Pharmacy & Pharmacists

Aetna Pharmacy Management has the tools and information you need, when you need them

Pharmacy Help Line

Call the Pharmacy Help Line 1-800-238-6279

We are here to answer any questions you may have about claims, policies, benefits and more — 24 hours a day, every day.

We're easy to work with

Join Aetna’s network

Become a participating pharmacy. Request an enrollment packet.

Submit pharmacy claims online

Participating pharmacies can submit claims 24 hours a day, 7 days a week.
Use the most current version of the National Council for Prescription Drug Program Telecommunication Standard (NCPDP Standard) to submit online claims for processing. Learn more about online claims submission.
Make sure you have a National Provider Identifier (NPI). We only accept NPIs for HIPAA standard online transactions. This also applies to Universal Claim Form (UCF) processing. Learn more about NPI.
To override the High Dose, Drug-Drug Interaction or Therapeutic Duplication Reject, follow the Procedure to Override DUR Rejects (PDF, 56 KB) after you have confirmed with the physician and/or member that the correct and appropriate drug(s), quantity and days supply are correct.

Now, you can quickly complete and submit drug authorization requests online. After you log in, choose the “Drug Auths” menu option from Aetna Plan Central. Or, choose the “Drug Authorizations” option under the Services menu. We’ll still fax the authorization directly to you.

While in your secure pharmacy professionals website, you can also find:

Aetna’s current Maximum Allowable Cost (MAC) list
Pharmacy Provider Services Manual
Formulary information (Medicare and non-Medicare)

As of April 1, 2012, pharmacy claims must be submitted in the NCPDP D.0 format or they will reject

The National Council for Prescription Drug Programs (NCPDP) maintains requirements regarding the standard way pharmacy claims must be transmitted. Telecommunications Standard Version D.0 is an updated version of the Health Insurance Portability and Accountability Act (HIPAA) standard for pharmacy claims transactions. It is an online, real-time request from the pharmacy to the health plan AND a response from the health plan to the pharmacy.

Covered entities, including pharmacies, are required to conform to HIPAA 5010 standards and upgrade to NCPDP D.0 by April 1, 2012. This will ensure the entity can support current pharmacy service transactions and that claims will not reject.

If you have questions about specific fields included within the Aetna D.0 Payer Sheets listed below, related to your software screens/capabilities, please consult with your chain headquarters (if applicable) or software vendor for assistance.

Pharmacy Communications Regarding D.0 Implementation (targeted to pharmacies, chain HQ and software vendors regarding key transaction requirements/changes for Aetna claims submissions in 2012):