Understanding how your pharmacy benefits and insurance plan works helps you make the most out of your benefits. Here are answers to some questions you may have.
What prescription drugs are covered?
Many Aetna prescription drug plans offer coverage based on our Preferred Drug List. This is also known as a formulary. It gives you an idea of generic and brand-name drugs your plan covers. Based on the plan, the Preferred Drug List may have different levels of coverage for preferred and non-preferred drugs.
We review the list often. That’s because it may change, based on:
To see what your plan covers, log in to your secure Aetna Navigator® website. Then look for Medication Search. From there, you can enter the name of a brand-name or generic drug. You can see if your drug is covered, the tier your drug is on and if a generic is available.
What if my doctor prescribes a drug that isn’t covered by your plan or is too costly?
It’s okay to ask questions when your doctor gives you a prescription.
A drug that is on a lower tier or generic may help save you money. If your plan has a Preferred Drug List, take a copy to your doctor’s ofﬁce. That way, you can see if the drug is covered. After all, decisions about your care are up to you and your doctor.
Are generic drugs right for me?
Generic drugs help you get more for your money. They are usually less expensive than brand-name drugs, but they do the same job. That’s why you and your doctor should consider them whenever you can.
Generic drugs are approved by the FDA to be as safe and effective as their brand-name counterparts. They have the same active ingredients in the same dose. The difference is that they may be another shape, size or color.
How can I get the generic version of a drug?
Most pharmacies can switch a generic for a brand-name drug. In fact, many will make the switch automatically, unless your state law says they can’t.
However, your doctor may have written “DAW” on your prescription. This stands for “dispense as written.” It means that the pharmacy can’t substitute a generic for a brand-name one without calling your doctor. Your doctor may do this if he or she believes that the generic drug is not right for you.
How can I ﬁnd out how much a drug will cost?
If you have Internet access, you can use our Price-A-DrugSM tool. Just log in to your website. Look under Aetna Pharmacy and Get Drug Prices to find our tool. It lets you estimate the cost of a prescription drug from your local pharmacy or by mail-order pharmacy. Compare the costs of generic and brand-name drugs. And see how much money you can save.
No Internet access? No worries. Call the toll-free number on your Aetna ID card.
How do I start using Aetna Rx Home Delivery®?
It’s fast and easy to order. Choose one of three ways.
1. Mail. Get a new prescription from your doctor. Mail it to Aetna Rx Home Delivery with a completed order form. The mailing address is listed on the form. You can find the form on Aetna Navigator. Just look under Aetna Pharmacy.
2. Fax. Your doctor can fax in the prescription. Our fax is 1-877-270-3317. Make sure your doctor includes your member ID number, your date of birth and your mailing address on the fax cover sheet. Only a doctor may fax a prescription.
3. Phone. Call the toll-free number on your member ID card. We’re here to help. So we’ll call your doctor to see if we can get a new prescription. Sometimes, your doctor may want to examine you before writing a new prescription. After we call your doctor, please gives up to 7 days to receive a reply. To help this process move quickly, it’s a good idea to let your doctor know we’ll be calling.
Some types of medicines require a written prescription from your doctor.
Once we receive your complete order, you should get your prescription within 10 – 14 days. Getting quicker delivery will cost you more.
How do I start using Aetna Specialty Pharmacy®?
It’s fast and easy to order. Choose one of three ways.
1. Fax. Your doctor can fax your prescription to 1-866-FAX-ASRX (1-866-329-2779).
2. Mail. You or your doctor can mail your prescription to: Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. If you mail in your own prescription, send it with a completed Patient Profile Form. Visit our Aetna Specialty website and click Enroll to get the form.
3. Phone. Your doctor can also call our registered pharmacists at 1-866-782-ASRX (1-866-782-2779). Business hours are 8 a.m. to 7 p.m. ET.
Do you need to transfer an existing prescription to Aetna Specialty Pharmacy? Call 1-866-353-1892 toll-free.
Can I manage my prescription beneﬁts online?
You sure can. Log in to Aetna Navigator to view your claims and benefit summary. Plus, you’ll find many helpful tools:
Aetna’s Preferred Drug List is subject to change.
Aetna Specialty Pharmacy and the Specialty Pharmacy Network may not be available to California HMO members. Talk to your doctor about the appropriate way to get the specialty medications you need. Doctors may have agreed to dispense and administer these drugs to you themselves. Or they may write a prescription so you can fill them at any participating retail or mail-service pharmacy.
*Estimated costs not available in all markets. The tool gives you an estimate of what you would owe for a particular service based on your plan at that very point in time. Actual costs may differ from the estimate if, for example, claims for other services are processed after you get your estimate but before the claim for this service is submitted. Or, if the doctor or facility performs a different service at the time of your visit. HMO members can only look up estimated costs for doctor and outpatient facility services.