News Releases

Pharmacists Urge Congressional Hearing on Aetna Medicare Part D Problems

by NCPA | Jan 22, 2015

Alexandria, Va. Jan. 22, 2015 - Leaders of Senate and House committees with health care jurisdiction should hold oversight hearings to examine the issues that plagued approximately 50,000 beneficiaries who are covered by Aetna Medicare Part D drug plans, the National Community Pharmacists Association (NCPA) wrote in a letter to key lawmakers today.

During the 2014 Medicare open enrollment period for 2015 year plans, Aetna submitted incorrect information that was posted on Medicare Plan Finder, Aetna websites, and provided by Aetna customer service representatives regarding which pharmacies were "in-network" for the affected plans. As a result some beneficiaries signed up for a Part D plan only to discover in early 2015 that the pharmacy they wanted to patronize was not in-network.

"We are extremely concerned that a problem of this magnitude might be exacerbated next year unless immediate action is taken to determine what led to these problems and proper controls enacted to ensure this does not happen to vulnerable Medicare beneficiaries again," NCPA CEO B. Douglas Hoey, RPh, MBA wrote in a letter to the Chairmen and Ranking Members of the Senate Finance Committee; Senate Health, Education, Labor and Pensions Committee; House Energy and Commerce Committee; and House Ways and Means Committee.

The situation continues to produce widespread confusion among pharmacists and patients and is significantly impacting beneficiaries' access to their prescription drugs.

  • A rural Montana pharmacist serves 25 patients impacted by this situation, some of whom have acute medication needs such as for the flu and mood disorders. The nearest "in-network" pharmacy is 85 miles away in North Dakota.

  • A Native American who resides in Northern California is accustomed to receiving his medications for chronic pain and depression from a local tribal clinic pharmacy for $5. That pharmacy is now out of network and he cannot afford the $918 out-of-pocket cost, potentially forcing him to the emergency room for treatment.

  • A 93-year-old, retired optometrist and veteran had to arrange a special trip to his community pharmacy to switch to a new Medicare drug plan that allowed him to stick with his pharmacy. Accompanied by his caregiver he sat beside the pharmacy counter in his wheelchair while breathing through his oxygen (supplied by the pharmacy) for over an hour on the phone with 1-800-MEDICARE.

Medicare officials have authorized a special enrollment period for affected beneficiaries who can switch drug plans by calling 1-800-Medicare.

The 2015 problems recall patient access issues experienced by other Medicare beneficiaries and help further illustrate the need for an effective "any willing pharmacy" policy.

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The National Community Pharmacists Association (NCPA®) represents the interests of America's community pharmacists, including the owners of nearly 23,000 independent community pharmacies. Together they represent an $88.8 billion health care marketplace, dispense nearly 40% of all retail prescriptions, and employ more than 300,000 individuals, including over 62,000 pharmacists. To learn more, go to www.ncpanet.org, visit facebook.com/commpharmacy, or follow NCPA on Twitter @Commpharmacy.