I’d already heard through the grapevine about a recent Sierra Health Services conference call –where Sierra admitted they were getting hammered on their SierraRx Plus plan, which offers full coverage through the Part D donut hole. But I hadn’t realized that a competitor may have been the source of some of the trouble.
Sounds like Humana may have sent unattractive candidates over to Sierra after (wisely) discontinuing its own doughnut hole coverage. From Kaiser’s Daily Health Policy Report:
CMS officials are investigating whether Humana inappropriately advised the highest-cost beneficiaries in its Medicare prescription drug benefit plans to switch to plans provided by Sierra Health Services… “We believed our level of adverse selection was in part due to certain high-utilizing members being referred to us by another PDP provider. We did not agree to these referrals.”
Sierra complained to CMS, which took up the investigation.
Humana doesn’t really deny sending members over to Sierra. And it seems to me like Sierra just screwed up and offered too good of a deal.March 8, 2007