Anthem's contract to provide drugs for state retirees comes under fire
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Jan. 31—CONCORD — Gov. Chris Sununu said 11,000 state retirees have faced unacceptable delays and roadblocks trying to get their medications refilled since Anthem Blue Cross and Blue Shield took over the program on Jan. 1.
Administrative Services Commissioner Charles Arlinghaus said he was "very angry" about the disruptions and the state is considering all its options, up to and including terminating a $68 million contract approved in July.
Sununu said he will soon bring these concerns to national Anthem officials, after concluding that talks between state officials and the company's New Hampshire executives have failed to get all the problems resolved.
"Technically, we could cancel the contract. There are performance penalties that they could have to pay for failing to meet metrics and standards," Sununu said.
In July, the Executive Council and Sununu approved naming Anthem as the sole Medicare Advantage provider for 11,000 state retirees and their dependents.
Aetna Insurance had previously provided some health care services to state retirees, with Express Scripts delivering some of the prescription drug benefits.
Under the Anthem contract, 98% of mail order prescriptions must be shipped within two business days.
Every quarter that the company fails to meet that standard, it could be fined $50,000 for each percentage point below 98.
Councilor Janet Stevens, R-Rye, opposed the contract in July, citing a civil fraud lawsuit Anthem faced from the federal Southern District of New York regarding reimbursements for its Medicare Advantage program in that state. In October 2022, a federal judge denied Anthem's bid to dismiss the lawsuit.
"Going forward, Anthem must improve their operations, or we will hold them accountable for their actions. Enough is enough," Stevens said.
Many constituents contacted Stevens and other councilors with complaints about setting up their medication orders with Anthem and getting them refilled.
"Paperwork gets lost, information gets deleted after it's already been provided. This is a system breakdown that is occurring and it's unfair to our seniors who depend on their medications," Stevens said in an interview.
Stephanie DuBois, spokesperson for Anthem Blue Cross, said the company is aware of the problems and addressing them.
"We recognize that some state of New Hampshire retirees who are members of Anthem Blue Cross and Blue Shield have experienced issues with their home delivery pharmacy benefit," she said in a statement.
"We deeply apologize for any inconvenience this may have caused these members. We continue to address issues and we have set up a designated call line for State retirees to be able to expedite their concerns. Our goal is to serve all members in a timely manner."
Dennis Martino, 77, president of the State Employees Association chapter of retired employees, has fielded several calls from confused and upset retirees.
"I was able to figure out the online platform myself, but a lot of our members are older, they aren't computer savvy and they all got sent this thick booklet of instructions that made my own head spin," Martino said.
"Getting medications timely and at the cost they expect is a critical thing for retirees and their families."
Joyce Pittman, director of benefits in the Department of Administrative Services, said the program has been beset by problems since her office started preparing for the transition weeks before the end of 2023.
"What we are experiencing is ridiculous. I am not sugarcoating it. That's not what I am here for," Pittman told the Executive Council.
The agency is creating a hotline for retired employees to air their complaints and plans to do a mailing to all members with instructions for getting help if they need it.
"We are not letting them off the hook," Pittman said of Anthem.
"The worst situation is our retirees feel helpless. We want them to feel they are being heard here, but I don't feel that is the case yet."
