A recent review of an Aetna ASO Agreement between a county and Aetna revealed the following provision:
“ASO rates are guaranteed until 10/1/23. If County changes medical and or pharmacy vendors in 2022, all unpaid pharmacy rebates from Aetna will be forfeited.”
If Bart Simpson ( the Aetna rep ) was responsible for implementing the shenanigans outlined in the above provision from the Aetna ASO Agreement (I can’t say I blame him), his chalkboard punishment might look something like this:
“ I promise to behave (pinky swear) and return all applicable rebates to the self-funded plan in the event the plan terminates and finds a better solution.”
“ I promise to behave (pinky swear) and return all applicable rebates to the self-funded plan in the event the plan terminates and finds a better solution.”
“ I promise to behave (pinky swear) and return all applicable rebates to the self-funded plan in the event the plan terminates and finds a better solution.”
“ I promise to behave (pinky swear) and return all applicable rebates to the self-funded plan in the event the plan terminates and finds a better solution.”
Strategy Moving Forward:
A) Five finger discounts of tax dollars are strictly prohibited;
B) Replace the local constable (“Bubba”) and his assistant (“Roxxy”) who have been “managing” the county health plan and implement an independent fiduciary committee (with appropriate fiduciary insurance coverage) that oversees the $12mm health plan budget;
C) This provision (and perhaps other onerous terms) may cumulatively serve as a basis for lack of enforceability because it is a contract of adhesion. Consider: Predatory terms plus Aetna serves as the TPA/PBM/Chief Cook and Bottle Washer, gullible customers (Bubba and Roxxy), detrimental reliance and REAL damages equals something that should be negotiated quickly.
D)*Contract of Adhesion: https://lnkd.in/gq8Zn87V)
