Aetna/Coventry Part D Update 1.15.15

Author: APCI Staff/Thursday, January 15, 2015/Categories: APCI News

Temporary fixes allowing non-network pharmacies to process prescription claims for patients with Medicare Part D plans from Aetna/Coventry are either working now or are should be functional by the end of the week, according to an update from NCPA.

The fix for claims processed by CVS Caremark is now functioning, and Aetna is implementing the fix for claims processsed by Express Scripts on a rolling basis and should be fully functional by the end of the week.

Please see the entire notification from NCPA below:

NCPA wants to notify you of several updates concerning your patients enrolled in Medicare Part D Aetna/Coventry drug plans. NCPA staff has been in constant contact with senior officials with the Centers for Medicare & Medicaid Services (CMS) to discuss the continuing Aetna Part D problems and the potential solutions proposed by NCPA. Based on the latest information NCPA has received:

  1. The temporary fix to allow non-network pharmacies to process prescription claims appears to be generally functioning for claims processed by CVS Caremark.
  2. The temporary fix for claims processed by Express Scripts is being implemented on a rolling basis and should be fully operational by the end of the week.
  3. Beneficiaries who wish to switch to a new drug plan should now have an easier time of it when they call 1-800-Medicare to do so. Customer service representatives have been instructed to facilitate plan switches for any beneficiary who says they are on an Aetna plan and want to switch because of a problem they experienced (e.g., I cannot get my prescription filled; my pharmacy is no longer in network; etc.).
  4. If your patients run into any difficulty switching from Aetna to a new drug plan, it is imperative to document the name of the customer service representative and the date and time of the phone call. This applies to both 1-800-Medicare phone calls and inbound/outbound calls with Aetna representatives. Please send these and other examples of patient harm or access issues to NCPA's complaint form on the NCPA homepage, under "Advocacy," or via: Then NCPA will notify senior CMS officials to take action. Concerned beneficiaries can also call the Medicare Rights Center, a patient advocacy organization, at 1-800-333-4114 as their staff is interested in hearing directly from beneficiaries.

Since mid-December, NCPA has been in regular contact with CMS, PSAOs, buying groups, Congress and other organizations regarding these problems and potential solutions.

Here are additional NCPA resources on this subject:

APCI is continuing to monitor the situation and will update our members as events warrant.