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Updated: Aetna wrongly identifies Part D in-network pharmacies

Thousands of beneficiaries must choose new plans, find other pharmacies

Editor's note: This story has been updated to include a response from CMS.

Because Aetna wrongly identified some 5,500 pharmacies as being in-network, the insurer, "at CMS' urging," will give more than 400,000 Medicare beneficiaries until the end of February to either find other pharmacies or switch plans, a Centers for Medicare & Medicaid official told FierceHealthPayer in an email. The company will offer the extension because of "the number of pharmacy disruptions, inaccurate information provided to beneficiaries and confusion experience at the beginning of 2015 by both beneficiaries and pharmacies."  

The insurer first discovered the problem with the CMS Medicare Plan Finder and its own websites in December, an Aetna spokesperson said in an email to FierceHealthPayer.

The mix-up was, in part, due to the fact that pharmacies serving nearly 222,000 members were in-network last year but are not for 2015. Additionally, in-network pharmacies that provided cost-sharing to 240,000 beneficiaries in 2014 do not offer the same option this year, CMS added. 

Aetna says it is monitoring claims that were filed incorrectly and ensuring members pay the in-network costs for their particular prescriptions.

"To further help all members understand their benefits and easily access their medicines, we have decided to provide temporary access for our members in Part D Plans to all pharmacies in the Aetna Premier Preferred (broadest) network," Aetna told FierceHealthPayer. Until at least Feb. 28, members may fill prescriptions at these pharmacies at in-network rates.

Aetna wants to provide members with "additional time ... to migrate to a pharmacy that is in their network, or to call CMS to request a special enrollment period and discuss their other plan options for the remainder of 2015," the spokesperson added. 

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