CMS issued an immediate sanction notice to Aetna after the insurer "continued to improperly administer the Medicare drug benefit in the plan's national standalone prescription drug plan and its 25 Medicare Advantage prescription drug contracts," according to CMS.
The immediate sanction prevents Aetna from marketing to and enrolling new beneficiaries effective April 21. The sanction will remain in place until Aetna "demonstrates to CMS that it has corrected its deficiencies and they are not likely to recur."
There are about 1 million Medicare Advantage and Part D members enrolled in Aetna plans, but CMS said the sanction will not impact them.
CMS said the problems were raised by members and physicians and if they are not corrected, the federal government may levy fines or terminate Aetna's contract with Medicare.
The specific issues raised by CMS are:
After the announcement, Aetna released a statement that said the company is cooperating with CMS and working to resolve the issues.
"Compliance problems are unacceptable to Aetna; the issues raised to us by CMS have our utmost attention," said Aetna President Mark T. Bertolini. "Aetna takes our obligations to our Medicare beneficiaries seriously, and our priority is to help ensure they have access to high-quality care, excellent service, and needed medications. We are working with CMS to resolve these matters, and we also will be doing proactive outreach to impacted members to resolve these issues."