Aetna Enrollees Get Faulty Materials

Jan. 08--Seniors enrolled in Aetna/?Coventry Medicare Part D plans may be getting an unhappy surprise when they fill prescriptions: In some cases, the pharmacy they thought was in Aetna's network actually isn't.

And one local pharmacist added that some low-income Medicare beneficiaries in Coventry's Advantra plan are paying more than they should.

In what the insurer acknowledges was a mistake, Aetna materials provided to seniors during the now-closed open enrollment period incorrectly listed some pharmacists as being in Aetna's network.

"Patients do have some confusion as to where they can go to receive their pharmacy benefit," said Timothy Davis, a pharmacist at Brighton Pharmacy in New Brighton, Beaver County. "Now they don't know where they can get their prescriptions filled and they don't trust the information they're getting."

While the exact number of affected beneficiaries is unknown, Mr. Davis said, "We're spending a lot of face time with folks" because of the confusion.

Aetna spokesman Walt Cherniak Jr. said the problem was fixed in December. "A limited number of pharmacies were listed as participating in some of Aetna's retail networks when they are only in network for long-term care or home infusion," he wrote in an email.

"The majority of pharmacies were not affected by this situation."

Aetna is watching for prescriptions filled at erroneously listed pharmacies, he added, "and proactively reaching out to those members to make them whole for the cost of the prescription."

Also, the Centers for Medicare and Medicaid Services, or CMS, is allowing seniors, on a case-by-case basis, to choose another Medicare Part D plan even though the open enrollment period ended Dec. 7. The National Community Pharmacists Association, which represents community pharmacists, recommends those affected call a CMS service representative at 1-800-633-4227 for help.

Patricia Epple, CEO of the Pennsylvania Pharmacists Association, said customers at independent pharmacists seem to be affected more than those at chains. A spokeswoman for CVS said their pharmacies have not reported any problem while a Walgreen representative referred questions to CMS.

For independent pharmacies, though, the confusion threatens to disrupt long-term relationships they've built with customers, pharmacists say, as well as inconvenience people who rely on a neighborhood pharmacy.

"Some of the patients we deliver to are home-bound," said Chris Antypas, a pharmacist at Asti's South Hills Pharmacy in Castle Shannon. "Just to get them to take their medicine is a challenge."

Erich Cushey, owner and operator of Curtis Pharmacy in Washington and Claysville, said Coventry also has miscoded some low-income Medicare beneficiaries in the Advantra plan and they are not getting the discounted co-payments they are eligible for.

As a result, he said, a patient with diabetes who made a $3.30 co-payment for insulin medication Lantus is being billed $45 this month.

"We know these people. They've been our customers for years," he said, so the pharmacy will fill the prescription and set the bill aside until it's corrected. But not every pharmacy is willing to do that, he added."When you have elderly people who are diabetic, they are on 10 or 12 medications a month. You present them with a bill for $125 or $150 and, guess what? They're not taking their insulin. And, in the worst case, they end up in the emergency room."

Steve Twedt: [email protected] or 412-263-1963.

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