For Immediate Release: May 7, 2010
Contacts: Kristin Milam 919-807-6011
Aetna's Ordered to Stop Ads and Enrollment of Medicare Part D Plans
SHIIP can help N.C. Medicare recipients who feel sanction's effects
RALEIGH -- Insurance Commissioner Wayne Goodwin today announced that the Department's SHIIP program is available to help some 23,000 N.C. Medicare recipients who may be affected by Medicare's sanction and suspension of Aetna Insurance Company's marketing and enrollment of its Part D prescription drug plans. The sanction will remain in effect until the company demonstrates that it has corrected the cited problems. Although the sanction does not impact current Aetna Part D members, if they are experiencing difficulties in getting their prescriptions SHIIP is here to help.
"North Carolina has more than 23,000 Medicare recipients enrolled in Aetna Part D plans, and I want those folks to know that if they've had delays getting their prescriptions filled, our SHIIP program can help," said Commissioner Goodwin. "We don't anticipate recipients having too much trouble - and remember their current coverage is not impacted - but if someone has a Medicare Part D plan with Aetna, and they're having problems they should call our SHIIP helpline at 1-800-443-9354."
Medicare issued the intermediate sanction because the plan has failed to fully meet its obligations to Medicare beneficiaries. More specifically those obligations include, but are not limited to:
- Failing to meet Medicare's transition requirements by ensuring that existing beneficiaries were able to continue to receive drugs they had been receiving in 2009 that were not on the plans' formularies in 2010;
- Improperly processing coverage determinations and expedited appeal requests in cases where delays would jeopardize the life or health of the enrollee;
- Applying prior authorization (PA) and step therapy (ST) drug requirements that had not been approved by Medicare; and
- Failing to take timely and proper steps to ensure that enrollees are eligible for the Part D low-income s ubsidy (LIS).
Anyone with questions about this issue or any Medicare-related issue should contact SHIIP (Seniors' Health Insurance Information Program) at 1-800-443-9354 or visit the SHIIP Web site by by clicking on this link.
SHIIP is a division of the North Carolina Department of Insurance that offers free, unbiased information about Medicare, Medicare prescription drug coverage, Medicare Advantage, long-term care insurance and other health insurance information. SHIIP's trained volunteers provide one-on-one counseling in all 100 counties.