Aetna Faces Medicare Sanctions

Health insurer Aetna announced Friday it will suspend "marketing to and enrollment of new members to its Medicare plans for the elderly because of sanctions imposed by the U.S. government," Reuters reports. The suspension will effect "Aetna's Medicare Advantage and standalone prescription drug plans, but not its current Medicare enrollees" (Krauskopf, 4/9).

Wall Street Journal: The problems pointed out by the Centers for Medicare and Medicaid Services involve "compliance problems related to drug-plan requirements." According to the Journal, "Aetna went from an open formulary in 2009 to a closed formulary this year for many of its Medicare plan benefit packages, spokesman Fred Laberge said. In an open formulary, patients can be prescribed most any drug, while a closed formulary restricts the choices of available medications. The issue relates mostly to existing individual-plan members who were prescribed a drug that was on the 2009 formulary but was no longer on the formulary this year, he said. While CMS approved the health insurer's 2010 formulary, affected members may not have received a one-time, 30-day transition supply of drugs, he said." The company has said it will cooperate fully with the CMS review and is working to resolve the problems as soon as possible. "The company estimates some 20,000 current members may have been affected by compliance problems related to transition" from an open formulary in 2009 to a closed formulary for "many of its Medicare plan benefits packages" (Wisenberg Brin, 4/9).