Anthem under fire for 'massively screwed-up' Medicare Advantage contract implementation

New Hampshire officials are planning to leverage fines against Anthem Blue Cross Blue Shield for issues with mail-order prescriptions. 

The Elevance Health-owned plan took over the state's Medicare Advantage plan for state retirees Jan. 1. Members of New Hampshire's executive council, which oversees the state's executive branch, said retirees have faced extended delays for delivery of mail-order medications and incorrect out-of-pocket charges for prescription drugs, New Hampshire Public Radio reported Feb. 22. 

Anthem was awarded a three-year, $69 million contract to manage a Medicare Advantage plan for 11,000 retired New Hampshire state employees in 2023, the New Hampshire Union Leader reported Feb 21. 

At a meeting of the state's executive council on Feb. 21, officials said they will leverage penalties against Anthem for the prescription delays. 

Charles Arlinghaus, administrative services commissioner, whose agency led the contract process, said everything is on the table in terms of penalties, including canceling the contract. 

The medical side of the Medicare Advantage contract has gone fine, Mr. Arlinghaus said, but the implementation of the prescription drug coverage has been "a disaster." 

"This contract and the implementation of it is massively screwed up, and the company that's implementing the new contract is doing a horrible job, and it's not getting better fast enough," Mr. Arlinghaus said. 

In a statement shared with Becker's, an Anthem spokesperson said the company has established a dedicated phone line for issues with prescription fills or refills and a concierge team to proactively contact state retirees who may have questions. 

"Our first priority is the retirees and ensuring they receive the care and support they need," the spokesperson said.

Anthem is "extremely disappointed in statements that detract from the focus at hand and include alarmist statements that are not accurate," the spokesperson continued. 

"We have been and will continue to direct all of our efforts on providing the retirees with the support that they need and will not be distracted from that purpose. We will continue to work closely with the state to address this and keep retirees informed," the spokesperson said. 

Under its contract with New Hampshire, Anthem must ship 98% of mail order prescriptions within two days, the New Hampshire Union Leader reported. Each quarter it fails to meet that standard, Anthem can be fined $50,000 for each percentage point under 98%. 

New Hampshire Gov. Chris Sununu said the state is committed to assessing these penalties against Anthem but is focused on improving customer services issues first. 

"They're going to pay, there's no question about that," Mr. Sununu said at the executive council meeting. 

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