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Using your prescription drug benefits
Your Aetna® prescription drug coverage comes with powerful coverage that, when used correctly, can help you save money. This video will help you better understand how to get the most coverage and savings out of your plan.
First, you’ll need to understand how your medications are priced. Each medication is placed on one of 5 different drug tiers. Tier 1 is the least-expensive option and Tier 5 is the most expensive. Generally, the lower the tier, the less you pay.
You can find what tier a drug is on by checking your formulary or drug list. You can find the formulary or drug list on your member portal. It details which drugs are covered and any plan requirements associated with these drugs.
For example, you may see acronyms like PA, ST, or QL next to a drug. Here are a few definitions so you can understand what they mean.
- Step therapy: You’ll need to try certain drugs first before we’ll cover another option. A drug like this will have “ST” in the “Requirements/Limits” column.
- Prior authorization: Your doctor needs to get approval from us before we cover the drug. A drug like this will have “PA” in the “Requirements/Limits” column.
- Quantity Limit: There’s a limit on the amount of the drug that we cover. A drug like this will have “QL” in the “Requirements/Limits” column.
Additionally, you’ll notice drug names are either in italics or UPPERCASE letters. These mean:
- Italics – generic drugs that are most often found on lower tiers
- UPPERCASE – brand-name drugs that are most often found on higher tiers
It’s also important to note that the amount you pay for your drugs may depend on your plan’s deductible and how that deductible applies to the medications on your plan. For example, the deductible might not apply to Tier 1 and Tier 2 drugs in some plans. You can double check your coverage by consulting your Evidence of Coverage.
You can also consult your Evidence of Coverage when you work with your doctor. It can help your doctor prescribe drugs covered by your plan. And it may help them prescribe a lower-cost drug to help treat your condition.
When you’re ready to choose a pharmacy and receive your drugs, you have choices:
The first option is to pick them up in person. To receive the highest savings possible, you’ll want to find a preferred pharmacy on your member portal. Make sure you use a pharmacy in our network. Your plan may offer lower cost shares at preferred pharmacies in our network.
Another option is to receive your prescription through the CVS Caremark Mail Service Pharmacy. This option is great for those who regularly take maintenance drugs, like those for diabetes or asthma.
The service allows you to have up to a 90 or 100-day supply depending on your plan. Your drugs are delivered directly to you and may be a great option if you take medications regularly. It can also help you save time and trips to the pharmacy. Visit your Aetna member website to learn more about this service.
For more details on the specifics of your drug coverage, please review your plan documents. And of course, you can always visit us at AetnaMedicare.com to learn more.
Using your prescription drug benefits
Learn how to get the most out of your prescription benefits. This video explains:
- How medications are priced – from a low Tier 1 to higher Tier 5
- How to read our formulary (drug list)
- How your plan affects your drug price
- Ways you can shop for the drug you need
- Where to go for more info
Choose how you’d like to search
Get a drug price estimate
You can use this search tool without logging in. See if your drugs are covered and if any lower-cost generic equivalents are available. Start with your ZIP code, select your plan and add your drug names and doses. Then select a network pharmacy to estimate drug prices.
Get the formulary (drug list)
Want a full list of every drug covered by your plan? Download the formulary and find other important prescription drug information. Check the tier a drug is on, any limits or requirements and mail order availability. Generally, the lower the tier, the less you pay.
Complete the requested information below to get your plan’s formulary (drug list).
If you’re in a plan that covers medical and prescription drug coverage (called a Medicare Advantage plan), your plan name is listed on your member ID card.
If you’re in a plan with prescription drug coverage only (PDP), look at the “S” number on the bottom right of your member ID card. Then, in the Plan Name drop-down, find the plan with the “S” number that matches what’s on your ID card.
If you’re in a Medicare Advantage plan, your plan name is listed on your member ID card.
If you’re in a plan with prescription drug coverage only (PDP), look at the “S” number on the bottom right of your member ID card to find your plan.
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Choose your state, county and plan name
Some drugs have coverage rules such as prior authorization, step therapy and quantity limits. To learn about coverage rules, requesting exceptions to coverage rules and more, visit our Drug information and resources page.
Have Medicare coverage through an employer?
Employer- and group-sponsored retiree plans vary. It’s important to review your plan information carefully. We can help you look up your plan and what it covers.