On April 2, 2015, CMS issued notice of imposition of a $1 Million civil money penalty (CMP) against Aetna for errors reported in Aetna’s pharmacy network directory. Due to this error, many Aetna enrollees presented prescriptions to their pharmacy, only to discover that the pharmacy was not in their plan. The Medicare enrollees complained to CMS resulting in over 33% of all complaints received by CMS, of which 73% of those complaints alleged the beneficiaries were misled about in-network pharmacy coverage by Aetna’s marketing. CMS based its CMP on Aetna’s failure to disseminate clear and accurate information about the number, mix, and addresses of network pharmacies from which the Medicare enrollees could obtain covered Part D drugs. In addition, Medicare beneficiaries enrolled in Aetna’s plan have been given a special enrollment period to disenroll from Aetna’s plan and reenroll in another Part D plan. A copy of the April 2, 2015 CMS notice to Aetna is attached.
This penalty is an indication that CMS takes misleading or misinforming Medicare beneficiaries seriously. This is the second time Aetna has faced penalties, as it was also sanctioned in 2010 for problems related to its Part D plan.
By Denise Bloch