1. Will current processes change for drug precertification, quantity limits, step-therapy or other utilization management programs?
There will be no changes to the above. Aetna will retain the development and updating of the Commercial and Medicare formularies. Along with the formulary development, the development and updating of the pharmacy utilization management (UM) clinical program, which includes development of precertification, quantity limits and step-therapy edits, will also be retained by the Clinical Pharmacy Unit within Aetna.
2. When will pharmacies begin to see changes?
CVS Caremark and Aetna are working collaboratively with the pharmacies to execute a smooth transition from the Aetna contracted network to the CVS Caremark contracted network effective 1/1/11. In most instances, rate changes become effective at this time.
3. Will I be required to recontract and/or re-verify credentials to participate in the Aetna pharmacy network as a result of this new relationship?
Any pharmacy already contracted with CVS Caremark would not be required to go through a special credentialing process for Aetna. Any pharmacy not currently contracted with CVS Caremark would be required to meet the standard credentialing requirements of CVS Caremark and contract with CVS Caremark.
4. Will day-to-day contact with Aetna change? If so, describe/explain (phone number change, use of Aetna Pharmacy Provider Help Line and/or Provider Service Center).
Not at this time. Providers can continue to call Aetna as they have previously and visit the same websites (www.Aetna.com, Health Care Professionals page), our secure pharmacy website (pharmacies) and our secure provider website via NaviNet® (physicians), which will remain active.
5. Will this affect the medications that physicians buy and bill in their offices?
No, this relationship affects certain functions of retail mail-service and specialty pharmacy fulfillment. This arrangement will not affect those medications or vaccines that you administer in your office and bill as a medical benefit, along with your services. We will continue to work with you and your patients to provide medical benefits and services as we have previously.