March 28, 2024
BANGOR DAILY NEWS (BANGOR, MAINE

Aetna HMO violated state pharmacy law> Insurer to pay fine, end unfair practices

One of the largest HMOs in Maine, Aetna U.S. Healthcare Inc., has admitted to breaking the state’s pharmacy law. It agreed in a settlement with the state to pay a fine and end a system of uneven compensation for pharmacists who fill prescriptions for HMO members.

The consent agreement, completed last week, came on the heels of a lawsuit filed in January on behalf of 25 independent pharmacies from Waterboro to Calais. The pharmacists will continue pursuing their suit in Franklin County Superior Court.

The consent agreement, which includes an $8,000 fine, states that Aetna violated Maine’s Third-Party Prescription Program Act by:

Giving a mail-order pharmaceutical company owned by Aetna an exclusive right to fill 90-day prescriptions for lower co-payments than those charged at local pharmacies.

Paying some druggists more than others for prescriptions filled for Aetna HMO members.

Failing to properly notify state agencies and participating pharmacies of certain program changes as required by law.

Assistant Attorney General Judith S. Chamberlain, who negotiated for the state, said the agreement restores a level playing field to pharmacists who work with Aetna.

The settlement calls for Aetna to immediately comply with all the requirements in the consent agreement.

“It’s very good news for our clients,” said Barbara G. Shaw, an attorney with Marcus, Grygiel & Clegg of Portland, which represents the pharmacists.

Donald DeGolyer, owner of Lubec Apothecary who took the lead in the lawsuit with Robb S. Witt, co-owner of Howard’s Rexall Drugs in Farmington, said the suit was intended to stop the practices and seek compensation for harm.

He said that even after the superintendent of the Bureau of Insurance declared the practices illegal in a Dec. 11, 1998, letter to Aetna, pharmacists continued to be treated unfairly.

The consent agreement doesn’t include details of the uneven payments. But, Witt said Aetna required its members to co-pay $5 for generic drugs or $10 for brand-name drugs each time a prescription was filled last year. By mail, the customer paid nothing to fill a generic prescription and $5 to fill a brand-name prescription, he said.

The lawsuit will continue as the pharmacists seek damages, DeGolyer said.

The extent of the harm caused by Aetna’s practices will be determined during discovery, Shaw said. The suit was filed Jan. 21 and the next move is for Aetna to respond to the complaints, she said.


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