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Life Health > Health Insurance > Your Practice

Delaware Fines Carrier Over Drug Co-Payments

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A Mid-Atlantic regulator says he believes a health insurer took the wrong approach to complying with a new pharmacy benefit co-payment law.

Delaware Insurance Commissioner Matt Denn has imposed a fine of at least $50,000 on the health insurance arm of CIGNA Corp., Philadelphia, in connection with allegations that the company charged the wrong co-payments for 90-day prescriptions.

A relatively new Delaware law now requires health insurers to offer the same co-payments for plan members who fill prescriptions at local pharmacies that the insurers offer to members who buy drugs through mail-order pharmacies.

In 2006, CIGNA complied with the law by increasing the co-payment for 90-day mail-order prescriptions.

Delaware officials believe that CIGNA was interpreting the law improperly and that it could not change co-payments after contracts had been signed, Denn says.

The Delaware Insurance Department sent out a bulletin about the issue in September 2006, then imposed a $25,000 fine on CIGNA in April 2007, when regulators found that the company had not yet changed its co-payments.

Delaware is issuing the new fine because it believes CIGNA has not yet changed its 90-day prescription co-payment practices or given excess co-payments back to customers, Denn says.

If CIGNA fails to meet Delaware requirements by Jan. 1, 2008, the company could end up paying a $250,000 fine, officials say.

CIGNA put out a statement saying it is working with Delaware regulators to develop a corrective action plan and pay any refunds owed to customers.

“At CIGNA we take compliance very seriously and make every effort to comply with all state and federal laws and regulations,” a CIGNA spokesman says. “The particular situation addressed by the Department of Insurance in Delaware resulted from a misinterpretation of a specific Delaware law and an unintentional error.


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