How to Assist Beneficiaries Impacted by Aetna/Coventry 2015 Part D Plans

Transcription

1 **SPECIAL ALERT** How to Assist Beneficiaries Impacted by Aetna/Coventry 2015 Part D Plans Due to inaccurate information posted about in-network pharmacies and cost-sharing for certain Aetna/Coventry Part D plans, CMS has authorized affected beneficiaries to take advantage of a "Special Enrollment Period" (SEP) to choose a new Part D plan. Here s how you can help your patients: Beneficiaries, or their caregivers, need to call Medicare ( ), and select 0 to speak directly with an agent. (Patients should be prepared to provide their Medicare information.) Phone lines may be busy, please be patient. This is the ONLY way beneficiaries can switch plans outside of the Annual Enrollment Period. Beneficiaries or their caregivers can explain to the customer service representative that they need to select a new Part D plan due to inaccurate, misleading, or deceptive marketing information about the pharmacy network that was presented on Medicare Plan Finder or Aetna s website during the 2014 open enrollment period. New enrollments won't take effect until February at the earliest, so patients may be forced to use another pharmacy for their January prescriptions or pay higher outof-pocket costs to continue to fill their prescriptions at your pharmacy. However, per CMS and Aetna, if patients continue to fill their prescriptions at your pharmacy (during the period from January 1 through March 31, 2015) they may qualify for a one-time in-network cost-sharing refund. Attached is a sample communication to affected beneficiaries on their plan options. Please continue to send in examples of patient harm or access issues to NCPA s complaint form on the NCPA homepage, under Advocacy.

2 Important Medicare Part D Patient Information Dear Valued Patient, Each year, Medicare prescription plans may make changes to their coverage, benefits, and costs that may affect you. Since January, you may have noticed that information provided by certain plans during the fall Annual Enrollment Period changed, affecting your ability to continue using your local trusted pharmacy. Our pharmacy s participation in Aetna s 2015 Medicare retail networks may have been inaccurately reflected on Medicare Plan Finder, Aetna s websites, and/or shared by Aetna representatives. If you have concerns about your coverage or your ability to continue to use your pharmacy, YOU MUST CALL MEDICARE ( ) and follow THESE STEPS: 1. Once connected, select option 0 to speak to an agent. 2. Tell the agent you name, plan ID number (if known) and the plan in which you are enrolled. 3. Tell the agent I was misled into selecting my plan based on incorrect marketing information about a plan s network of pharmacies on Medicare s Plan Finder. I want to request a special enrollment period to switch my plan due to inaccurate information posted about my plan. As your pharmacy, we are happy to answer questions you may have about your current prescription drug plan, along with any others you may be considering. We can also print a copy of the prescriptions you re currently taking, so you can use it to make sure your drugs are covered and how much they will cost. As always, we re happy to help you get the most from your Medicare drug coverage. To your health, Your Community Pharmacy

3 Medicare Alert: Temporary Member Access Plan Sponsor: Coventry/Aetna Medicare Part D Effective Date: Jan. 12, 2015 Geographic Area: National If your pharmacy is a Non Participating provider in the Aetna/Coventry 2015 Standard or Standard Preferred networks, you will be able to TEMPORARILY process claims for certain Coventry Medicare Part D members at Premier Preferred in-network reimbursement rates starting Monday, Jan. 12, The effective date of this temporary transition will be Jan. 1, Standard Network Coventry Medicare Part D claims associated with this network should successfully process starting Jan. 12, Standard Preferred Network: During the temporary transition period, non-participating providers will be able to process claims for Coventry Medicare Part D members associated with the Standard Preferred network in weekly transition phases through January/February and thereafter. Announcement: This TEMPORARY Medicare Part D network transition will not impact the ongoing contracting process for the Standard or Standard Preferred Network, and you will continue to receive separate communications concerning the status of your agreement. If you have previously requested network access via our pharmacy network mailbox (PharmNetwrkSrvc@Aetna.com), we are continuing to process those requests. Aetna s goal with this temporary transition is to ensure members can easily access the drugs they need at Aetna s network pharmacies. Please look for continuing updates. We will keep you informed, including providing the date when this temporary access will end. If there are any questions regarding this communication, please contact our pharmacy network mailbox: PharmNetwrkSrvc@Aetna.com

4 Medicare Alert: Temporary Member Access (Continued) Please process claims for these members using the information below. Prescription Processing Information: BIN: PCN: MEDDPRIME RxGroup: CVTYMED Or CVTYRTL Or CVTYMEB Sample ID Card:

5 Medicare Alert: Temporary Member Access (Continued) ATTACHMENT A: Plan to Network Crosswalk Contract PBP Plan Name States Pharmacy Network COVENTRY MAPD H Coventry Vista Ideal (HMO) FL Premier Preferred H Coventry Vista Ideal (HMO) FL Standard Preferred H Coventry Vista Maximum (HMO SNP) FL Standard H Coventry Summit Plus (HMO) FL Standard Preferred H Coventry Summit Maximum (HMO SNP) FL Standard H Coventry Summit Ideal (HMO) FL Premier Preferred H Coventry Summit Plus (HMO) FL Premier Preferred H Coventry Summit Ideal (HMO) FL Premier Preferred H Coventry Summit Maximum (HMO SNP) FL Standard H Coventry Summit Ideal (HMO) FL Premier Preferred H Coventry Advantra Platinum (PPO) IA, SD Standard Preferred H Coventry Total Care (PPO) SD Standard Preferred H Coventry Total Care (PPO) IA Standard Preferred H Coventry Total Care (PPO) IA Standard Preferred H Coventry Advantra Silver (HMO) IA Standard Preferred H Coventry Total Care (HMO) IA Standard Preferred H Coventry Total Care (HMO) IA Standard Preferred H Advantra Silver (HMO) WV Premier Preferred H Advantra Silver (HMO) WV Premier Preferred H Advantra (PPO) IL, MO Standard H Advantra Premier Plus (PPO) AR Standard Preferred H Coventry Premier Plus (PPO) MO Standard Preferred H Advantra Option 2 (HMO) IL, MO Standard H Gold Advantage (HMO) IL, MO Standard H Advantra Option 1 (HMO-POS) IL, MO Standard H Advantra Dual Eligible SNP (HMO SNP) MO Standard H Coventry Total Care (HMO-POS) MO Standard H Coventry Total Care (HMO) IL Standard H Coventry Total Care (HMO) IL Standard H Advantra (HMO) IL Standard H Coventry Advantage (HMO) MO Standard Preferred H Coventry Advantage Plus (HMO-POS) MO Standard Preferred H Advantra Advantage (HMO) KS, MO Standard Preferred H Advantra Advantage (HMO) KS Standard Preferred H Coventry Medicare Advantage Total Care (HMO) KS Standard Preferred H Advantra Total Care (HMO) AR Standard Preferred H Coventry Advantage (HMO) OK Standard Preferred H Advantra Select Plus (HMO) AR, KS, MO, OK Standard Preferred H Advantra (HMO) LA Premier Preferred H Advantra (HMO) LA Premier Preferred H Advantra Gold (HMO) PA Premier Preferred H Advantra Gold (HMO) PA Premier Preferred H Advantra Silver (HMO) PA Standard H Advantra Silver (HMO) PA Premier Preferred H Advantra Silver (HMO) PA Standard H Advantra Silver Plus (HMO) PA Premier Preferred H Advantra Silver (HMO) PA Standard H Advantra Cares (HMO SNP) PA Standard H Advantra Cares (HMO SNP) PA Standard H Advantra Northern Pennsylvania Gold (HMO) PA Premier Preferred

6 ATTACHMENT A: Plan to Network Crosswalk Contract PBP Plan Name States Pharmacy Network H Advantra UCPN Plus (HMO) PA Standard H Advantra Silver Plus (HMO) PA Premier Preferred H Advantra (HMO) TX Standard Preferred H Advantra (HMO) TX Standard Preferred H Advantra Silver (HMO-POS) GA Premier Preferred H Advantra Freedom (PPO) KS, MO Standard Preferred H Coventry Medicare Advantage (PPO) KS Standard Preferred H Advantra Freedom (PPO) KS, MO Standard Preferred H Advantra Freedom (PPO) MO Standard Preferred H Advantra Freedom (PPO) KS Standard Preferred H Advantra Freedom (PPO) AR Standard Preferred H Coventry Freedom (PPO) OK Standard Preferred H Advantra Freedom Plus (PPO) KS, MO Standard Preferred H Coventry Total Care (PPO) KS Standard Preferred H Advantra Gold (PPO) PA Premier Preferred H Advantra Gold (PPO) PA Premier Preferred H Advantra Silver (PPO) PA Premier Preferred H Advantra Silver (PPO) PA Premier Preferred H Advantra Silver Plus (PPO) PA Premier Preferred H Advantra Gold (PPO) PA Premier Preferred H Advantra Gold (PPO) PA Premier Preferred H AdvantraOne (PPO) PA Premier Preferred H ADVANTRA SILVER (PPO) PA Premier Preferred H Coventry Advantra Silver (HMO) NE Standard Preferred H Coventry Total Care (HMO) NE Standard Preferred H Advantra Select Plus (HMO) NE Standard Preferred H Advantra (PPO) IL Standard H Advantra Value (PPO) IL Standard Preferred H Advantra Value (PPO) IL Standard Preferred H Advantra Select Plus (PPO) IL Standard Preferred H Advantra (PPO) TX Standard H Coventry Advantra Platinum (PPO) NE Standard Preferred H Altius Advantra (HMO) UT, WY Standard Preferred H Advantra Silver (PPO) OH Standard Preferred H Advantra Gold (PPO) OH Standard Preferred H Advantra Gold (PPO) WV Premier Preferred H Advantra Gold (PPO) WV Premier Preferred H Advantra Gold (PPO) NC Standard Preferred H Advantra Preferred (PPO) GA Premier Preferred COVENTRY PDP S First Health Part D Value Plus (PDP) NY Standard Preferred S First Health Part D Premier Plus (PDP) NY Premier Preferred S First Health Part D Value Plus (PDP) NH, ME Standard Preferred S First Health Part D Value Plus (PDP) CT, MA, RI, VT Standard Preferred S First Health Part D Value Plus (PDP) NJ Standard Preferred S First Health Part D Value Plus (PDP) DE, DC, MD Standard Preferred S First Health Part D Value Plus (PDP) PA, WV Standard Preferred S First Health Part D Value Plus (PDP) VA Standard Preferred S First Health Part D Value Plus (PDP) NC Standard Preferred S First Health Part D Value Plus (PDP) SC Standard Preferred S First Health Part D Value Plus (PDP) GA Standard Preferred S First Health Part D Value Plus (PDP) FL Standard Preferred S First Health Part D Value Plus (PDP) AL, TN Standard Preferred

7 ATTACHMENT A: Plan to Network Crosswalk Contract PBP Plan Name States Pharmacy Network S First Health Part D Value Plus (PDP) MI Standard Preferred S First Health Part D Value Plus (PDP) OH Standard Preferred S First Health Part D Value Plus (PDP) IN, KY Standard Preferred S First Health Part D Value Plus (PDP) WI Standard Preferred S First Health Part D Value Plus (PDP) IL Standard Preferred S First Health Part D Value Plus (PDP) MO Standard Preferred S First Health Part D Value Plus (PDP) AR Standard Preferred S First Health Part D Value Plus (PDP) MS Standard Preferred S First Health Part D Value Plus (PDP) LA Standard Preferred S First Health Part D Value Plus (PDP) TX Standard Preferred S First Health Part D Value Plus (PDP) OK Standard Preferred S First Health Part D Value Plus (PDP) KS Standard Preferred S First Health Part D Value Plus (PDP) IA, MN, MT, ND, NE, SD, WY Standard Preferred S First Health Part D Value Plus (PDP) NM Standard Preferred S First Health Part D Value Plus (PDP) CO Standard Preferred S First Health Part D Value Plus (PDP) AZ Standard Preferred S First Health Part D Value Plus (PDP) NV Standard Preferred S First Health Part D Value Plus (PDP) OR, WA Standard Preferred S First Health Part D Value Plus (PDP) ID, UT Standard Preferred S First Health Part D Value Plus (PDP) CA Standard Preferred S First Health Part D Premier Plus (PDP) DE, DC, MD Premier Preferred S First Health Part D Premier Plus (PDP) PA, WV Premier Preferred S First Health Part D Premier Plus (PDP) VA Premier Preferred S First Health Part D Premier Plus (PDP) NC Premier Preferred S First Health Part D Premier Plus (PDP) SC Premier Preferred S First Health Part D Premier Plus (PDP) GA Premier Preferred S First Health Part D Premier Plus (PDP) AL, TN Premier Preferred S First Health Part D Premier Plus (PDP) MI Premier Preferred S First Health Part D Premier Plus (PDP) OH Premier Preferred S First Health Part D Premier Plus (PDP) WI Premier Preferred S First Health Part D Premier Plus (PDP) IL Premier Preferred S First Health Part D Premier Plus (PDP) MO Premier Preferred S First Health Part D Premier Plus (PDP) AR Premier Preferred S First Health Part D Premier Plus (PDP) MS Premier Preferred S First Health Part D Premier Plus (PDP) LA Premier Preferred S First Health Part D Premier Plus (PDP) TX Premier Preferred S First Health Part D Premier Plus (PDP) OK Premier Preferred S First Health Part D Premier Plus (PDP) KS Premier Preferred S First Health Part D Premier Plus (PDP) CO Premier Preferred S First Health Part D Premier Plus (PDP) AZ Premier Preferred S First Health Part D Premier Plus (PDP) NV Premier Preferred S First Health Part D Premier Plus (PDP) NH, ME Premier Preferred S First Health Part D Premier Plus (PDP) CT, MA, RI, VT Premier Preferred S First Health Part D Premier Plus (PDP) NJ Premier Preferred S First Health Part D Premier Plus (PDP) FL Premier Preferred S First Health Part D Premier Plus (PDP) IN, KY Premier Preferred S First Health Part D Premier Plus (PDP) IA, MN, MT, ND, NE, SD, WY Premier Preferred S First Health Part D Premier Plus (PDP) NM Premier Preferred S First Health Part D Premier Plus (PDP) OR, WA Premier Preferred S First Health Part D Premier Plus (PDP) ID, UT Premier Preferred S First Health Part D Premier Plus (PDP) CA Premier Preferred S First Health Part D Premier Plus (PDP) HI Premier Preferred S First Health Part D Premier Plus (PDP) AK Premier Preferred

8 ATTACHMENT A: Plan to Network Crosswalk Contract PBP Plan Name States Pharmacy Network S First Health Part D Value Plus (PDP) AK Standard Preferred S First Health Part D Value Plus (PDP) HI Standard Preferred