Does this graphic represent the state of our healthcare system… in a death spiral… you can pull out of a death spiral but you have to have someone at the controls that knows what they are doing..
By now we have all experienced the wonderful gift of restricted access to care that Aetna has given Independent Pharmacy and the Medicare Recipients that we serve. Thumbing it’s nose at every single rule and regulation set forth by CMS regarding marketing materials, Aetna has left patients scrambling to find the care they so desperately deserve.
How did this happen? Aetna’s Contracts were so bad for 2015 that numerous PSAOs and chain pharmacies could not accept the terms and conditions therein. Aetna did not remove the names of the affected pharmacies from it’s marketing materials for 2015 giving the perception that those pharmacies were indeed part of it’s network. Therefore, affected patients were not compelled to ask questions and seek advice regarding plan choices for the 2015 plan year. Beginning January 1,2015, these patients abruptly learned that their pharmacy of choice was not able to fill their prescriptions. Many of these patients are among our Nations’ most vulnerable and reside in underserved areas, where the only health-care provider is their trusted Community Pharmacist.
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What do we do? The only option available at this writing is to take care of those patients as best as you can, assisting them in making sure they get their medications. Have the patient call 1-800-MEDICAR(E) or 1-800-633-4227 and ask for a representative. Have the patient explain that marketing misrepresentations by Aetna caused them to experience hardship and to please enroll them in a new plan for 2015 effective immediately. You can also reach out to your states’ SHIP (State Health Insurance Assistance Program) Counselors for help. These counselors have special Medicare numbers that allow them to speak on behalf of patients that may otherwise be unable to complete this process on their own.
Filed under: General Problems
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