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Your pharmacy benefits
At Aetna Assure Premier Plus (HMO D-SNP), we cover a wide variety of prescription and over-the-counter medications to keep you healthy. We’ll even mail your medicine to you, so you can save time and effort.
Have a question?
If you have a question about your prescription benefits or using out-of-network pharmacies, please call Member Services at 1-844-362-0934 (TTY: 711).
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What medications are covered under my plan?
What medications are covered under my plan?
We cover the medications listed in our List of Covered Drugs (Formulary), also known as our Drug List, at no cost to you. You can download our Drug List. Or check if your medicine is covered with our online Drug List.
Download the 2024 Drug List — English (PDF) | Español (PDF)
Where can I fill my prescriptions?
Where can I fill my prescriptions?
We keep health care close to home. You can fill your prescriptions at any pharmacy in our network. You can also get prescriptions from a long-term care (LTC) pharmacy if you are in a nursing home or long-term care facility. A Home Infusion (HI) pharmacy may fill a prescription for medication given to you by an intravenous route or other non-oral routes, such as intramuscular injections in your home.
You can learn more about where to fill your prescriptions below.
Get your prescriptions mailed to you
Get your prescriptions mailed to you
Do you take medications regularly? Our home delivery pharmacy may be a great option for you. You can have your medicine mailed to your home. Aetna Assure Premier Plus (HMO D-SNP) works with CVS Caremark® to provide you this service at no cost to you. Each order is checked for safety. And you can speak with a pharmacist on the phone anytime. Your order should arrive 7 to 10 days after it’s processed.
You’ll just need the following information:
Plan member ID card
Mailing address, including ZIP code
Provider’s first and last name and phone number
A list of your allergies and other health conditions
Your original prescription from your Provider (if you have it)
Getting started
Call us at 1-844-362-0934 (TTY: 711), 8 AM to 8 PM, seven days a week and we can help you determine which of your medications can be filled through the mail service pharmacy and answer any questions. We will contact you or your Provider if additional information is needed. Once your order is processed, your prescriptions will be shipped directly to you.
Do you already have a prescription?
You can sign up for our mail service:
Online
Log in to the secure Member Portal. Go to “tasks” and then click “pharmacy services.” Click on the “CVS” link to go to Caremark.com. Then, choose “start mail service.”
Prior authorization
Prior authorization
Some medications have rules you need to follow before we cover them. These include:
- Prior authorization – You or your doctor needs approval from us before we cover the drug.
- Quantity limits – For certain drugs, we limit the amount you can get.
- Step therapy – We require you to try another drug first before we cover your drug.
You and your provider can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule.
What if my medicine isn’t covered?
We might be able to make an exception for you. We may be able to cover your medicine if it isn’t on our Drug List. If your medicine has a limit, we may be able to increase it. You can request an exception, or your Provider or representative can request one on your behalf. We also need a statement from your prescriber supporting your request. After we receive the statement, we will give you a decision on your exception request within 72 hours. If you or your prescriber think your health may be harmed if you have to wait 72 hours for a decision, you can ask for an expedited exception. This is a faster decision. If your prescriber supports your request, we will give you a decision within 24 hours of receiving your prescriber’s supporting statement.
An exception to your prescription can be requested:
By phone
You can ask for an exception by calling Member Services at
1-844-362-0934 (TTY: 711).
By fax
Complete the coverage determination form — English (PDF) | Spanish (PDF) and fax it to 1-844-814-2260.
By mail
Complete the coverage determination form — English (PDF) | Spanish (PDF) and send it to:
Aetna Assure Premier Plus (HMO D-SNP)
Attn: Part D Coverage Determination
Pharmacy Department
4750 S. 44th Place Suite 150
Phoenix, AZ 85040-4015
Appealing a decision
You can appeal our decision if you don’t agree with it. You can request an appeal, or your provider or representative can request one on your behalf. You can request an appeal within 60 calendar days of receiving your Notice of Denial:
By phone
You can call Member Services at 1-844-362-0934 (TTY: 711).
By fax
You can complete the coverage redetermination form — English (PDF) | Spanish (PDF) and fax it to 1-844-814-2260.
By mail
You can complete the coverage redetermination form — English (PDF) | Spanish (PDF) and send it to:
Aetna Assure Premier Plus (HMO D-SNP)
Attn: Part D Appeals
Pharmacy Department
4750 S. 44th Place Suite 150
Phoenix, AZ 85040-4015
Prescription drug transition policy
Prescription drug transition policy
There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it.
Learn about our transition process to see if you’re eligible for a short-term supply of medication. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.
If you have any questions, you can call Member Services. Or read more about our prescription drug transition process.
Medication Therapy Management (MTM) program
Medication Therapy Management (MTM) program
Aetna Assure Premier Plus (HMO D-SNP)’s Medication Therapy Management (MTM) program can help you manage your medications. We automatically enroll members in our MTM program if you qualify. Read about the program here.
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Members must use participating/network providers, pharmacies, and durable medical equipment (DME) suppliers. Members will be enrolled into Part D coverage under Aetna Assure Premier Plus (HMO D-SNP) and will be automatically disenrolled from any other Medicare Part D or creditable coverage plan in which they are currently enrolled. Members must understand and follow the plan’s rules on referrals.
The formulary, pharmacy network and/or provider network may change at any time. You will receive notice when necessary.
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 to 10 days. You can call the phone number listed 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.