More Pharmacy Issues from Coventry

[G.Gordon]

Wow! What a morning. Call after call of plan members getting outbound calls from Coventry telling them that the pharmacy that they use us not in network.

Most of these clients had plan reviews done that showed their pharmacy as in network at a Standard level. These plan reviews were done on Medicare.gov.

Not just one pharmacy either.

What a disaster. This company is going down hill fast after Aetna bought them. The under age side is even more screwed.

 

[MedicareAgent]

Same here, very disappointing. I was hoping Aetna would be the go to instead of Blue.

 

[TwoCents]

This was sent to me; can't post a link since it's for a paid subscription site: insidehealthpolicy.com. If they want to try to switch, clients need to call 1800Medicare to be reviewed case-by-case.

Article start:
Incorrect information about pharmacies participating in Aetna's 2015 Medicare Part D plans was posted onto Medicare Plan Finder, Aetna websites and given to CMS during Medicare open enrollment, according to a December letter Aetna sent to pharmacies. Community pharmacists and beneficiary advocates say the situation is problematic, and the National Community Pharmacists Association called the situation a “bait-and-switch” on beneficiaries.

CMS has entered into a mediation plan with Aetna that calls for the insurer to notify pharmacies of the situation, and the agency says a Special Enrollment Period will be offered on a case-by-case basis if beneficiaries call 1-800-Medicare. Aetna will reimburse beneficiaries once during the first 90 days of the plan year, but NCPA and a beneficiary advocate argue that consumers should not be required to pay the full price upfront.

“We regret to inform you that your pharmacy's participation in Aetna's 2015 Medicare retail networks may have been incorrectly reflected on Medicare's Plan Finder website (Medicare.gov) and other Aetna sites that Medicare beneficiaries may have used to select a 2015 Medicare Advantage (MAPD) or Prescription Drug Plan (PDP),” a Dec. 29 letter to pharmacies says. “Aetna representatives may have used this information to provide in-network retail pharmacies and cost sharing amounts for 2015 to prospective members.”

CMS says Aetna submitted incorrect pharmacy information to the agency for Aetna plans, and the Aetna letter says the information was corrected by Dec. 22 -- after open enrollment for Medicare closed on Dec. 7. A CMS spokesperson says the agency is aware of the situation and is monitoring it. The agency has also entered into a mediation plan with Aetna, which includes notifying the pharmacies of the situation. Plus, CMS is calling existing enrollees in Aetna and Coventry plans who got a prescription within the last six months at an affected pharmacy. CMS says this affects about 50,000 beneficiaries.

Aetna will also reimburse beneficiaries who go to a pharmacy that was incorrectly listed as in-network one time during the first 90 days of the plan year, CMS said. Beneficiaries will have to pay the full price upfront, and Aetna will reimburse them so that they pay at an in-network level.

One beneficiary advocate said Aetna should process the claims at an in-network level, and beneficiaries -- especially those eligible for the Low Income Subsidy -- should not have to pay more upfront. Otherwise a higher upfront cost may make it too expensive for beneficiaries to access their prescriptions, the advocate said. NCPA agrees.

“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,” NCPA CEO Douglas Hoey said in a statement. “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.”

Another beneficiary advocate said that this situation underscores the need for more accountability and improvements to the Medicare Plan Finder. If beneficiaries are expected to be informed consumers and to help shape the market, they need to be able to make decisions based on accurate information, the beneficiary advocate said.

The first beneficiary advocate also said Aetna should face a sanction of some form for this behavior. Hoey said beneficiaries may feel they were victims of a “bait-and-switch.” NCPA is encouraging those who feel misled to switch plans.

Beneficiaries can take advantage of a Special Enrollment Period if they would like to switch plans. CMS said the Special Enrollment Period will be handled on a case-by-case basis if beneficiaries call 1-800-Medicare.

The beneficiary advocate said there is concern that the outbound calls Aetna makes need to make it clear that beneficiaries can keep their pharmacy and switch plans, and that option needs to be adequately conveyed.

Aetna's letter to pharmacies asks that they “assist in properly informing Medicare beneficiaries about your pharmacy's participation in Aetna's 2015 Medicare pharmacy networks. Additionally, we ask that you help inform beneficiaries about their options and where to obtain help if they have questions or concerns.”

Aetna also says pharmacies should warn beneficiaries before filling a prescription that the pharmacy isn't in network and they may have to pay more out-of-pocket or pay the full retail price of the drug as a result. -- Michelle M. Stein ([email protected])

Article End.

 

[wehotex]

Wow! What a morning. Call after call of plan members getting outbound calls from Coventry telling them that the pharmacy that they use us not in network. Most of these clients had plan reviews done that showed their pharmacy as in network at a Standard level. These plan reviews were done on Medicare.gov. Not just one pharmacy either. What a disaster. This company is going down hill fast after Aetna bought them. The under age side is even more screwed.

Aetna/coventry cancelled a contract with our main and practically only grocery store in south Texas. That pharmacy sent letters and made phone calls to all of the affected members. Besides that, they had UHC kiosks with agents who were pitching those products to these Aetna members.