Aetna Medicare Choices

Participating Pharmacies

Visit one of more than 60,000 network pharmacies.
Aetna has a nationwide network of pharmacies, including both national chains and neighborhood pharmacies. There are three ways to find participating pharmacies:

• Check with your current pharmacy.
• Look up pharmacies near you.
• Call our Member Services toll-free number at 1-800-213-4599
  (TTY/TDD 1-888-760-4748), 8 a.m. to 8 p.m., 7 days a week.

 

Aetna has contracts with pharmacies that equal or exceed CMS requirements for pharmacy access in your area.

Home Delivery

Aetna Rx Home Delivery^® is the prescription mail service pharmacy for Aetna pharmacy benefit members taking maintenance medications. Maintenance medications treat chronic conditions such as arthritis, asthma, diabetes, high cholesterol, heart conditions, high blood pressure and others.

• If you are an Aetna member, you can learn more about Aetna Rx Home Delivery, download an order form, and more by logging in to your secure Aetna Navigator member website, and selecting the "Pharmacy Benefits" tab under "Related Shortcuts."
• If you are not yet an Aetna member, visit the Aetna Rx Home Delivery information page.

Aetna Specialty Pharmacy^®

Fill your injectable medication needs at Aetna Specialty Pharmacy.

Aetna Specialty Pharmacy provides convenient, mail-order services for medications that require special handling, storage or shipping. These are drugs that treat certain conditions such as hepatitis, psoriasis, rheumatoid arthritis and multiple sclerosis.

Aetna Specialty Pharmacy:

• Provides convenient mail-order services for specialty medications that are not always available at retail pharmacies.
• Offers educational and clinical support services to help members manage their medications and health conditions.
• Features a dedicated team of patient-care coordinators, pharmacists and registered nurses.

To learn more about Aetna Specialty Pharmacy, visit www.AetnaSpecialtyPharmacy.com or call toll free at 1-866-782-2779 (TTY/TDD 1-877-833-2779), Monday through Friday, 8 a.m. to 7 p.m.

Out-of-Network Pharmacies

You may use an out-of-network pharmacy in certain non-routine situations when at least one of the following applies:

• If you are unable to get a covered drug when you need it because there is no network pharmacy within a reasonable driving distance that provides 24-hour service.
• If you are trying to fill a prescription drug that is not regularly stocked at an accessible network retail or mail-order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).
• If you are traveling outside your service area (within the United States) and run out of your medication, lose your medication, or become ill and cannot get to a network pharmacy.
• If you receive a Part D drug, dispensed by an out-of-network institutional-based pharmacy, while you are in the emergency department, provider-based clinic, outpatient surgery or other outpatient setting.
• If you have received your prescription during a state or federal disaster declaration or other public health emergency declaration in which you are evacuated or otherwise displaced from your service area or place of residence.

When you go to an out-of-network pharmacy, you may have to pay the full cost of the drug (rather than just your copay) when you get your prescription. To be reimbursed for Aetna's share of the cost of the drug for up to a 10-day supply, you need to submit claim forms to Aetna. You may need to pay an additional cost for drugs received at an out-of-network pharmacy.

Timely Filing of Your Aetna Medicare Prescription Drug Claim

When you go to a network pharmacy and use your membership card, your claim is automatically submitted to us by the pharmacy. However, if you go to an out-of-network pharmacy and attempt to use your membership card, the pharmacy may not be able to submit the claim directly to us. When that happens, you'll have to pay the full cost of your prescription. Aetna will accept paper claim submissions from your date of service, until three months after the end of the plan year.  If you submit a claim for reimbursement after this timeframe, the claim will be denied for untimely filing.

For example: For the contract year ending December 31, 2009, you will have until March 31, 2010, to submit your paper claims for reimbursement.

Aetna Medicare Refill Frequency Policy

Our refill policy promotes the safe and appropriate use of medications. Follow these guidelines for getting refills on your prescriptions:

Retail Pharmacies

• You may refill a supply of 9 days or less after you have used 50 percent of the prescription.
• You may refill a supply of 10 days or more after you have used 75 percent of the prescription.

Mail Order Pharmacies

• You may refill a supply of 30 days or less after you have used 50 percent of the prescription.
• You may refill a supply of 31 to 60 days after you have used 60 percent of the prescription.
• You may refill a supply of 61 days or more after you have used 66 percent of the prescription.

Cumulative Refill Too Soon

A “cumulative refill too soon” occurs when a 450-day supply of medication is accumulated. For prescriptions filled at retail pharmacies, you must use 90 percent of the accumulated medication before a refill will be allowed. For prescriptions filled at mail-order pharmacies, you must use 80 percent of the accumulated medication before a refill will be allowed.