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Are your drugs covered?

Use our drug search tool to look up your prescription drugs. You can check to see if your drugs are covered and about how much they would cost. You can also find retail and mail order pharmacy options. And compare costs to find the best deal on your drug. Log in to get started.

  

Does your Aetna® plan cover your medical care and prescriptions (Medicare Parts C and D)? Log in to your Medicare Advantage prescription drug (MAPD) plan.

  

Does your Aetna plan only cover prescriptions (Medicare Part D)? Log in to your prescription drug plan (PDP).  

Using your prescription drug benefits

Your Aetna® prescription drug coverage comes with powerful coverage that, when used correctly, can help you save money. This video will help you better understand how to get the most coverage and savings out of your plan.

 

 

First, you’ll need to understand how your medications are priced. Each medication is placed on one of 5 different drug tiers. Tier 1 is the least-expensive option and Tier 5 is the most expensive. Generally, the lower the tier, the less you pay.

 

 

You can find what tier a drug is on by checking your formulary or drug list. You can find the formulary or drug list on your member portal. It details which drugs are covered and any plan requirements associated with these drugs.

 

 

For example, you may see acronyms like PA, ST, or QL next to a drug. Here are a few definitions so you can understand what they mean.

 

 

  • Step therapy: You’ll need to try certain drugs first before we’ll cover another option. A drug like this will have “ST” in the “Requirements/Limits” column.
  • Prior authorization: Your doctor needs to get approval from us before we cover the drug. A drug like this will have “PA” in the “Requirements/Limits” column.
  • Quantity Limit: There’s a limit on the amount of the drug that we cover. A drug like this will have “QL” in the “Requirements/Limits” column.

 

Additionally, you’ll notice drug names are either in italics or UPPERCASE letters. These mean:

 

  • Italics – generic drugs that are most often found on lower tiers
  • UPPERCASE – brand-name drugs that are most often found on higher tiers

 

It’s also important to note that the amount you pay for your drugs may depend on your plan’s deductible and how that deductible applies to the medications on your plan. For example, the deductible might not apply to Tier 1 and Tier 2 drugs in some plans. You can double check your coverage by consulting your Evidence of Coverage.

 

You can also consult your Evidence of Coverage when you work with your doctor. It can help your doctor prescribe drugs covered by your plan. And it may help them prescribe a lower-cost drug to help treat your condition.

 

When you’re ready to choose a pharmacy and receive your drugs, you have choices:

 

The first option is to pick them up in person. To receive the highest savings possible, you’ll want to find a preferred pharmacy on your member portal. Make sure you use a pharmacy in our network. Your plan may offer lower cost shares at preferred pharmacies in our network.

 

Another option is to receive your prescription through the CVS Caremark Mail Service Pharmacy. This option is great for those who regularly take maintenance drugs, like those for diabetes or asthma.

 

The service allows you to have up to a 90 or 100-day supply depending on your plan. Your drugs are delivered directly to you and may be a great option if you take medications regularly. It can also help you save time and trips to the pharmacy. Visit your Aetna member website to learn more about this service.

 

For more details on the specifics of your drug coverage, please review your plan documents. And of course, you can always visit us at AetnaMedicare.com to learn more.  

Using your prescription drug benefits

Learn how to get the most out of your prescription benefits. This video explains:

 

  • How medications are priced – from a low Tier 1 to higher Tier 5
  • How to read our drug list (or formulary)
  • How your plan affects your drug price
  • Ways you can shop for the drug you need
  • Where to go for more info  
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Choose how you’d like to search

 

Get a drug price estimate 

 

You can use this drug search tool without logging in. Check to see if your drug is covered and if there are lower-cost generic versions. First, enter your ZIP code. Then, add the names of your drugs and how much you take. After that, pick a plan to see nearby pharmacies and get an estimate of your drug cost.

Get the drug list (formulary)

 

Want a list of all the drugs covered by your plan? Download the formulary and get important info on your medicine. You can check which tier a drug is on, if there are any limits or rules and if you can get the drug by mail order. Usually, the lower the tier, the less you pay. 

  

Enter your state, county and plan name to start. 

  

How to find your plan name

  

Medicare Advantage prescription drug (MAPD) plans

Does your plan cover your medical care and prescriptions (Medicare Parts C & D)? If so, your plan name is listed on your member ID card. 

  

Prescription drug plans (PDP) 

Does your plan only cover prescriptions (Medicare Part D)? If so, look at the S number on the bottom right of your member ID card. Then, in the Plan name menu, find the plan with the S number that matches what’s on your ID card. 

Choose your state, county and plan name

 

Drug coverage rules

Some drugs have coverage rules. There are times we may need to approve a drug before we cover it. Some drugs may have limits on the amount you can get. Learn more about these rules and how to ask for exceptions.

Do you get Medicare through an employer?

Employer and group retiree plans can be different. So, check your plan details carefully. Get help to find your plan and what it covers.

 

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