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:


For PSAO’s:

1)      CMS indicates that if a PSAO has directly asked Aetna for their Standard Terms and Conditions for their Part D pharmacy networks that you should be able to receive them and participate if you agree to the terms.  As stated above, we are aware of the process Aetna utilized to get to this point with their pharmacy networks, however, CMS indicates that a direct ask of Aetna as outlined above needs to be made and DOCUMENTED.  So we encourage any PSAO’s that would like to consider participation in the Aetna networks to make a renewed outreach/request to Aetna AND DOCUMENT that effort.  Please keep us informed as to whether you received the information requested from Aetna if you choose to request it.


For Patients (feel free to communicate the information in this section to your pharmacy network/customers):

1)      THERE IS CURRENTLY A SPECIAL ENROLLMENT PERIOD IN EFFECT THAT AETNA PART D PLAN PATIENTS CAN UTILIZE TO REQUEST A CHANGE IN PART D PLANS.  If patients have been deceived by misinformation on the Medicare Plan Finder website, Aetna sites or Aetna representatives, they can call 1-800-Medicare, state their circumstances, and change plans.  So we encourage all pharmacies to ensure that those beneficiaries know about this option.  This option is available to all Aetna patients affected by this situation.  WHILE CONTACTING CMS, PATIENTS MAY ALSO CHOOSE TO LODGE A COMPLAINT ABOUT BEING MISLED BY INACCURATE PHARMACY NETWORK INFORMATIONON PLAN FINDER OR ELSEWHERE.

2)      Patients may be eligible for a one-time in-network cost share refund from Aetna if they pay the full price of their prescription at an out-of-network pharmacy before March 31, 2015.


Please let me know if you have additional questions and we will keep you informed of any further developments.




Patrick M. Berryman


National Community Pharmacists Association

100 Daingerfield Road

Alexandria, VA  22314


703-683-3619 Fax