Dive Brief:
- The Centers for Medicare and Medicaid Services has announced that the more than 400,000 Medicare beneficiaries who were confused or misinformed about their 2015 Aetna prescription drug plans can now take until the end of February to change plans or find participating pharmacies. In the meantime, all Part D plan members will get in-network access to Aetna's broadest pharmacy network.
- Aetna had inaccurately listed about 5,000 pharmacies as in-network, both on the Medicare Plan Finder and on their own website. The inaccurate information was also disseminated through the insurer's customer service representatives, reported CMS.
- Aetna had made major changes to its pharmacy networks for 2015. According to the CMS, pharmacies that had been in-network for roughly 220,000 members last year no longer are, and the in-network pharmacies that had provided preferred cost-sharing for 240,000 members do not in 2015.
Dive Insight:
The extent of the confusion illustrates the increasing complexity of many Medicare prescription drug plans, experts note—and just how difficult it is for consumers to navigate their options. For most plans, those who want to keep their out-of-pocket costs as low as possible have to figure out whether a pharmacy is in a plan's network, as well as make sure that their pharmacy is part of the "preferred" network, and consider whether a preferred pharmacy is actually the one with the best prices for their individual drug needs. There's a lesson there for issuers on the need for consumer education.
"Many members saw changes to their networks and plans for 2015," Cynthia Michener, a spokesperson for Aetna, told Kaiser Health News in an email. "Throughout last year, we reached out to members in several ways to ensure these changes were well communicated. But we're finding members may need more time to understand their benefits."