- The Centers for Medicare and Medicaid Services has fined Aetna $1 million as a result of the insurer's misidentification of 6,887 pharmacies as in-network.
- After January 1, many Aetna enrollees presented their prescription at their pharmacy only to learn that it was out-of-network. "The confusion created by errors in Aetna's pharmacy network directory on their website led to disruption in the marketplace," CMS Director of Medicare Parts C and D Oversight and Enforcement Group Gerard Mulcahy wrote in a letter to the issuer.
- If Aetna wishes to request a hearing to appeal the penalty, it must do so by June 2.
Mulcahy didn't mince words when describing the scope of the problem: Aetna's complaint rates for Part D issues were five times those of all Part D parent organizations. Its 3,767 complaints accounted for a third of all complains CMS received—and 73% of those complaints were associated with marketing materials that misled beneficiaries about pharmacy coverage.