Express Scripts takes over Smart Insurance plans for Idaho Medicare beneficiaries

newsroom@idahostatesman.comSeptember 17, 2013 

Smart Insurance Co., a company that handled Idaho Medicare prescription drug benefits for beneficiaries in Idaho, will no longer cover those beneficiaries, according to the Department of Insurance.

Idaho Medicare beneficiaries who have Part D plans through Smart Insurance are now covered by Express Scripts Inc., which bought Smart Insurance's contract. New membership cards have been sent out to beneficiaries from Express Scripts, according to the department.

The Centers for Medicare and Medicaid Services put Smart Insurance under sanctions recently after finding that "its enrollees ... experienced delays or denials in receiving prescription drug coverage and increased out-of-pocket costs." The centers said in a report that Smart Insurance "inappropriately rejected drug claims" at the pharmacy counter, denied appeals of rejected claims and failed to properly process enrollment transactions.

"The severity of Smart's conduct is magnified by the fact that approximately 85 percent of its enrollees are [low-income subsidy] beneficiaries who are likely unable to afford to by medication that is not covered by their insurance," the report said.

The Idaho Department of Insurance did not say how many Idaho consumers may have been affected.

Call the Centers for Medicare and Medicaid Services at (800) MEDICARE (800-633-4227) with any questions.

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