Are You Caught Up In Aetna’s Pharmacy Network Mix-Up?

Did you know that more than 400,000 Aetna members,
who are also on Medicare, were caught by surprise
when it turned out their pharmacy couldn’t, or wouldn’t,
fill their prescription at what was thought to be the agreed upon rate?

Jessica Hill/AP

According to a recent article by Kaiser Health News:

“More than 400,000 Medicare beneficiaries who may have been confused or misinformed about the pharmacy details of their 2015 Aetna prescription drug plans have until the end of this month to find participating pharmacies or switch plans, according to the Centers for Medicare & Medicaid Services (CMS.gov).”

Did you get that: until the END of FEBRUARY 2015.
That means you only have 23 calendar days left.

Like we say with so many catastrophes: it’s only 400,000 out of how many millions?
But if you are that one in the 400,000, fixing this can take you hours if not days
or weeks, right?! So, we’re encouraging you now to get on this…do not put it off
until the last week! PLEASE!

Ok, so maybe you want to know what happened.
The article offers a little bit of education and back story:

“Plans with preferred pharmacy networks typically offer Medicare beneficiaries the lowest copayments or coinsurance at select pharmacies or pharmacy chains. Members can also use other pharmacies that are in their plan’s network, but their out-of-pocket costs will generally be higher, though not as high as if they went to a pharmacy that was outside their plan’s pharmacy network.

“Figuring out those details isn’t always straightforward, even for those who use the CMS’ online Medicare Plan Finder, where beneficiaries can enter their drug and pharmacy specifics and compare drug plans. Choosing a plan is complicated, and a preferred pharmacy may not always offer the best price for every drug someone takes. In addition, other factors such as star ratings may influence a beneficiaries’ choice of plan.

“Beneficiary problems with Aetna plans were twofold. The insurer inaccurately identified roughly 5,000 pharmacies as available in-network for retail customers on both the Medicare Plan Finder and the insurer’s own website, as well as through its customer service representatives, according to CMS.

“In addition, the insurer made significant changes to its pharmacy networks this year. In 2015, pharmacies that were in network for approximately 220,000 members last year no longer fall into that category, CMS says. Similarly, the in-network pharmacies that provided preferred cost-sharing to 240,000 members last year no longer do so in 2015.”

Good grief, right? Aren’t you confused just reading about it,
let alone having to live through it?!

So, here’s the fix:

“According to an email from a CMS spokesperson, “Because of the number of pharmacy disruptions, inaccurate information provided to beneficiaries, and confusion experienced at the beginning of 2015 by both beneficiaries and pharmacies,” Aetna, at CMS’ urging, gave all its Part D plan members in-network access to its broadest pharmacy network until at least the end of February. During that time, members who want to remain in the plan but have discovered that their pharmacy of choice is out of network can identify a pharmacy that’s in their plan’s network; others can request a Special Enrollment Period to pick a new plan.”

Maybe you’re wondering: is it worth the time to fix this?
Maybe the cost differential isn’t a big enough deal…?

“According to an analysis of 2014 drug plan premiums by Avalere Health, average monthly premiums were $29.83 for basic plans with preferred networks, 17 percent less than the average cost of plans without. Likewise, the average premium for enhanced drug plans–which generally have lower cost sharing but higher premiums than basic plans, and may cover more drugs–was $49.15 with a preferred network, 57 percent less than for a plan without.”

57%?! Is that a big enough deal?
Maybe not if you’re only talking about $2, but we all know
that prescriptions are often at least $10 and often much more
than that, right?

If you have been caught up in this, please share your story
in the comments section below, on our facebook page, so others
can learn from you (and commiserate with you). However, if you
are still confused (just as one of our newbie colleagues was when
she went to the CMS.gov site), please give us a call at 877.789.5831 or
complete the confidential form found on our Contact Us page and
on of our expert advisers will be in touch with you right away!

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