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Regulation and Compliance > Federal Regulation

CMS warns Aetna on Medicare pharmacy rules

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(Bloomberg) — Aetna Inc. (NYSE:AET) was ordered by U.S. regulators to change its Medicare Part D drug plan program.

The Centers for Medicare & Medicaid Services (CMS) said Aetna violated federal regulations by shutting some qualified pharmacies out of its pharmacy network.

Aetna, the third-largest U.S. health insurer, didn’t allow all pharmacies that met its plan’s terms and conditions to participate in its network, CMS said in a letter to the company. Aetna must develop a plan to follow the regulation or face potential fines or other sanctions, the agency said.

See also: Aetna Medicare customers can switch plans after error.

“Aetna will fully comply with this request,” the company said in an e-mail. “We are working to ensure all pharmacies have a clear understanding of their network status with us.”

The company, based in Hartford, Conn., had 1.6 million people enrolled in stand-alone Medicare Part D plans at the end of last year.

The Medicare pharmacy network issue was brought to light by the National Community Pharmacists Association in Alexandria, Va., which represents independent pharmacies. Shortly after the beginning of the year, the group began receiving reports from its members that they were unexpectedly dropped from some of Aetna’s pharmacy networks.


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