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Pharmacy management program FAQs for health care providers

How do I become a participating provider to service Aetna members?
Effective January 1, 2011, CVS Caremark® became the pharmacy benefits administrator for Aetna Pharmacy Network.

In order to service Aetna members, you will need to be a participating provider with CVS Caremark. Please submit a request through the Pharmacy Pre-Enrollment Questionnaire located on the CVS Caremark website. Go to, and follow the links to Enrollment Self Service, Pre-Enrollment Questionnaire.

Who do I call when I have questions regarding prescription drug programs at Aetna?
Call one of our Aetna pharmacy customer service professionals. You can reach them toll-free at 1-800-238-6279 (TTY: 711).

Our customer service professionals are available 24 hours a day, every day. They can help you with questions regarding claims processing, member eligibility, maximum allowable cost (MAC) list, the Aetna preferred drug list (also called a formulary) and other related issues.

Find preferred drug lists

How can I support the Aetna preferred drug list and the precertification and step-therapy programs?
As a pharmacist participating in our network, you play an important role in caring for Aetna members. Let’s say a member presents a prescription for a drug that:

  • Needs precertification or prerequisite therapy, or
  • Is on the formulary exclusions list and may not be covered

Please help our members. Intervene on their behalf by contacting the prescribing doctor. The doctor may want to request a medical exception so that a formulary exclusions list drug or step-therapy drug will be covered. If so, tell the doctor to contact the Aetna Pharmacy Precertification Unit.

  • For Medicare coverage determinations, fax the request to 1-800-408-2386 or call 1-800-414-2386 (TTY: 711).
  • For Commercial coverage determinations, fax the request to 1-877-269-9916 or call 1-855-240-0535 (TTY: 711).

See our pharmacy clinical policy bulletins

There you will find Aetna pharmacy guidelines for determining health care coverage for selected outpatient prescription drugs.

In cases where a physician has prescribed an analgesic or antibiotic that requires medical exception or precertification, you may initiate the process by calling the Precertification Unit directly. If the Precertification Unit is closed, you may dispense one filling for an analgesic or antibiotic to an eligible Aetna member in accordance with the contracted rates. When the Precertification Unit reopens, you must call to receive authorization to transmit the claim online. 

What is the Member ID number format?
You will see Member ID cards with numeric and alpha-numeric member numbers. In addition, there are Preferred Provider Organization (PPO) and Managed Choice (MC) plans that are social security number-based.

It is a good idea to request to see the Member ID card prior to filling any new prescription. If you have any problems transmitting a claim, call one of our customer services professionals at 1-800-238-6279 (TTY: 711). They are available 24 hours a day, every day to help you.

Do I need to enter a person code or group number when transmitting a claim?
Yes, both the person code and the group number are required when transmitting a claim. Please see the member's identification card to obtain the correct codes to use.

What BIN code do I use to process claims?
All prescriptions submitted to Aetna for online adjudication must use BIN code 610502. Your software vendor will help you to obtain and install/set up the necessary software to submit claims online. If you have any problems or questions, call one of our customer service professionals at 1-800-238-6279 (TTY: 711). They are available 24 hours a day, every day to help you.

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