Determining which coverage policies would need to be modified in a pandemic and when to implement modifications:
In a pandemic, our members may need to seek care in alternative settings. Aetna is prepared to make policy or procedural modifications as necessary both to our internal operations and to our coverage policies based on clinical considerations as well as direction from state and federal authorities and plan sponsors. We already have extensive experience in meeting our members' needs during large-scale crises that affect the delivery of health care, such as the hurricanes that have ravaged the Gulf Coast in recent years. Our well-established mechanisms in place evaluate local and regional situations and rapidly implement coverage policy modifications as needed.
During the major hurricanes, we modified our coverage policies with the support of plan sponsors to help members access the care they needed in a difficult situation. Depending on the circumstances of pandemic, we may make pharmacy modifications such as encouraging early prescription refills and waiving precertification or step-therapy requirements. Among modifications for medical plans, we may approve requests for out-of-network services and lift requirements for medical precertification, referrals and notification of hospital admission. We can also help members find alternative providers if their regular physicians are not available, and assist those providers with access to personal health claim records for the members they treat.
