Aetna Fined $1M After Thousands Complain About Erroneous Pharmacy Network


Aetna has been penalized $1 million by federal Medicare officials after thousands of people complained about the nearly 6,900 pharmacies the insurer listed as in-network when they were really out of network.

The 6,887 pharmacies were listed as in-network for 2015 on the company’s website and by its call-center customer-service representatives, according to an April 2 notice to Aetna from the federal Centers for Medicare & Medicaid Services, or CMS.

“Beneficiaries that selected a plan based on its in-network pharmacies may have been misled by this incorrect information,” Gerald J. Mulcahy, director of the CMS’ Oversight and Enforcement Group wrote to Francis Soistman, who oversees Aetna’s Government Services business.

“The confusion created by errors in Aetna’s pharmacy network directory on their website led to disruption in the marketplace,” Mulcahy wrote. After Jan. 1, 2015, many Aetna customers went to their usual pharmacy with a prescription “only to discover that the pharmacy was not in their plan’s network.”

Aetna’s customers complained to CMS because they had to pay cash at the pharmacies they thought were in-network, or they had to leave the pharmacy empty-handed.

Thousands of people complained about Aetna’s prescription-drug plans. The rate of complaints was five times greater than the average for all insurers that sell Medicare Part D plans, which are stand-alone prescription drug plans, according to the CMS notice.

The notice does not identify the pharmacies involved.

The 3,767 complaints against Aetna accounted for 33 percent of all complaints received by CMS.

Federal Medicare officials granted Aetna beneficiaries a special enrollment period to drop Aetna plans and re-enroll in a Medicare Part D plan offered by a different health insurer.

Aetna has the right to request a hearing to appeal the penalty by CMS. If the Hartford-based health insurer appeals, it must do so by June 2.

Aetna spokeswoman Kendall Marcocci said in a statement: “Unfortunately, a select number of pharmacies were listed incorrectly as participating in some of Aetna’s Part D pharmacy networks. These issues were swiftly resolved, and the majority of pharmacies and our members were not affected by this situation.

“We strive to provide our members high quality coverage, with high satisfaction, at the best value, and take this matter very seriously,” Marcocci said.



– Matthew Sturdevant

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