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Medicare Drug Plans

Aetna Medicare Rx Plans (PDP): Find 2012 Prescription Drugs

How do you know which prescriptions are covered?
Check out our Preferred Drug List for the Aetna Medicare Rx® Plans (PDP).

Clarification of the 2012 Aetna Medicare Part D Formulary Guides

Formulary Clarification: The 2012 Aetna Medicare Part D Formulary contains some drugs that generally are not covered in a Medicare Prescription Drug Plan. These drugs are called Excluded Drugs and are identified in the formulary with an abbreviation of ED under the header of "Requirements/Limits". Examples of Excluded Drugs include alprazolam, diazepam, lorazepam, temazepam and phenobarbital.

The Excluded Drugs that are listed in the formulary aren't covered in the Aetna CVS/pharmacy Prescription Drug Plan, the Aetna Essentials Prescription Drug Plan, or the Aetna Medicare Advantage plans that include prescription drug coverage ("MAPD"). If you're a member of the Aetna CVS/pharmacy Prescription Drug Plan, the Aetna Essentials Prescription Drug Plan, or an Aetna MAPD plan and fill a prescription for an excluded drug, you'll have to pay the full cost of the drug. 

The only time these Excluded Drugs are covered is if you're a member of the Aetna Medicare Rx Premier Plan. 

The amount you pay when you fill a prescription for an Excluded Drug doesn't count toward your total drug costs or help you qualify for catastrophic coverage. In addition, if you receive extra help to pay for your prescriptions, you won't get extra help to pay for Excluded Drugs.

Public notice of transition process

The Centers for Medicare and Medicaid Services (CMS) implemented a transition program to allow Medicare Part D members to receive a temporary supply of medication to avoid disruption of medication therapy.

Aetna has established a transition program that provides new and existing members with up to a one time fill (maximum of a 31-day supply OR multiple fills for a combined medication supply of no more than 31 days) for each prescription:

  • that you may already be taking and
  • that is not on our formulary, or
  • that requires prior authorization (precertification), quantity limits, or step therapy.

If you live in a Long Term Care facility and are entitled to a transition supply, we will cover a 31-day supply (unless your prescription is for fewer days) and will also honor refills up to a maximum of a 93-day supply during your transition period.

What is the formulary?

The Aetna Medicare Preferred Drug List, also known as our formulary, includes both brand-name and generic prescription drugs. You may be able to reduce your costs by asking your doctor to prescribe drugs in a preferred tier.

  • Brand-name prescription drugs are marketed by manufacturers with a brand or trade name. When the manufacturers lose their patents for brand-name drugs, generic versions may become available.
  • Generic drugs have the same active ingredients in the same amounts as brand-name drugs. Generic prescription drugs usually cost less than brand-name prescription drugs and are rated by the FDA to be as safe and effective as brand-name drugs.

All drugs are FDA approved

All the medications on the formulary have been approved by the U.S. Food and Drug Administration (FDA). This includes generic drugs as well as brand-name drugs. The FDA promotes and protects public health by making sure prescription drugs and other products are safe, effective, and reach the market in a timely way. Once medications and other products have entered the market, the FDA keeps track of them for continued safety.

Regular updates keep the formulary current

The Aetna Medicare formulary is updated from time to time and may change during the year. We will let affected members know at least 60 days before a medication is removed from coverage, moved to a higher cost-sharing level, or if precertification, quantity limit or step-therapy restrictions have been placed on a medication. If the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug's manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and let members taking the drug know.

Quality assurance policies

Aetna members should refer to their Evidence of Coverage to learn more about quality assurance policies and procedures, including utilization management, drug utilization review, and medication therapy management programs. Aetna's Medicare Rx Evidence of Coverage PDF files can be found in the Help and Resources > Download Documents section of this website under Evidence of Coverage. Find your plan, open the PDF, and go to the "Drug Management Programs" section.

Medication Therapy Management (MTM) programs are aimed at helping members safely and effectively take medications prescribed by their physicians. Eligible members will be offered a medication review. Trained professionals will do the review by phone. Aetna Medicare's 2012 MTM programs include members:

(1) with two or more chronic conditions from the following list:

  • Asthma
  • COPD
  • Heart Failure
  • Hypertension
  • Diabetes
  • Rheumatoid Arthritis

(2) on eight or more Part D covered medications which are used for the conditions above

(3) likely to spend over $3100.20 per year on those medications which are used for the conditions above.

 

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Page Last Updated: January 22, 2013