.
Walker attributed some differences to variations in PBM formularies and said that when a generic is available PBMs often substitute it; she also said some brand prescriptions require paperwork from doctors if a patient needs to remain on the brand. She repeatedly urged callers to call the CalPERS 800 number and provide specifics so CalPERS can track repeat issues.
To improve direct communication in urgent cases, Walker offered a CalPERS contact number ((916) 397-0170) and asked members to text or call and identify themselves so she can prioritize follow-up. She promised to "dig in" and report back within a few weeks on systemic problems.
CalPERS staff said the health-care team and board reviewed PBM and insurer options through an open bidding process and judged CVS and Blue Shield the better choices at the time; Walker acknowledged the rollout had kinks to work out and said the agency will continue monitoring performance.
Next steps Walker described included coordinating with the health-care team to publish status updates on the CalPERS website and reporting on every future call where member concerns are raised. She did not set a timeline for when individual disputes would be resolved.
