• Hypertrophic Cardiomyopathy (HCM)
  • Vaccines: 2023 Year in Review
  • Eyecare
  • Urothelial Carcinoma
  • Women's Health
  • Hemophilia
  • Heart Failure
  • Vaccines
  • Neonatal Care
  • Type II Inflammation
  • Substance Use Disorder
  • Gene Therapy
  • Lung Cancer
  • Spinal Muscular Atrophy
  • HIV
  • Post-Acute Care
  • Liver Disease
  • Pulmonary Arterial Hypertension
  • Biologics
  • Asthma
  • Atrial Fibrillation
  • Type I Diabetes
  • RSV
  • COVID-19
  • Cardiovascular Diseases
  • Breast Cancer
  • Prescription Digital Therapeutics
  • Reproductive Health
  • The Improving Patient Access Podcast
  • Blood Cancer
  • Ulcerative Colitis
  • Respiratory Conditions
  • Multiple Sclerosis
  • Digital Health
  • Population Health
  • Sleep Disorders
  • Biosimilars
  • Plaque Psoriasis
  • Leukemia and Lymphoma
  • Oncology
  • Pediatrics
  • Urology
  • Obstetrics-Gynecology & Women's Health
  • Opioids
  • Solid Tumors
  • Autoimmune Diseases
  • Dermatology
  • Diabetes
  • Mental Health

Aetna subscribers can switch plans due to information errors


A reprieve has been granted for Medicare beneficiaries who may have been confused or misinformed about the pharmacy details of their 2015 Aetna prescription drug plans.

A reprieve has been granted for Medicare beneficiaries who may have been confused or misinformed about the pharmacy details of their 2015 Aetna prescription drug plans.

The Centers for Medicare & Medicaid Services (CMS) says affected subscribers will have until the end of February to find participating pharmacies or switch plans.

According to Aetna spokesperson Cynthia B. Michener, there are two issues.

“The first is that we discovered and fixed an issue with CMS’ Medicare Plan Finder and Aetna’s websites in December 2014 that affected a limited number of pharmacies that were listed as participating in some of Aetna’s retail networks when they are only in network for long-term care or home infusion,” Michener says. “It’s important to note that the majority of pharmacies were not affected by this situation.”

If the pharmacy was listed incorrectly in Aetna’s network listing, Aetna is watching for those claims, and will ensure that the member pays the in-network costs for that fill of their medicine. Aetna will then call the member to help them find another pharmacy that is in their plan's network.

“We are informing these members that they can call CMS to request a Special Enrollment Period and discuss their other plan options for the remainder of 2015,” Michener says.

The second issue is unrelated to the error, according to Michener.   

“Many members saw changes to their networks and plans for 2015,” she explains. “Throughout last year, we reached out to members in several ways to ensure these changes were well communicated. But we’re finding members may need more time to understand their benefits. 

“If a pharmacy was listed correctly in our network listing-and is in one of our networks but isn't in the member's specific plan network-we are providing temporary access to our broadest network until at least February 28 for Part D plan members to allow their prescriptions to be covered at any network pharmacy at in-network costs. And we can help them locate a pharmacy in their plan’s network for their future prescriptions,” Michener says. “We’re eager to help any member who is having difficulty using their prescription drug benefits, and if anyone has a question, they should call us directly, using the number on their member ID card.”   

Aetna is keeping CMS informed of its activities and following their guidance on any additional direction for serving members.

NEXT: Medicare Part D concerns 


Devon M. Herrick, PhD, senior fellow at the National Center for Policy Analysis, Dallas, believes that this episode should not be used to condemn the process of Medicare Part D drug plans offering seniors access to preferred networks.

Devon M. Herrick, PhD

“As you probably recall, CMS issued a proposed rule last year to do away with preferred networks,” Herrick says. “CMS had to back down after a groundswell of opposition from across the ideological spectrum. The Federal Trade Commission even weighed in on the topic supporting the right of PBMs to use network exclusion to negotiate better deals with pharmacies competing to be included in the preferred network.

“Of course, seniors don’t have to use preferred network pharmacies; they can use just about any pharmacy they choose.,” Herrick says. “Seniors like to patronize the preferred networks because they appreciate lower cost-sharing.  Actually, my friends on Medicare inform me they’ve never found their preferred network to be restrictive-one told me most of the area pharmacies seemed to be in the preferred network.”

Herrick, who has done research on Medicare drug plans, believes that Part D plans are too complex.

“Medicare Part D has a good track record of holding costs down,” he says. “It’s certainly in drug plans’ interests to steer seniors to the pharmacies where prices are lowest.  It makes sense for seniors to take time to identify the plan that’s right for them. They should not approach plan selection as something they can do in five minutes. There is published research that finds seniors with cognitive disorders enroll in optimal Medicare Part D plans with greater success than seniors who don’t have cognitive problems. The reason is assumed to be because their kids or friends take the time to help them select a plan. It makes sense to shop and compare plans.”

The Federal Trade Commission has long opposed calls to make Medicare Part D simpler-using restrictive regulations-because it believes these restrictive regulations reduce the tools drug plans use to control costs, according to Herrick.  

“Drug plan executives can reduce the complexity by communicating the tools available to help seniors find the drugs each plan covers and which pharmacies are in-network and which are preferred network pharmacies.  Clear and concise communication is always a good thing,” Herrick says.

Related Videos
Related Content
© 2024 MJH Life Sciences

All rights reserved.