CMS / Aetna-Coventry Part D Update

Posted Feb. 4, 2015


NCPA had a call with CMS this afternoon and we have some developments to report.  In summary, CMS conveyed or confirmed the following information:


1)      CMS has issued a Corrective Action Plan (CAP) request to Aetna specifying that Aetna did not meet the Any Willing Pharmacy provisions for 2015 Part D basic plans and  that Aetna must reach out to pharmacies to offer standard terms & conditions to see if they want to participate in any networks they were not included in via the “bid” process from last year.  The CAP includes specific issues that Aetna must address.  CMS has not currently imposed sanctions, only a CAP at this point, but CMS reserved the right to take further action at a later date.

Sections of a recent letter entitled Not Crying Wolf This Time

by Douglas Hoey, CEO of NCPA offer information on preparing for pay for services.

Posted Feb. 3, 2015


For decades, pharmacy students and pharmacists have been assured that they will be paid for services. And, for decades that's been mostly like the boy who cried wolf. Despite dozens of studies plus good old common sense indicating that pharmacists save health care dollars and improve quality of life, the closest the vast majority of pharmacists have come to direct payment for non-dispensing services is from MTM in the Medicare Part D program. But there were some big developments this week that are finally going to make all of those past false alarms a reality—whether we like it or not.

From NCPA – Congress Needs to Hear From Seniors (edited)

Posted Jan. 28, 2015

In a recent letter, Douglas Hoey, CEO of NCPA made relevant observations and suggestions regarding coverage for seniors.


“What's to say that this year's still unsettled Aetna/Coventry Part D snafu won't be repeated in the 2016 plan year? What assurances should patients have that the Medicare Plan Finder, the government's plan cost and pharmacy access comparison tool, contains accurate information? Should patients—and the Centers for Medicare & Medicaid Services—just assume that plan sponsors or PBMs aren't knowingly trying to rig the system?


Congress created Medicare Part D a decade ago, and now is a good time for it to ask some specific questions and examine if this public-private partnership is operating at maximum efficiency or if it could do even more for seniors. It's at the micro level where the impact is felt from situations like the one involving Aetna.

PQA Retires 'Diabetes: Appropriate Treatment of Hypertension' Performance Measure

Posted Jan. 14, 2015

By Michael Johnsen – Published in Drug Store News


SPRINGFIELD, Va. — The Pharmacy Quality Alliance on January 12,2015, announced the retirement of the performance measure, "Diabetes: Appropriate Treatment of Hypertension." PQA member organizations had the opportunity to comment on this measure prior to the official vote.  As many as 83% of member respondents voted to retire the performance measure. 


Key points of the rationale supporting retirement of the measure include:

  • The PQA-endorsed measure looked for either an angiotensin converting enzyme inhibitor, or angiotensin receptor blocker, or direct renin inhibitor to be prescribed in a population with diabetes and hypertension; and
Aetna Part D Plans / CMS

Aetna Part D Plans / CMS

Posted Jan. 9, 2015

By Patrick M. Berryman SRVP & COO

National Community Pharmacists Association

Dear independent pharmacy leaders,


We know that many of you have members that may have been experiencing problems with pharmacy network participation in certain 2015 Aetna Part D plans.  We have worked directly with some of you coordinating with CMS.  We are aware of the inaccurate Plan Finder information and the process that Aetna utilized to create their 2015 pharmacy networks which ultimately contributed to the current marketplace confusion.


To address these concerns as they have come to the forefront, NCPA has communicated with CMS multiple times starting in December including two separate letters and a conference call today outlining the problems for patients and pharmacies and suggesting solutions to the current confusion created by the Aetna actions.  Among our recommendations to CMS were an extended Special Enrollment Period (SEP) for Part D beneficiaries who have been misled in the 2015 enrollment process due to misinformation about the pharmacy network (to allow patients to switch Part D plans), a mechanism for pharmacies to transmit claims and receive payment for these patients’ prescriptions in a transition period during the SEP, and for scrutiny to be placed on the 2015 and current 2016 Aetna Request for Information process being utilized by Aetna for network development which we feel does not meet the Any Willing Pharmacy guidelines for Medicare Part D Basic plans.

In today’s conference call, we were able to verify the following information:

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