February 7: CMS Sanctions Clear Spring Health Plans

Plus, the latest pharmacy and healthcare news to know this week.

The Story

CMS has imposed sanctions against health plans from Delaware Life Insurance, a private health insurer. Some of the plans are marketed under the Clear Spring Health name. 

Why It Matters

Effective January 31, Delaware Life is prohibited from enrolling beneficiaries into Medicare Advantage (MA-PD) and Prescription Drug Plans (PDP). It must also suspend all marketing activities to Medicare beneficiaries. 

In a letter to the company, CMS explained that it determined the company’s conduct posed “a serious threat to the health and safety of beneficiaries.” Specifically, it says, the company failed to process enrollment transactions on time, send enrollment documents to enrollees, and ensure Part D benefits were administered at point of service. Long wait times at call centers also made it difficult for enrollees to access essential information. In all, it had received over 160 complaints from beneficiaries. The CMS sanctions are to remain in effect until the Agency is satisfied that the issues have been resolved and are unlikely to recur.

The Medicare Advantage plans Delaware Life offers have become increasingly popular with beneficiaries. In a statement to Chicago Business, the company noted that it enrolled about 80,000 new members in its health plans during Open Enrollment last year and suggested the volume of growth could have led to delays in service. The company has the option to respond by February 11, but the sanctions are to remain in effect until CMS is satisfied that the issues have been resolved and are unlikely to recur. In the meantime, patients in Medicare Advantage plans can take advantage of the MA Open Enrollment period to switch plans before March 31.

Other important healthcare news to know:

1. CMS may soon require Part D plans to provide real-time pricing comparisons to members. Fierce Healthcare.

2. Flu activity has picked up across the U.S. Pharmacist.com.

3. New prescription drug transparency rules are now in effect in Maine. AP.

4. Humana launches $600 million joint venture to give Medicare patients greater access to value-based primary care. Courier-Journal.

5. The number of confirmed coronavirus cases in the U.S. rises to 12. CBS.