Tools and Resources

Get forms and documents easily. Read online or print, it’s that simple.

• Pharmacy Directory - Coming in October
• Provider Directory - Coming in October
• Aetna Quick Charge Program for members that receive a premium notice from Aetna
• Medicare Prescription Drug Claim Form for reimbursement of covered prescription drug services.
• Aetna Medical Exception/Precertification Request Form for Prescription Medication
• CMS Medicare Part D Coverage Determination Form

Aetna Medicare Advantage: Appeals and Grievances

We understand the importance of having the coverage you need. If you have a coverage issue or problem, Member Services can help you to resolve it. If you feel that Aetna Medicare should pay for benefits and services that are not covered, you have the right to appeal any decision. You have two options:

• Appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive
• File a grievance to address your complaints and problems if Member Services cannot resolve your issue.

For more complete information about the appeal and grievance processes, download this Appeals and Grievances information (5 pages, 139kb).

Aetna Medicare Rx Plan (PDP): Exceptions, Appeals and Grievances 

We understand the importance of having the coverage you need — and that includes your prescription drugs. If you're taking a medication that's not currently covered by Aetna Medicare Rx^® Plan (PDP), you have several options: 

• Request an exception for nonformulary Part D drugs and for brand, tiered cost sharing.  
• Appeal to have Aetna Medicare make a decision on the benefits you feel you are entitled to receive.  
• File a grievance to address your complaints and problems if Member Services is unable to resolve your issue.

For more complete information about the various appeals processes, download Exceptions, Appeals, and Grievances Information Y0001_M_OT_WB_01245_R2 Pending CMS Approval  (9 pages, 45kb).  

• CMS Appointment of Representative form CMS-1696 Y0001_M_AG_FM_10121 File & Use 02/15/2011 (2 pages, 273 kb)
• Aetna Medicare Plans Grievance or Appeal Form Y0001_M_AG_MM_01047 CMS Approved 03/04/2011 (5 pages, 32kb)

Look up your covered prescriptions and more.

• For a partial list of covered prescription drugs for 2012, view and/or print our 2012 Aetna Medicare Abridged Formulary (prescription drug list). 2012 Aetna Medicare Abridged Formulary (48 pages, 582 kb)

• For a complete listing of all covered prescription drugs for 2012, view and/or print our 2012 Aetna Medicare Formulary (prescription drug list).

• 2012 Aetna Medicare Standard Formulary (188 pages, 999 kb)

• 2012 Aetna Medicare Open Formulary (212 pages, 1,103 kb)

• 2012 Aetna Medicare Base Closed Formulary (144 pages, 1,002 kb)

• Pharmacy Benefits – Aetna Rx Home Delivery – If you are looking for information about Aetna Rx Home Delivery, you can learn more by visiting AetnaMedicare.com/member, or members can log on to Aetna Navigator. Select the "Coverage & Benefits" then choose "Pharmacy Benefits."
  

Get forms and documents easily. Read online or print, it’s that simple.

Access the following forms and documents

• Pharmacy Directory
• Provider Directory
• Aetna Quick Charge Program for members that receive a premium notice from Aetna
• Medicare Prescription Drug Claim Form for reimbursement of covered prescription drug services.
• Aetna Medical Exception/Precertification Request Form for Prescription Medication
• CMS Medicare Part D Coverage Determination Form

Aetna Medicare Advantage: Appeals and Grievances

We understand the importance of having the coverage you need. If you have a coverage issue or problem, Member Services can help you to resolve it. If you feel that Aetna Medicare should pay for benefits and services that are not covered, you have the right to appeal any decision. You have two options:

• Appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive
• File a grievance to address your complaints and problems if Member Services cannot resolve your issue.

For more complete information about the appeal and grievance processes, download this Appeals and Grievances information (5 pages, 139kb).

Aetna Medicare Rx Plan (PDP): Exceptions, Appeals and Grievances 

We understand the importance of having the coverage you need — and that includes your prescription drugs. If you're taking a medication that's not currently covered by Aetna Medicare Rx^® Plan (PDP), you have several options: 

• Request an exception for nonformulary Part D drugs and for brand, tiered cost sharing.  
• Appeal to have Aetna Medicare make a decision on the benefits you feel you are entitled to receive.  
• File a grievance to address your complaints and problems if Member Services is unable to resolve your issue.

For more complete information about the various appeals processes, download Exceptions, Appeals, and Grievances Information Y0001_M_OT_WB_01245_R2 Pending CMS Approval  (9 pages, 45kb).  

• CMS Appointment of Representative form CMS-1696 Y0001_M_AG_FM_10121 File & Use 02/15/2011 (2 pages, 273 kb)
• Aetna Medicare Plans Grievance or Appeal Form Y0001_M_AG_MM_01047 CMS Approved 03/04/2011 (5 pages, 32kb)

Look up your covered prescriptions and more.

• For a partial list of covered prescription drugs for 2011, view and/or print our 2011 Aetna Medicare Abridged Formulary (prescription drug list). 2011 Aetna Medicare Abridged Formulary (48 pages, 582 kb)
• For a complete listing of all covered prescription drugs for 2011, view and/or print our 2011 Aetna Medicare Formulary (prescription drug list).
• 2011 Aetna Medicare Standard Formulary 2011 Aetna Medicare Standard Formulary (228 pages, 967 kb)
• 2011 Aetna Medicare Open Formulary 2011 Aetna Medicare Open Formulary (124 pages, 427 kb)
• 2011 Aetna Medicare Base Closed Formulary 2011 Aetna Medicare Base Closed Formulary (128 pages, 901 kb)
• Pharmacy Benefits – Aetna Rx Home Delivery – If you are looking for information about Aetna Rx Home
  Delivery, you can learn more by visiting AetnaMedicare.com/member. Select “RX” and then “Rx by mail”, or members can log on to Aetna Navigator. Select the "Coverage & Benefits" then choose "Pharmacy Benefits."