NCPA Reacts to Medicare $1M Fine for Aetna

April 7, 2015

Aetna was fined for the significant disruption to patients and community pharmacists that occurred in early 2015 as a result of its inaccurate representation of "in-network" pharmacies in some plans.

PRESS RELEASE

ALEXANDRIA, Va. (April 7, 2015) — The National Community Pharmacists Association (NCPA) CEO B. Douglas Hoey, RPh, MBA, issued the following statement today regarding the $1 million civil monetary penalty that the Centers for Medicare & Medicaid Services (CMS) imposed on Aetna regarding the significant disruption to patients and community pharmacists that occurred in early 2015 as a result of the company’s inaccurate representation of “in-network” pharmacies in some plans:

“Many seniors, caregivers and pharmacists were impacted by avoidable glitches in Aetna/Coventry Medicare Part D drug plans. As CMS noted in its letter, beneficiary complaints about these plans were five times greater than that of all other plan sponsors during the same time period and 73 percent of the complaints centered on misleading marketing about in-network pharmacy coverage.

“We commend CMS for its work with beneficiaries, pharmacists and Aetna to try and resolve these problems as swiftly and smoothly as possible. We encourage the agency to work with plans to take additional steps to help prevent a similar situation from recurring in the future. In addition, the magnitude of the fine and the underlying disruption will hopefully serve as a warning to all plan sponsors regarding marketing and pharmacy network adequacy issues.”