Prescription Drug Plan - Aetna Medicare

We may add or remove pharmacies from the
network throughout the year. Here’s how to find
the most up-to-date list of network pharmacies:
• Log on to www.aetna.com and select Find a
Doctor. When completing the search fields,
choose “Pharmacy” under Provider Category.
• Call us at the toll-free number on your Aetna ID
card. If you don't have your card you can call us
at 1-877-AETNA-11 (1-877-238-6211).
Show your Aetna ID card
When you have a prescription filled, show your
Aetna Medicare Rx Plan (PDP) ID card so the
pharmacist knows to send the claim to us. If you
forget to take your ID card, you may have to pay the
full cost of the prescription (rather than just your
copay) and then submit a claim for reimbursement.
What you pay
You will share in the cost of your prescription
medication. These are called “out-of-pocket”
costs. Your plan documents show the amounts
that apply to your specific plan. Pay your share of
the cost directly to the pharmacy when you have a
prescription filled. Those costs may include:
• Copay – A fixed amount (for example, $15) you
pay for a covered medication
• Coinsurance – Your share of the costs of a
covered medication. Coinsurance is calculated
as a percent (for example, 20%) of the allowed
amount for the medication.
• Deductible – Some plans include a deductible.
This is the amount you must pay out of your own
pocket for covered medications before your plan
begins to pay. For example, if your deductible
is $100, your plan won’t pay anything until you
have paid $100 for any covered medications that
are subject to the deductible.
Circumstances when you can use an
out-of-network pharmacy
Prescriptions are covered at pharmacies that are
not in the Aetna network if at least one of the
following applies:
• You are traveling out of the plan’s service area
(but within the United States) and run out or
lose your medication, or become ill and need a
covered prescription drug and cannot access
a network pharmacy. (Note: Foreign claims are
not covered by Aetna Prescription Drug Plans.)
• You cannot get a covered drug in a timely
manner within our service area because there
is no network pharmacy within a reasonable
driving distance that provides 24-hour service.
• You are trying to fill a prescription drug that is
not regularly stocked at an accessible network
retail or mail-order pharmacy (including highcost
and unique drugs).
• The prescription is related to care for a medical
emergency or urgent care (dispensed by an
out-of-network institution-based pharmacy
while a patient is in an emergency department,
provider-based clinic, outpatient surgery or
other outpatient setting.
• You are evacuated or otherwise displaced from
your home as a result of any state or federal
disaster or other public health emergency,
and you cannot get covered Part D drugs at
a network pharmacy. Also, “refill too soon
edits” will not apply during any voluntary
or mandatory state or federal evacuations,
and will last for the period of the emergency
declaration.
Before you fill your prescription in one of these
situations, call Member Services to see if there is
a network pharmacy in your area where you can
fill your prescription. If you do go to an out-ofnetwork
pharmacy for the reasons listed above,
you will have to pay the full cost (rather than
paying just your copayment) when you fill your
prescription.
S5810_D_PE_MM_20509 CMS Approved
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