Community pharmacists and some Medicare beneficiaries reported a number of problems in early January related to changes to the pharmacy network of 2015 Aetna/Coventry Medicare Part D plans.
Beneficiaries and community pharmacists received an unwelcome surprise when Aetna recently made known that some pharmacies advertised as “in-network” during the open enrollment period (on the Medicare Plan Finder website and elsewhere) were actually out of network.
Here are some of the most compelling cases brought to the attention of NCPA staff:
A rural Montana pharmacist said he 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 and the area has experienced blizzard conditions to boot. Pharmacists in other rural, Northern states relayed similar experiences.
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 and may yet wind up in the emergency room for treatment.
A Wisconsin pharmacist said after repeated, lengthy phone calls to Aetna she ultimately still had to transfer a patient’s prescription to another pharmacy only to find that it did not stock that particular medication. Other beneficiaries are unhappy about the need to transfer to another pharmacy. The pharmacy staff serves one disabled beneficiary by bubble packing her medication at no cost to help keep her adherent, and it is unlikely that another pharmacy in the area would do that, let alone without an additional charge.
A Midwestern pharmacist has a nursing home patient who is impacted. But patients in long-term care facilities cannot switch to another pharmacy at the drop of a hat especially in this rural community as no pharmacy is going to deliver medication 50 miles away to one patient who also has specific packaging requirements for the drugs. Other pharmacists also reported problems serving patients in group homes and custodial facilities who are on these drug plans and for whom switching pharmacies is not realistic.
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. The patient paid cash (his request) for an immediate supply of warfarin and levothyroxine.
In addition, beneficiaries and pharmacists alike consistently reported difficulty getting help with these problems over the phone. Calls to 1-800-Medicare take some time to complete and customer support representatives seem to give out inconsistent responses when beneficiaries ask to enroll in a different plan. Aetna’s pharmacy-relations staff appears to be bombarded with inquiries as pharmacists said they have to call repeatedly to get issues resolved.
NCPA staff continues to have regular interactions with Medicare officials, beneficiary advocacy organizations and others regarding these issues and the need for short and long-term solutions.