Drug benefits

Part D prescription drugs

Your Medicare plan covers most of your prescription drugs. This is called Medicare Part D. It lowers your out-of-pocket cost for prescription drugs.

In this section you’ll find information about the prescription drugs that Aetna Better Health FIDA Plan covers, including specialty drugs. There are some limits on how much we cover for some drugs.  You can also learn about our Medication Therapy Management Program and a low-income subsidy.

Prescription drugs are often an important part of managing a health issue. For your peace of mind, it helps to know that our plan covers a drug you need to take. It’s easy to find out. Just check our formulary.  The List of Covered Drugs lists the drugs we cover and any costs you may have to pay.

Your Aetna Better Health FIDA Plan List of Covered Drugs is below. If you have any questions about a drug that is not listed, please call Participant Services at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY NY Relay 711.

The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.

 

Find out if your medicine is covered
The formulary below lists the drugs covered by Aetna Better Health FIDA Plan. (A formulary is just another name for a prescription drug list.) We consulted with a team of health care providers to develop this list. It includes prescriptions we believe are needed in a quality treatment program.

We generally cover the drugs in our formulary as long as:

‒        The drug is needed to treat an illness or injury

‒        Your prescription is filled at a pharmacy in our network

‒        You follow any other plan rules that apply

View Aetna Better Health FIDA Plan 2017 Prescription Drug Search Tool.

View the 2017 List of Covered Drugs

You can get this information for free in other languages. Call 1‑855‑494‑9945 and 711 for TTY/TDD, 24 hours a day, 7 days a week. The call is free. And you can contact us for the most recent list of drugs at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY NY Relay 711.

View the monthly formulary updates.

Contact us for the most recent list of drugs at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY  711.

View your 2017 pharmacy locator tool.

Contact us for the most recent list of pharmacies at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY NY Relay 711.

For certain kinds of drugs, you can use the plan’s mail-order services. Generally, the drugs available through mail order are drugs that you take regularly for a chronic or long-term medical condition. The drugs that are available through the plan’s mail-order service are marked as “MO” (Available at Mail Order) in our Drug List.

To use our mail-order service, you need to order a 90-day supply.

Download the Prescription Drug Mail-order Form English | Spanish here.

To get order forms or get more information about filling your prescriptions by mail, call our Participant Services at 1-855-494-9945 (hearing impaired TTY/TDD 711). Lines are open 24 hours a day, 7 days a week. You can also request a mail order form by registering online with CVS Caremark. Once registered, you will be able to order refills, renew your prescription and check the status of your order.

Ask your doctor to write a new prescription(s) for up to the maximum mail order day supply. Please be advised that our mail order pharmacy will call you to obtain consent before shipping or delivering any prescriptions you do not personally initiate.

Fill out the order form completely, including your member ID#, your doctor's name, medications you are taking and any allergies, illnesses or medical conditions you may have.

Mail the order form and the prescription(s) to:
CVS Caremark
PO Box 2110
Pittsburgh, PA 15230-2110

Generally, it takes CVS Caremark up to 21 days to process your order and ship it to you. If your mail order is delayed 21 days or more, the pharmacy should contact you. After 21 days, if you haven’t received your order, just call CVS Caremark Customer Care at 1-800-552-8159 (hearing impaired only, TTY 1-800-231-4403). They’ll send you a replacement. You will receive your order quickly. Calls to this number are free.

Sometimes you (or your doctor) need to get prior authorization for certain drugs. This means that you need to get approval from the plan before you fill these prescriptions. If you don’t, Aetna Better Health FIDA Plan may not cover the drug. Learn more about 2017 Prior Authorization Criteria

Download the 2017 Prior Authorization Form

Download the Hospice Part D exception form

Visit the 2017 online formulary tool or contact us for the most recent list of drugs at 1-855-494-9945 (TTY NY Relay 711). Our lines are open 24 hours a day, 7 days a week.

Sometimes we need you to try certain drugs first to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, Aetna Better Health FIDA Plan may not cover Drug B unless you try Drug A first. If Drug A doesn’t work, Aetna Better Health FIDA Plan then covers Drug B. Learn more about the 2017 Step Therapy Criteria

Visit the 2017 online formulary tool or contact us for the most recent list of drugs at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY NY Relay 711.

Find out if your medicine is covered
The formulary below lists the drugs covered by Aetna Better Health FIDA Plan. (A formulary is just another name for a prescription drug list.) We consulted with a team of health care providers to develop this list. It includes prescriptions we believe are needed in a quality treatment program.

We generally cover the drugs in our formulary as long as:

‒        The drug is needed to treat an illness or injury

‒        Your prescription is filled at a pharmacy in our network

‒        You follow any other plan rules that apply

View Aetna Better Health FIDA Plan 2017 Prescription Drug Search Tool.

View the 2017 List of Covered Drugs

You can get this information for free in other languages. Call 1‑855‑494‑9945 and 711 for TTY/TDD, 24 hours a day, 7 days a week. The call is free. And you can contact us for the most recent list of drugs at 1-855-494-9945 (toll-free), 24 hours a day, 7 days a week. TTY NY Relay 711.

When you change health plans, you may find you now have different benefits. You also may have different drug coverage. We want to make your transition easy for you.

If you join our plan and find out we don’t cover a prescription drug you’ve been taking, let us know. You may be able to get at least a one-time supply of that drug. We can supply up to 90 days, depending on your prescription.

This gives you a chance to work with your doctor to find a new treatment plan and avoid disruption. This process is called Prescription Drug Transition Policy/Transition of Coverage (TOC).

Learn about how the Prescription Drug Transition Policy works.

If you have questions or would like more information about our transition policy, please call Participant Services toll-free at 1-855-494-9945 (TTY NY Relay 711).  Lines are open 24 hours a day, 7 days a week.

Medication Therapy Management (MTM) Program

The Aetna Better Health FIDA Plan MTM program helps you get the greatest health benefit from your medications by:

  • Preventing or reducing drug-related risks
  • Increasing your awareness
  • Supporting good habits

Who qualifies for the MTM program? We will automatically enroll you in the Aetna Better Health FIDA Plan MTM program at no cost to you if all three conditions apply:

1. You take eight or more Medicare Part D covered maintenance drugs, and

2. You have three or more of these long-term health conditions:

  • Asthma
  • Chronic obstructive pulmonary disease
  • Diabetes
  • Depression
  • Osteoporosis
  • Chronic heart failure
  • HIV
  • Cardiovascular disorders such as high blood pressure, high cholesterol or coronary artery disease, and

3. You reach $3,919 in yearly prescription drug costs paid by you and the plan.

Your participation is voluntary, and does not affect your coverage. This program is free of charge and is open only to those who are invited to participate. The MTM program is not a benefit for all members.

What services are included in the MTM program?

The MTM program provides you with a:

  • Comprehensive medication review (CMR), and a
  • Targeted medication review (TMR)

Comprehensive Medication Review

A CMR is a one-on-one discussion with a pharmacist, to answer questions and address concerns you have about the medications you take, including:

    • Prescription drugs
    • Over-the-counter (OTC) medicines
    • Herbal therapies
    • Dietary supplements and vitamins

The pharmacist will offer ways to manage your conditions with the drugs you take. If more information is needed, the pharmacist may contact your prescribing doctor. A CMR review takes about 30 minutes and usually offered once each year—if you qualify. At the end of your discussion, the pharmacist will give you a Personal Medication List with the medications you discussed during your CMR.

You will also receive a Medication Action Plan. Your plan may include suggestions from the pharmacist for you and your doctor to discuss during your next doctor visit.

Here is a blank copy of the Personal Medication List  for tracking your prescriptions.

Targeted Medication Review

With a TMR, we mail or fax suggestions to your doctor every three months about prescription drugs that may be safer, or work better than your current drugs. As always, your prescribing doctor will decide whether to consider our suggestions. Your prescription drugs will not change unless you and your doctor decide to change them.

How will I know if I qualify for the MTM program?

If you qualify, we will mail you a letter letting you know that you qualify for the MTM program. Afterward, you may receive a call from the pharmacy, inviting you to schedule a one-on-one medication review at a convenient time.

Will the MTM program pharmacist be calling from my regular pharmacy?

Yes. The MTM program pharmacist may be calling from your regular pharmacy if your regular pharmacy chooses to participate in the MTM program as a service provider. You will be given the option to choose an in-person review or a phone review.

If your regular pharmacy does not participate in the program, you may be contacted by a call center pharmacist to provide your MTM review, and ensure that you have access to the service if you want to participate. These reviews are conducted by phone.

Why is a review with a pharmacist important?

Different doctors may write prescriptions for you without knowing all the prescription drugs and/or OTC medications you take. For that reason, a pharmacist will:

  • Discuss how your prescription drugs and OTC medications may affect each other
  • Identify any prescription drugs and OTC medications that may cause side effects and offer suggestions to help
  • Help you get the most benefit from all of your prescription drugs and OTC medications
  • Review opportunities to help you reduce your prescription drug costs

How do I benefit from talking with a pharmacist?

  • Discussing your medications can result in real peace of mind knowing that you are taking your prescription drugs and OTC medications safely
  • The pharmacy can look for ways to help you save money on your out-of-pocket prescription drug costs
  • You benefit by having a Personal Medication List to keep and share with your doctors and health care providers

How can I get more information about the MTM program?

Please contact us if you would like additional information about our MTM program, or if you do not want to participate after being enrolled in the program. Our number is 1-855-494-9945, 24 hours a day, 7 days a week. (TTY users, call 711).

An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603.

To get information about filling your prescriptions at an IHS/ITU Pharmacy please call Aetna Better Health FIDA Plan Participant Services at 1-855-494-9945 (TTY 711) 24 hours a day, 7 days a week.

LTC pharmacies are included in the network.  These pharmacies offer pharmacy services to patients that are housed in a type of group home like a Nursing home or Rehabilitation center.  Generally all LTC pharmacies are in network.  LTC pharmacies will fill prescription orders written by medical staff in the group home and deliver the medication directly to the medical staff who will distribute the medication to the members. Generally, each group home will have one or two LTC pharmacies that supply most of the pharmacy services to all of the members residing in the facility.

To get information about filling your prescriptions at an LTC Pharmacy please call Aetna Better Health FIDA Plan Participant Services at 1-855-494-9945 (TTY 711) 24 hours a day, 7 days a week.

Home infusion pharmacies are included in the network. These pharmacies supply drugs that may need to be given to you by an intravenous route or other non-oral routes, such as intramuscular injections, in your home.

To get information about filling your prescriptions at a Home Infusion Pharmacy please call Aetna Better Health FIDA Plan Participant Services at 1-855-494-9945 (TTY 711) 24 hours a day, 7 days a week.