Pharmacists: Aetna Medicare Part D Drug Plans Plagued with Glitches

Patients can call 1-800-Medicare to Enroll in a New 2015 Plan

News provided by

National Community Pharmacists Association

Jan 07, 2015, 10:00 ET

ALEXANDRIA, Va., Jan. 7, 2015 /PRNewswire-USNewswire/ -- Medicare beneficiaries and caregivers, in an unwelcome New Year's surprise, are discovering that they are unable to fill prescriptions at pharmacies promoted by Aetna/Coventry Part D drug plans listed on the Medicare Plan Finder website used during the 2014 Medicare open enrollment to select a 2015 drug plan.

Incorrect information was posted on Medicare Plan Finder, Aetna websites, and provided to the Centers for Medicare & Medicaid Services (CMS) regarding which pharmacies were in-network. Thus, beneficiaries may have signed up for Aetna plans believing the pharmacy they wanted to patronize was in-network, when, as Aetna recently acknowledged in a letter to pharmacies, it was not. Medicare open enrollment closed on Dec. 7. This situation has resulted in complications, such as for a 91-year-old patient in a long-term care facility accustomed to home delivery from her local pharmacy, but now forced to find another pharmacy to fill her rescue inhaler.

"Community pharmacists help patients every January with challenges that stem from new or revised health insurance policies. However, this situation is more problematic and complicated for Medicare beneficiaries enrolled in Aetna/Coventry drug plans who may feel like the victims of a bait-and-switch," said National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA. "As a result, we encourage Medicare beneficiaries who feel misled to switch drug plans by calling 1-800-Medicare."

Affected beneficiaries can take advantage of a Special Enrollment Period (SEP) to choose a new Part D plan, NCPA confirmed with CMS officials. Beneficiaries, or their caregivers, can call 1-800-Medicare and explain to the customer service representative that they need to select a new Part D plan because of inaccurate marketing information that was presented on the Plan Finder website during the 2014 open enrollment period.

"In light of this disruption to beneficiaries and pharmacies, Aetna should honor the prescriptions filled at the plan's 'non-network' pharmacies that were inaccurately reported to be in-network," Hoey added. "Aetna's purported solution to require low-income subsidy beneficiaries to pay the full drug cost, and apply for a one-time reimbursement from the insurance company, is impractical and unacceptable."

The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of nearly 23,000 independent community pharmacies. Together they represent an $88.8 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more go to www.ncpanet.org or read NCPA's blog, The Dose, at http://ncpanet.wordpress.com/.

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SOURCE National Community Pharmacists Association