Aetna Medicare has Solutions to Help You Save on Prescriptions

Transcription

1 Aetna Medicare has Solutions to Help You Save on Prescriptions Information Booklet Aetna Medicare Rx SM Plan

2 Enrolling is Easy Eligibility Just like the Original Medicare Plan, you must meet certain federal requirements to join the plan. You must be entitled to Medicare Part A, or You must be enrolled in Medicare Part B, and You must reside in the plan service area offered by your former employer Enrolling Once you know you qualify for the plan, follow these two steps to get started. Review the information included in this packet. Complete the enrollment form or follow your former employer s enrollment instructions. If you are unable to complete the form, call or TTY/TDD and a plan specialist can help you personally.

3 Count on Our PrescriptionDrugCoverage to Deliver Value Your former employer and Aetna have joined together to offer you a solution to your Medicare prescription drug needs, the Aetna Medicare Rx Plan. Prices on almost everything keep going up. That includes prescription drugs. With the Aetna Medicare Rx Plan, you can save on medications you are taking now or those you may need in the future. Our pharmacy network is nationwide, which makes filling your prescriptions easy. Whether you travel across the U.S. or visit your local pharmacy for your prescriptions, there s bound to be a pharmacy near by. You can also use Aetna Rx Home Delivery for your maintenance medications. Our Aetna Specialty Pharmacy helps to fill those hard to find medications. Get convenient and easy to use coverage for your medications. If you have questions about the coverage or the information inside, call us. A plan specialist is available at or TTY/TDD Highlights of the Aetna Rx Plan Coverage for a wide selection of top generic and brand name medications used by Medicare members. Over 57,000 participating pharmacies to get your prescriptions filled. Access the Aetna Rx Home Delivery and Aetna Specialty Pharmacy for mail-order and hard-to-fill medications. Dedicated Aetna Medicare plan specialists to answer your questions and provide assistance with your plan. Our experience, knowledge, commitment, and extensive pharmacy network are all reasons to learn more about the Aetna Medicare Rx Plan. Need to contact us? (TTY/TDD) Monday to Friday 8 a.m. to 6 p.m.

4 Coverage for a Wide Selection of Generic and Brand Name Drugs Medications like Nexium, Crestor and Lipitor are covered. Take a look at our formulary The Aetna Medicare Preferred Drug List (our formulary) includes medications our plans cover. Our formulary includes drugs like Nexium, Lipitor, Crestor and Vytorin and many other drugs that you may already be using. There are two types of formularies offered with our plan. The closed formulary covers a specific list of drugs and the open formulary will include a wider choice of possible Part D medications. Both provide prescription drug coverage, just in different ways. Check your Benefits Summary to find out which kind of formulary is included with your plan. You can get a complete listing of our formulary by visiting us online at and using the formulary search engine. Or you can call us at (TTY/TDD: ) and a plan specialist can help you. Our formulary is developed with help from pharmacists and physicians and has been approved by the federal government. This list provides a choice of quality, cost-effective generic and brand medications approved by the U.S. Food and Drug Administration (FDA). Get medications you need Your physician directs your medical care. He or she can prescribe any medication he or she believes is appropriate for you. Coverage is determined according to your Medicare prescription drug plan. Help save money by checking with your doctor to determine if a generic medication from the drug list is right for you. Drugs on formulary are safe To be considered for the Aetna Medicare preferred drug list a medication first must be approved by the U.S. Food and Drug Administration (FDA). The FDA is a federal agency charged with promoting and protecting public health by making sure drugs and other products are safe and effective and reach the market in a timely way. Once drugs and other products have entered the market, the FDA monitors them for continued safety. To determine whether an FDA-approved medication belongs on our Aetna Medicare Preferred Drug List, Aetna evaluates its safety, and effectiveness. 2

5 Our Plans Give You Convenient Locations to Have Prescriptions Filled Our network of pharmacies includes more than 57,000 locations. Get prescriptions filled at CVS, Walgreens, Rite Aid, Target and many other pharmacies throughout the country. Below is a partial listing of network pharmacies. Call us or go to for more information. A & H Stores A & P Ameridrug Big A Drug Stores Big Y Foods Bi-Lo BJ s Wholesale Club Brooks Brookshire Grocery CBC Professional Costco Cummings CVS D & W Food Centers Discount Drug Mart Duane Reade Eckerd Emporium Drug Mart Falley s Food Lion Fred Meyer Gessler s Giant Food Stores Giant Pharmacy H E B Hartig Drug Harvest Foods Ingles Markets JH Harvey Co Kash & Karry Kerr Drug Kmart Kroger Longs Drug Stores Lowe s Marketplace May s Drug Stores Medicine Shoppe NCS Healthcare Osco Pharmacy Express Services Price Chopper Publix Quick Chek Rite Aid Safeway Save Mart Shop N Save Supervalu Target Walgreens Walmart Winn Dixie 57,000 participating pharmacies Note: If you enroll in an Aetna Medicare Rx Plan, you must use network pharmacies to receive your prescription drug benefit except for nonroutine situations and emergency circumstances.

6 Simple Options for Mail-Order Prescriptions Safe and Convenient Mail-Order Prescriptions As a member, you have access to our preferred prescription mail order service, Aetna Rx Home Delivery, for your maintenance medications. Aetna Rx Home Delivery may also help you save on medications for arthritis, diabetes, heart conditions, asthma, high blood pressure, high cholesterol and other chronic conditions. Key advantages for using the prescription mail-order service include: Convenience: Quick and confidential free standard shipping of your medications to the location of your choice. Save trips to the pharmacy and order a three-month supply of your maintenance medications. Ease of Use: A simple process makes ordering maintenance medications easy. Quality of Service: Registered pharmacists check orders for accuracy and are available 24 hours a day, 7 days a week, in case of emergency. Savings: The prescription mail order service can provide significant savings for people taking maintenance medications. For select plans, when a three-month supply of medicine is ordered, you make only two copayments rather than three. Plus our deep discounts on medications help us fill your prescriptions for less and standard shipping is free.

7 Access and Discounts for Members Aetna Specialty Pharmacy Finding specialty medications like injectables or infused medications can be difficult. That s why we provide our members access to the Aetna Specialty Pharmacy. Advantages of Aetna Specialty Pharmacy Convenient, free delivery to your home or doctor s office. Educational support 24 hours a day, 7 days a week, by phone to help you, your family members and caregivers manage specialty medications. Personal instruction on how to use your medication. Refrigerated medications are specially packaged and shipped to ensure they do not move during delivery. Work closely with your doctor to make sure that you are receiving the right care, medications and supplies you need. Discounts on eyeglasses, vitamins, fitness clubs and more With Aetna Medicare, you get the medications you need plus a few extra services for no additional cost. You will receive: Discounts on vision services and eyewear. Membership discounts at fitness centers. Reduced rates on selected services from acupuncturists, chiropractors, massage therapists and nutritional counselors. Savings on vitamins and more than 14,000 natural health and wellness products including aromatherapy, meditation aids and yoga tools. Call us at (TTY/TDD: ) for more information about these programs. The products and services described above for discounted products are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the Aetna grievance process. 5

8 You can Receive Information and Help When You Need It Speak to an Aetna Representative If you need help, call us for answers. A trained plan specialist can talk with you about our plan and the Medicare program. Call our toll-free number at or TTY/TDD: for help. Use the Web for Facts and Savings Tips You can go online for general benefit information about our plan. Use the formulary search to see which drugs the Aetna Medicare Rx Plan covers. Just go to the Aetna Medicare Rx plan section on the website Financial Assistance Eligibility for financial help with prescription drug coverage is based on guidelines set by the federal government. You can apply for extra help through the Social Security Administration or a state Medical Assistance Office. Remember, the amount of help received depends on income and resources, and is determined by the federal government. If you think you qualify for help, call the Social Security Administration at TTY users should call (24 hours a day/7 days a week) or visit on the Web. You may also go to the Social Security Administration Medicaid office and apply. If you receive extra financial help, you will still need to join a Medicare prescription drug plan in order to receive this assistance.

9 Answers to Frequently Asked Questions Who is eligible to enroll in a Medicare prescription drug plan? You are eligible to enroll in a plan if you: Are entitled to Medicare benefits under Part A or enrolled in Part B, and Reside in the service area of the plan offered by your former employer After I join an Aetna Medicare Rx Plan, will there be someone to call if I need help? Yes. Trained Aetna Medicare Specialists are available to assist our members. So, whether you need information about your coverage, a drug formulary or a pharmacy, we can answer your questions. Can I get medications filled when I m traveling or when I am away from home? Yes. You can get covered prescriptions filled at any network pharmacy in the United States. In fact, we have over 57,000 locations where you can purchase medications. You can also use the prescription mail order service. 7

10 Answers to Frequently Asked Questions How does Medicare Part D fit in? Here s an overview of what the Original Medicare Plan includes: Part A: The hospital insurance program; the part of Medicare that pays for inpatient hospital, skilled nursing facility and hospice care. Part B: Coverage for physican, outpatient and preventive services. Part C: Includes Medicare Advantage Plans (such as HMOs or PPOs) that provide Part A and B benefits to enrollees, as well as offer optional prescription drug benefits. Part D: The Medicare prescription drug benefit that started in What are the benefits of the Aetna Medicare Rx Plan? Coverage for a wide selection of medications used by Medicare members. Safe and convenient mail order service from Aetna Rx Home Delivery. Use of the Aetna Specialty Pharmacy for hard to fill prescriptions. Receive discounts on eyeglasses, vitamins and more as part of your Aetna membership. Online formulary search to look up your medications. Contact Information Phone (TTY/TDD) Hours of Operation Monday through Friday 8 a.m. to 6 p.m. Website 8

11 Glossary of Terms Beneficiary Centers for Medicare & Medicaid Services (CMS) Coinsurance Deductible Copay Coverage Gap Creditable Coverage Donut Hole Dual Eligibles Drug Tiers Formulary Generic Drug Medicare Medicare Advantage Program Medicare Modernization Act Plan Premium Prescription Drug Program Rx A person who has health care insurance through the Medicare or Medicaid program. The federal agency that runs the Medicare program. In addition, CMS works with the states to run the Medicaid program. CMS works to make sure that the beneficiaries in these programs are able to get high quality health care. Typically, the amount of money that you might pay toward the cost of a prescription. For instance, if the cost of a prescription was $ and your coinsurance was 25%, you would be responsible for $25.00 of the cost, while your plan would pay the remaining 75%. Typically, the amount you pay out of your pocket for covered Part D drugs before your insurance plan begins to pay. Typically, an amount you pay that may be a specific dollar amount or a percentage of the total cost for a service or product. For example, you might be required to pay a $10 copay for a prescription while your insurance pays the rest. Commonly referred to as the donut hole. It is that portion of the Part D benefit in which you pay all expenses until you have spent a specific amount for eligible drugs. Prescription drug coverage that is on average at least as good as standard Medicare Part D coverage. See Coverage Gap. Individuals eligible for both Medicare and Medicaid. Cost sharing categories for different types of medications, like generic, brand and specialty drugs. A list of drugs covered under the Aetna Medicare Rx Plan. A prescription drug that has the same active-ingredient formulas as the brand name drug. Generic drugs usually cost less than brand name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand name drugs. The federal health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with End- Stage Renal Disease (permanent kidney failure with dialysis or a transplant, sometimes called ESRD). A Medicare program that gives you more choices among health plans. Everyone who has Medicare Parts A and B is eligible. The legislation passed by Congress and signed by President George W. Bush creating the Medicare Part D prescription drug benefit. The monthly costs of a plan to pay for your coverage. Plan coverage offered by private entities like Aetna and approved by the federal government that provides insurance protection for the costs of prescription medications. Also known as Part D. A commonly used symbol for a prescription or pharmacy.

12 Benefits coverage is provided by Aetna Life Insurance Company, a Medicare Prescription Drug Plan sponsor with a Medicare contract and benefits, limitations, service areas and premiums are subject to change on January 1 of each year. This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Aetna receives rebates from drug manufacturers that may be taken into account in determining Aetna s Preferred Drug List. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Pharmacy clinical programs such as pre-certification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Discount programs provide access to discounted prices and are not insured benefits. Vision One is a registered trademark of Cole Vision Corporation. Value-added services are not offered or guaranteed under our contract with the Medicare program; they are not subject to the Medicare appeals process. They may be subject to Aetna s grievance process. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable, if not otherwise paid for under Medicaid or by another third-party. You must reside in the Aetna Medicare Prescription Drug Plan service area. Enrollees must use network pharmacies to receive plan benefits except under emergency circumstances. Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling within the United States but outside of the plan s service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out-of-network pharmacy. You may be enrolled in only one Medicare Prescription Drug Plan at a time. If you are enrolled in a Medicare Advantage (MA) Plan, you may not enroll in a Medicare Prescription Drug Plan, unless you are a member of a Private Fee-for-Service MA Plan (PFFS), a Medical Savings Account MA Plan (MSA), or a 1876 Cost Plan. If an individual qualifies for extra help with the Medicare prescription drug plan costs, premium and costs at the pharmacy may be lower. Upon enrollment in the Aetna Medicare plan, Medicare will tell us how much extra help an individual is getting. An individual can obtain information on whether they qualify by calling Medicare ( ). TTY/TTD users should call Translation of this material into another language may be available. For assistance, please call our plan specialists at (TTY/TDD: ), Monday to Friday, 8 a.m. to 6 p.m. Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al AETNA ( ) Aetna Inc. S5810_7D_60806 (8/2006) A (8/06)