Magazine article Drug Topics

New York R.Ph.S Sue Aetna over Defunct Capitation Fund

Magazine article Drug Topics

New York R.Ph.S Sue Aetna over Defunct Capitation Fund

Article excerpt

The New York City Pharmacists Society (NYCPS) has filed a class action lawsuit on behalf of about 1,000 pharmacies against Aetna U.S. Healthcare for damages stemming from a capitated prescription drug benefit plan that went belly up last summer.

Filed in the New York State Supreme Court, the suit demands an accounting for payments allegedly owed by Aetna to pharmacies that participated in its capitated pharmacy service plan between July 1, 1996, and June 30, 1997.

The court filing asserted that pharmacies in the program were entitled to a set monthly fee for each Aetna plan member enrolled at their pharmacy. Of that amount, 15% was to be held by Aetna in a pooled catastrophic fund for pharmacies whose prescription drug costs exceeded their capitated payments in any given month. Anything left over was to be distributed to participating pharmacies semiannually. Seeking unspecified damages, the court filing charged that Aetna failed to distribute any money from that catastrophic fund.

"It's like in the movie Jerry Maguire; just show us the money," said Jim Schiffer, president of the society headquartered in the Brooklyn pharmacy he co-owns, Jim and Phil's Family Pharmacy. "Where did it go? We never got any answers. We know the plan included pharmacies in Connecticut, Delaware, New Jersey, New York, and Pennsylvania, but we don't know where else it was. Because of legalities, we couldn't bring a federal suit, so we had to file a class action in New York State."

Aetna, which has until Feb. …

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