You can also file a grievance by phone by calling the Customer Service phone number listed on your benefit ID card (TTY: 711). Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The member's benefit plan determines coverage. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Its important to review your plan information carefully. Select a state below to update coverage details. You can reach one by calling 1-877-890-14091-877-890-1409 TTY Users: 71124 hours a day, 7 days a week. Plans may offer low copay amounts for Tier 1 and Tier 2 drugs at preferred retail pharmacies and through home delivery. . 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 http://www.aetnamedicare.com/pharmacyhelp. Copyright document.write(new Date().getFullYear()) Aetna Better Health Premier Plan MMAI, All Right Reserved. TTY users should call 711. Treating providers are solely responsible for medical advice and treatment of members. 5021 0 obj <> endobj While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. (Serbo-Croatian), Na ye jam thudt tn tho Dlth, ke kuny luilooi thok path aa t thn. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. 2 According to internal data from TZ Insurance Solutions in 2021. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). CVS Caremark may also contract with other plans. View the 2022Formulary (English|Spanish), View the 2023 Formulary (English|Spanish). CPT only copyright 2015 American Medical Association. The drugs on this list are not covered under your plan. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Visite nuestro sitio web o llame al nmero de telfono que figura en este documento. It also lists them in alphabetical order. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). Health benefits and health insurance plans contain exclusions and limitations. For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. We: If you need these services, visit our website, call the phone number listed in this material or on your benefit ID card. Aetna handles premium payments through Payer Express, a trusted payment service. 2022 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN This formulary was updated on 09/26/2022. Prescriptions usually arrive within 7 to 10 days. . New and revised codes are added to the CPBs as they are updated. You also can mail a written request to Aetna PA, 1300 E. Campbell Rd., Richardson, TX 75081. Members may have the option to sign-up for automated mail-order delivery. Copyright 2015 by the American Society of Addiction Medicine. They'll be on our Formularies & Pharmacy Clinical Policy Bulletins page. Every 60 seconds, we help someone enroll in a Medicare Advantage plan.2. The AMA is a third party beneficiary to this Agreement. Visiti il nostro sito web oppure chiami il numero di telefono elencato in questo documento. A formulary is a list of drugs covered by a Medicare plan. We do not offer every plan available in your area. This information is neither an offer of coverage nor medical advice. Vizite sitwb nou an oswa rele nan nimewo telefn ki make nan dokiman sa a. In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. Treating providers are solely responsible for dental advice and treatment of members. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. (Italian), Caso voc seja falante de um idioma diferente do ingls, servios gratuitos de assistncia a idiomas esto disponveis. 25, 2022). By clicking "Sign me up! you are agreeing to receive emails from MedicareAdvantage.com. This benefit covers certain items such as vitamins and cold medicine at no extra cost to you. You can typically get up to a 90-day supply for most medications through this home delivery service. If you do not intend to leave our site, close this message. Your benefits plan determines coverage. Medicare Advantage in 2022: Enrollment Update and Key Trends. To find out which drugs are covered by Aetna Medicare plans in your area, you can speak with a licensed insurance agent. Under this policy . Preferred specialty drugs and formulary excluded specialty drugs (PDF), Specialty drugs treat complex conditions that often require support by a nurse or pharmacist during treatment. If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. We'll help you find the information you need. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. All rights reserved. Traditional Generic Step Therapy (PDF). Check patient-specific eligibility and benefits on CignaforHCP. There's a lot more information on changes to our drug list (formulary), prior authorization, step therapy, quantity limits . No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. (Syriac), (Thai), , . ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. You can reach one by calling 1-877-890-14091-877-890-1409 TTY Users: 71124 hours a day, 7 days a week. Aetna Value drug list fixed-rate copay (PDF) Others have four tiers, three tiers or two tiers. Applicable FARS/DFARS apply. Online - You can visit CVSSpecialty.com and select Get Started. . It shows the drugs we cover, the tier a drug is on, any limits or requirements and mail order availability. Well help you find the information you need. 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. Drug coverage Find a covered drug Search another plan or year Aetna Standard Plan drug guide (PDF) Plan guide changes hbbd``b `vl7S(`? The list shows you the non-covered drugs and the similar covered ones. All Rights Reserved. To view the form just select Continue. . The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). Check your plan benefit documents for details on filling a 90-day supply of drugs on this list. [e @B,P5 V !H8e`bHu UeK It also lists them in alphabetical order. - , . Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. For instance, arthritis, asthma, diabetes or high cholesterol. Maintenance Choice drug list includes drugs a person takes regularly to treat chronic conditions. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. You will receive notice when necessary. Mus saib peb lub website los yog hu rau tus xov tooj sau teev tseg nyob rau hauv daim ntawv no. Generally, the lower the tier, the less you pay. This search will use the five-tier subtype. Find coverage and formulary details, check copays and estimate drug costs for your plan on your member website. For language services, please call the number on your member ID card and request an operator. Enter your ZIP code to get started. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends, Plans may offer prescription drug coverage and routine vision and dental benefits, Over 3.1 million people are enrolled in an Aetna Medicare Advantage Plan, Any limits and requirements your plan may have for the drug. If you believe that we have failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Grievance Department (write to the address listed in your Evidence of Coverage). Generally, the lower the tier, the less you pay. Search our formulary for covered drugs and get the information you need. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. When billing, you must use the most appropriate code as of the effective date of the submission. Some medically administered Part B drugs, like injectables or biologics, may have additional requirements or coverage limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. You can check your plans formulary to see which drugs are available. This site has its own login. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Members who get Extra Help are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. 2022 Comprehensive Formulary Aetna Medicare (List of Covered Drugs) GRP B2 PLUS 5 Tier PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION . Reprinted with permission. There are similar products with the same active ingredients that are covered. Want to see options for a different location? The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Find a covered drugSearch another plan or year, Changes to this guide effective 1/1/22 (PDF), Changes to this guide effective 4/1/22 (PDF), Changes to this guide effective 7/1/22 (PDF), Changes to this guide effective 10/1/22 (PDF). Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Employer- and group-sponsored retiree plans vary. A Medicare formulary organizes prescription drugs into tiers. %%EOF To find out which lists apply to you, check your plan benefits documents. You are now being directed to CVS Caremark site. Our 2023 Medicare drug list and other prescription drug resources. Each main plan type has more than one subtype. A Medicare formulary is a list of medications that are covered by a Medicare plan. Complete the steps below to get a full list of all covered drugs. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Under health care reform, you can get some drugs and products with no member cost share. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. Note:The step therapy requirement does not apply to patients whove already received treatment with the non-preferred drug within the past 365 days. Weve compiled the Aetna Better Health Premier Plan MMAIPart B Step Therapy Preferred Drug Lists below for your convenience. MA plan changes 2022 to 2023; Drug Finder: 2023 Medicare Part D drug search; Formulary Browser: View any 2023 Medicare plan's drug list; 2023 Browse Drugs By Letter; Guide to 2022/2023 LIS Mailings from CMS, Social Security and Plans; Out-of-Pocket Cost Calculator; Q1Medicare FAQs: Most Read and Newest Questions & Answers ; Q1Medicare News . Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 2022 PA Criteria. *This pharmacy is a pharmacy in our network in 2022. Will my doctor accept my Aetna Medicare plan? Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. 2022 Aetna Standard Plans You can find a list of the most commonly covered drugs under your plan (your formulary) below. (Russian), . La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Find answers to common questions about policies, drug costs and more. Contact will be made by an insurance agent/producer or insurance company. Use our helpful resources to find plans by ZIP code, see if your doctor or medicine is covered and more. Please contact Medicare.gov or 1800MEDICARE to get information on all of your options. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You can find a list of the most commonly covered drugs under your plan (your formulary) below. Yes, I'm a memberNo, I'm looking for a plan. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Important information. We have many Medicare Part D resources available to help you understand the prescription drug coverage that comes with your 2023 HealthPartners Medicare plan. Visitez notre site Internet ou appelez le numro indiqu dans ce document. Any information we provide is limited to those plans we do offer in your area. If you'd like to speak with an agent right away, we're standing by for that as well. Medicare Advantage plans provide Original Medicare (Part A and Part B) benefits combined into a single plan.Aetna Medicare Advantage plans may include additional benefits, such as prescription drug coverage with low copay amounts at preferred retail pharmacies and through home delivery. (Yiddish). You are leaving our Medicare website and going to our non-Medicare website. (Navajo), Wann du en Schprooch anners as Englisch schwetzscht, Schprooch Helfe mitaus Koscht iss meeglich. Aetna Medicare is an HMO, PPO plan with a Medicare contract. 1 Freed M, et al. Join our email series to receive your Medicare guide and the latest information about Medicare. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. Step Therapy Criteria. CVS Specialty and Aetna are part of the CVS Health family of companies. hW]lSeNw-zNsS6 dbmI Y* 0$^BHp r!1z *uy}{yk 6 T.x 7q{-WCm WWg#;)E}*$P'r2#7xxFD29>::g(z)SxGo,j@Qxm$afQ/:~6 !N~GquWEt^H}hD;z}a?F[YQikZ^.JoUS luk;w}wN_j%mm?aSusw\IO6mFFeQcIT]uc[RW6hYxMV[Qm|af IHcH4B6+VuOO&GCG"K^^_ZNVCl,Bu7'vgr$>Vigl:WGC]8 .F3\7 Qa#*%ZS9&&. Your Medicare guide will arrive in your email inbox shortly. After your effective date, just log in to your member website to check costs and coverage for a specific drug. The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). High Performance Generic Step Therapy (PDF) Is SilverScript a Good Part D Plan? Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. You can also look forward to informative email updates about Medicare and Medicare Advantage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Besuchen Sie unsere Website oder rufen Sie die Telefonnummer in diesem Dokument an. Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Under Aetna Better Health Premier Plan MMAI, some drugs may have special requirements or coverage limits. All services deemed "never effective" are excluded from coverage. HSA-associated plans: Prescription drugs on the Preventive list below will be covered as if you have already met your deductible. You are now being directed to the CVS Health site. *These circumstances exist when you are suffering from a health condition that may seriously jeopardize your life, health, or ability to regain maximum function, or undergoing a current course of treatment using a non-covered drug. 2022 Step Therapy Criteria. 2022 formulary.13 Additionally, while the other MCOs have updated their formularies, prior authorization forms for preferred hepatitis C drugs remain publicly available on the websites for Aetna, Anthem, and UnitedHealthcare, which may cause confusion for providers who are unaware of the policy change.14. Aetna Medicares pharmacy network includes limited lower cost, preferred pharmacies in: Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Suburban West Virginia. Were bringing you to our trusted partner to help process your payments. Changes may affect all drug lists, precertification, step therapy and quantity limit programs. Your Payer Express log-in may be different from your Aetna secure member site log-in. Applicable FARS/DFARS apply. Plan features and availability may vary by service area. Why choose ${company} Medicare Solutions? You can call call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) if you do not receive your mail-order drugs within this timeframe. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If Drug A and Drug B both treat a medical condition, we may prefer Drug A and require a trial of it first. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. (Hmong), , . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Check our drug list Search our formulary for covered drugs and get the information you need. Links to various non-Aetna sites are provided for your convenience only. 2022 Formulary Updates . If you do not intend to leave Aetna Medicare, close this message. The Appointment of Representative form is on CMS.gov. (Portuguese), Si ou pale yon lt lang ki pa Angl, wap jwenn svis asistans pou lang gratis ki disponib. This website does not contain a complete listing of plans available in your service area. The member's benefit plan determines coverage. Your copay for each drug may differ based on the tier in which the drug fits. Theres a lot more information on changes to our formulary, prior authorization, step therapy, quantity limits, exceptions and transition rules. Disclaimer of Warranties and Liabilities. Unlisted, unspecified and nonspecific codes should be avoided. You can receive Aetna Medicare prescription drug coverage by enrolling in an Aetna Medicare Advantage plan that include prescription drug coverage (MAPD). (English), Si habla un idioma que no sea ingls, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Bezoek onze website of bel naar het telefoonnummer in dit document. - , . Use the tools and lists below to find pricing and coverage information for any prescription your patient might need. It may be different from your Aetna secure member site login. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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). That may include step therapy, where we require a trial of a preferred drug to treat a medical condition before covering another non-preferred drug. CPT is a registered trademark of the American Medical Association. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. . In case of a conflict between your plan documents and this information, the plan documents will govern. You are leaving our website and going to a non-Medicare/Medicaid website. Aetna Better Health Premier Plan (Medicare-Medicaid Plan). Drug Coverage. (Ukrainian), (Urdu), , . CPT is a registered trademark of the American Medical Association. The information you will be accessing is provided by another organization or vendor. Here you'll also find information about the Medicare Extra Help program, answers to frequently asked questions about . This means they are covered 100 percent by your plan. Prior Authorization Criteria. 0 . . You would be responsible only for your copay. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. The formulary copay tiers are as follows: Generally speaking, lower-cost drugs appear on lower tiers. Search for a specific drug by name and see if generic equivalents are available. Your Summary of Benefits tells you the drug costs for tiers. See a complete list of our covered drugs and other important prescription drug information. The ABA Medical Necessity Guidedoes not constitute medical advice. (Farsi), ,' '(Punjabi), Dac vorbii o alt limb dect engleza, avei la dispoziie servicii gratuite de asisten lingvistic. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. (Polish), (Japanese), Nse nuk flisni gjuhn angleze, shrbime ndihmse gjuhsore pa pages jan n dispozicionin tuaj. Aetna Medicare has a transition policy for prescription drugs you may be taking that aren't on our formulary or are subject to new utilization management requirements. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Additional plans may be available in your service area. (Spanish), (Traditional Chinese), Kung hindi Ingles ang wikang inyong sinasalita, may maaari kayong kuning mga libreng serbisyo ng tulong sa wika. If you need help filing a grievance, call Customer Service at the phone number on your benefit ID card. Phone - Your doctor may also call and speak to one of our registered pharmacists at 1-800-237-2767 (TTY: 711) during our normal business hours of 7:30 AM to 9:00 PM ET. Your Summary of Benefits tells you the drug costs for tiers. Nem t tn internet td ke y cl akun ctmecc gat thin n athrduyic. Enrollment in any plan depends on contract renewal. Other Pharmacies are available in our network. Acesse nosso site ou ligue para o nmero de telefone presente neste documento. After your effective date, just log in to your member website to check costs and coverage for a specific drug. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Choosing a drug from this list will help you get the most value from your drug coverage. You'll be able to view the changes as early as May 1. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. CPT only Copyright 2020 American Medical Association. Bisitahin ang aming website o tawagan ang numero ng telepono na nakalista sa dokumentong ito. Choose how you'd like to search Go to the American Medical Association Web site. (Tagalog), Si vous parlez une autre langue que l'anglais, des services d'assistance linguistique gratuits vous sont proposs. (Albanian), - (Amharic), , (Armenian), (Bengali), (Khmer), Ako govorite neki jezik koji nije engleski, dostupne su besplatne jezike usluge. TheAetna Better HealthPremier Plan MMAI formulary can be found below. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Aetna handles premium payments through InstaMed, a trusted payment service. You are now leaving Aetna Better Health Premier Plan MMAI. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Changes to commercial drug lists begin on July 1 On July 1, 2022, we'll update our pharmacy drug lists.