Using the Aetna Medicare formulary

A Medicare formulary is a list of medications that are covered by a Medicare plan. A formulary includes details about:

You can get Aetna ® Medicare prescription drug coverage when you enroll in an Aetna Medicare Advantage plan that offers prescription drug coverage (MAPD).

What drugs are covered by Aetna Medicare plans?

An Aetna Medicare formulary typically lists drugs grouped by the types of medical conditions they are used to treat. It also lists them in alphabetical order.

To find out which drugs are covered by Aetna Medicare plans in your area, you can speak with a licensed insurance agent. You can reach one by calling 1-877-890-1409 TTY Users: 711 24 hours a day, 7 days a week.

A licensed insurance agent can use Aetna Medicare plan formularies to help you find Aetna Medicare prescription drug coverage that fits your needs.

What are the drug tier copay levels in a formulary?

A Medicare formulary organizes prescription drugs into tiers. Your copay for each drug may differ based on the tier in which the drug fits.

The copay amount you pay will vary from one Aetna Medicare plan to another. So be sure to check your plan’s Summary of Benefits or Evidence of Coverage. In them you’ll find the copay or coinsurance amounts you can expect for the plan year.

The formulary copay tiers are as follows:

Generally speaking, lower-cost drugs appear on lower tiers.

Does Aetna offer mail order prescription drug coverage?

Some drugs on an Aetna Medicare plan formulary may be eligible for home delivery through CVS Caremark ® Mail Service Pharmacy.

You can typically get up to a 100-day supply for most medications through this home delivery service. Prescriptions usually arrive within 7 to 10 days.

Some medications aren’t available through home delivery. You can check your plan’s formulary to see which drugs are available.

How can I get Aetna Medicare prescription drug coverage?

You can receive Aetna Medicare prescription drug coverage by enrolling in an Aetna Medicare Advantage plan that includes prescription drug coverage (MAPD).

Plans with low copay amounts for Tier 1 and Tier 2 drugs at preferred retail pharmacies and through mail-order delivery.

Medicare Advantage plans provide Original Medicare (Part A and Part B) benefits combined into a single plan.

Aetna Medicare Advantage plans include additional benefits, such as dental, vision and hearing benefits.

Medicare Advantage plans from Aetna may also include an over-the-counter (OTC) benefit. This benefit covers certain items such as vitamins and cold medicine at no extra cost to you.

To learn more about your Aetna Medicare plan options or to enroll in an Aetna Medicare plan that includes prescription drug coverage, speak with a licensed insurance agent. You can reach one by calling 1-877-890-1409 TTY Users: 711 24 hours a day, 7 days a week.

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Ochieng N, et al. (Aug 9, 2023). Medicare Advantage in 2023: Enrollment Update and Key Trends. Kaiser Family Foundation. www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends.

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Not all plans offer all of these benefits. Availability of benefits and plans varies by carrier and location. Deductibles, copays, coinsurance, limitations, and exclusions may apply.

We do not offer every plan available in your area. Currently we represent 43, which offer 3,745 products in your area. Please contact http://medicare.gov, 1-800-Medicare, or your local State Health Insurance Program (SHIP) to get information on all of your options.

Aetna and CVS Pharmacy ® are part of the CVS Health ® family of companies.

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Other Pharmacies are available in our network. Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The formulary and/or pharmacy network may change at any time. You will receive notice when necessary.

The Aetna Medicare pharmacy network includes limited lower cost, preferred pharmacies in: Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Suburban West Virginia. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at www.aetnamedicare.com/pharmacyhelp.

For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7-10 days. You can call the number on your member ID card if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.

To send a complaint to Aetna, call the Plan or the number on your member ID card. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-486-2048), 24 hours a day/7 days a week. If your complaint involves a broker or agent, be sure to include the name of the person when filing your grievance.

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