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Medicare Part D, D-SNP, network, appeals and coverage

Medicare expansion information

Part D prescriber enrollment requirement

Part D prescriber enrollment requirement

Any health care professional who prescribes drugs to patients with Part D plans must now enroll in the Medicare program or opt out. This helps ensure that patients get their prescriptions without disruption.

 

We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and non­retail pharmacies, both independent and chain.


Learn how to participate in our Part D network

You may have patients who take Part D drugs that are not on the plan’s formulary or have utilization management requirements. These members can get a transition supply of their medicine under certain circumstances. We can work with you to complete a successful transition and avoid disruption in treatment.

 

More about the Part D transition process (PDF)

Find formularies, prior authorization criteria and step-therapy criteria for our Medicare prescription drug plans.

 

Use our drug search tool


Find Part D prescription drug prior authorization and exception forms

Join our Medicare Advantage Quality Incentive Program

Join our Medicare Advantage Quality Incentive Program

This program includes ways to promote early detection and assessment of chronic conditions. You provide the care your patients need, while earning incentives. You can participate in this program if: 

 

  • You are a primary care physician with 50 to 749 attributed Aetna Medicare Advantage members
  • You are not participating in another Aetna value-based contract or program

Why join the Aetna Medicare PPO network?

Why join the Aetna Medicare PPO network?

More members are joining our Medicare Advantage Preferred Provider Organization plans. So you’re likely to see more patients with these health plans. You can find more information about these plans and how to join our network.

More resources for you

 

Medicare appeals information

 

Learn about submitting a dispute or appealing a decision.

 

Disputes and appeals overview

 

Medicare appeals for non-participating providers 

 

Appealing a Medicare hospital discharge

Determining Medicare coverage

 

The Centers for Medicare & Medicaid Services sometimes makes changes to coverage rules. These National Coverage Determinations (NCDs) may affect patient coverage.

 

Learn about National Coverage Determinations

 

Find Aetna Part B step therapy criteria

 

State of Connecticut retiree for special handling of Part B drugs

 

Medicare prior authorization, coverage criteria and access to care - effective January 1, 2024 (PDF)

Legal notices

Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Health benefits and health insurance plans contain exclusions and limitations.

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