Prescription Drug Plan - Aetna Medicare

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Getting help The information in this document is a brief summary, not a comprehensive description of benefits. For more information, refer to the Evidence of Coverage. Limitations, copayments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or copayments/ coinsurance may change on January 1 of each year. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. Medicare beneficiaries may enroll in a plan only during specific times of the year. For more information, please contact Aetna Medicare at 1-800-213-4599 (TTY/TDD: 711), from 8 a.m. to 8 p.m., 7 days a week. Contact us After you enroll, Member Services can help with your questions. To contact Member Services, call the toll-free number on your ID card. You can also send Member Services an e-mail. Just go to your secure Aetna Navigator ® member website at www.aetna.com. Click on “Contact Us” after you log on. Member Services can help you: • Understand how your plan works or what you will pay • Get information about how to file a claim • File a complaint or appeal • Get copies of your plan documents and the preferred drug list • And more Help for those who speak another language and for the hearing impaired This information is available for free in other languages. Please contact our customer service number at 1-800-282-5366 (TTY/TDD: 711) for more information. Hours of operation: 7 days per week, 8 a.m. until 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Si desea más información, comuníquese con Servicios al Miembro al 1-877-AETNA-11 (TTY/ TDD: 711). Horario de atención: los 7 días de la semana, de 8 a.m. a 8 p.m. A Medicare approved Part D sponsor. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include Aetna Health Inc., Aetna Health of California Inc., and or Aetna Life Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year. What’s covered Because plans may vary, please refer to the Aetna Medicare Preferred Drug List and the Evidence of Coverage to see what is covered under the specific plan. The Aetna Medicare Preferred Drug List Some of our plans encourage you to buy certain prescription drugs over others. The plan may even pay a larger share for those drugs. We list those drugs in the Aetna Medicare Preferred Drug List (also known as a “drug formulary”). This list shows which prescription drugs are covered on a preferred basis. It also explains how we choose medications to be on the list. When you get a drug that is not on the preferred drug list, you usually will pay more. Check your plan documents to see how much you will pay. Drug Manufacturer Rebates Drug manufacturers may give us rebates when our members buy certain drugs. While those rebates for the most part apply to drugs on the Preferred Drug List, they may also apply to drugs not on the Preferred Drug List. But, in any case, in plans where you pay a percent of the cost, your share of the cost is based on the price of the drug before any rebate is received by Aetna. In plans where you pay a percent of the cost instead of a flat dollar amount, you may pay more for a drug on the Preferred Drug List than for a drug not on the list. S5810_D_PE_MM_20509 CMS Approved Visit us www.aetnamedicare.com
Changes to the Aetna Medicare Preferred Drug List The Aetna Medicare Preferred Drug List can change in accordance with applicable state law. You should find a copy of the Aetna Medicare Preferred Drug List among your enrollment materials. We will send you an updated list each year that you remain a member. Get a copy of the Aetna Medicare Preferred Drug List We are constantly adding new drugs to the list. The most up-to-date Aetna Medicare Preferred Drug List is posted to our website at www. aetnamedicare.com/2013formulary. If you don’t use the Internet you can ask for a printed copy. Just call Member Services at the toll-free number on your Aetna ID card. You might not have to stick to the list If it is medically necessary for you to use a drug that’s not on your plan’s preferred drug list, you or your doctor (or pharmacist in the case of antibiotics and pain medicines) can ask us to make an exception. Check your plan documents for details. Generic drugs A generic drug is the same as a brand-name drug in dose, use and form. They are FDA approved and safe to use. Generic drugs usually sell for less; so many of our plans give you incentives to use generics. That doesn’t mean you can’t use a brand-name drug, but you’ll pay more for them. What’s not covered New drugs may not be covered Your plan may not cover drugs that we haven’t reviewed yet. You or your doctor may have to get our approval to use one of these new drugs. If they are covered, you will likely pay more for these drugs than others. Ask your doctor about possible alternatives that are covered under the plan. How to use the plan Precertification: Getting approvals for certain medications Sometimes the plan pays for medications only if we have given an approval before you get it. We call that “precertification.” Precertification is usually limited to more expensive medications. Your plan documents list all the drugs that require precertification. Call the number shown on your Aetna ID card to ask to precertify any medications. You must get the approval before you purchase the drugs, or they will not be considered for coverage under your plan. You may have to try one drug before you can try another Step therapy means you have to try one or more "prerequisite" drugs before a "step-therapy" drug will be covered. The preferred drug list includes step-therapy drugs. Your doctor might want you to skip one of these drugs for medical reasons. If so, you or your doctor (or pharmacist in the case of antibiotics and pain medicines) can ask for a medical exception. Getting a prescription filled Use network pharmacies In most cases, prescription drugs are covered only when you get them from an Aetna network pharmacy or one of the Aetna owned mail-order pharmacies. A network pharmacy is a pharmacy that participates in the Aetna network. You do not have to use the same network pharmacy each time; you can go to any of over 65,000* Aetna network pharmacies in the country to get your covered prescriptions filled. *Aetna Pharmacy Management System as of June 2012. Contact us 1-800-213-4599 S5810_D_PE_MM_20509 CMS Approved
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Prescription Drug Plan - Aetna Medicare

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