US regulators ordered Aetna Inc. to fix its Medicare drug program after the company’s website inaccurately advertised that Aetna plan networks included pharmacies that were not in their network.
The Centers for Medicare and Medicaid Services (CMS) has announced that more than 400,000 Medicare beneficiaries who were confused or misinformed about their 2015 Aetna prescription drug plans now have until the end of February to change plans or identify participating pharmacies.
During the open enrollment period, Aetna and the Medicare Plan Finder website wrongly advertised that Aetna plan networks included pharmacies that were actually out-of-network, which may have affected approximately 400,000 beneficiaries, according to CMS. The company had inaccurately listed around 5,000 pharmacies as in-network.
“Beneficiaries relied upon erroneous posted information to choose their Part D plan and, unfortunately, Aetna/Coventry did not act in a timely enough manner to try to remediate this situation,” said the National Community Pharmacists Association (NCPA) CEO B Douglas Hoey, RPh, MBA, in a statement responding to the corrective action plan. “The corrective action plan requested by CMS is a welcome first step. But we believe more must be done to avoid reliving next January what has been a very disruptive experience for seniors, caregivers and community pharmacists. We encourage CMS to take additional steps to mitigate similar problems in the future.”
Aetna’s pharmacy networks significantly changed for 2015. Pharmacies that had been in-network for about 220,000 members in 2014 no longer are, and the in-network pharmacies that had provided preferred cost-sharing for 240,000 members no longer do in 2015, according to CMS.
CMS concluded that Aetna failed to comply with its obligation to invite and allow any willing pharmacy in the standard pharmacy network of its Part D plans to participate. CMS said that the insurer must comply with this requirement as soon as possible for both 2015 and 2016 plan years. Aetna must also provide a set of network pharmacy standard terms and conditions for all of its 2015 Part D plans that include a provision clearly identifying the plans to which the terms and conditions apply. If Aetna does not comply in a timely manner, CMS said that it reserves the right to impose additional enforcement actions, such as suspending marketing enrollment, fining the company or issuing a contract termination notice.
Sources: Centers for Medicare and Medicaid Services; National Community Pharmacists Association