Federal regulators announced sanctions Friday that will prohibit Aetna from marketing to or enrolling new Medicare beneficiaries until the health insurer fixes problems that have made it difficult for seniors to get their prescriptions filled.
The enforcement action by Centers for Medicare and Medicaid Services takes effect April 21 and will remain in place until Aetna shows it has corrected the problems and demonstrated they are unlikely to recur.
The enforcement action doesn’t affect Aetna’s roughly 1 million Medicare beneficiaries nationwide, including 321 in the Sacramento area. Aetna is better known in the region for its private-sector health plans, which cover more than 45,000 local residents.
Medicare issued the sanctions because problems were not corrected after federal regulators first notified Aetna of complaints from members and their doctors about the company’s prescription drug benefit.
Complaints include:
• Improper processing of coverage decisions and expedited appeal requests in cases where delays would jeopardize the life or health of the member
• Application of prior authorization and step therapy drug requirements that had not been approved by Medicare, and
• Failure to take timely and proper steps to ensure members are eligible for the Part D low-income subsidy.
Current Aetna health and drug members who are having difficulty getting prescriptions filled should contact 1-800-MEDICARE or their local state health insurance assistance program, Jonathan Blum, acting director of CMS’ Center for Drug and Health Plan Choices, said in a news release.
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