Updated! ~ Do You Have an Aetna Medicare or First Health Part D Plan?

Updated! ~ Do You Have an Aetna Medicare or First Health Part D Plan?

If yes, you may find that your pharmacy is no longer a network pharmacy. Pharmacies that are not in your plan’s network can charge you more, even full price, for your drugs. But Aetna is putting in place a temporary solution so you pay the network price.

What happened? Incorrect information about network pharmacies
CHA was alerted early January 2015 that incorrect information was posted on the Medicare Plan Finder and other Aetna sites during the last Annual Enrollment Period, aka Open Enrollment. Pharmacies no longer contracted with Aetna as network pharmacies were incorrectly listed as such. Beneficiaries may have relied on the incorrect information and enrolled in an Aetna Medicare or First Health Part D plan.

Aetna’s remedy
CHA learned mid January that Aetna is allowing members to get their prescriptions at network rates until the end of February 2015 at any pharmacy that was in Aetna’s network in 2014. If the pharmacy that is no longer in Aetna’s network charges you a higher or full price, ask the pharmacist to call Aetna’s pharmacy technical help desk to get instructions to give you the network rate. Members who want to change to another plan have a Special Election Period to do so.

Which plans?
Below is a list of Aetna Medicare plans available in 2015 in California. First Health Part D plans are listed because First Health contracts with Aetna. First Health Part D plans have prescription drug benefits only. Aetna Medicare plans include stand-alone prescription drug plans (PDP) and Medicare Advantage (MA) plans that cover prescription drugs as well as medical and hospital benefits.

  1. Aetna Medicare Rx Saver (PDP)
  2. Aetna Medicare Rx Premier (PDP)
  3. First Health Part D Value Plus (PDP)
  4. First Health Part D Premier Plus (PDP)
  5. Aetna Medicare Choice (MA-PPO offered in Orange and San Diego)
  6. Aetna Medicare Prime (MA-HMO offered in LA, Orange and San Bernardino)
  7. Aetna Medicare Select Plan (MA-HMO offered in Kern, LA, Orange, Riverside, San Bernardino and San Diego)
  8. Aetna Medicare Select Plus Plan (MA-PPO offered in Orange and San Diego)

Reviewing your options ~ What can you do

  1. Ask pharmacy to call Aetna. If a pharmacy no longer in Aetna’s network charges you more than the network price, ask the pharmacy to call Aetna’s pharmacy technical help desk for instructions on how to process the claim at the network price. You may get the network price only until the end of February 2015.
  2. Request reimbursement. If you are charged a higher than network or full price at a pharmacy no longer in the network and pay out-of-pocket, you may request reimbursement during the first 90 days of the plan year. Save the receipt and expect a call from Aetna within 48 hours to tell you how to submit for reimbursement. Aetna will follow-up with information and a form to complete.
  3. Find a network pharmacy. Call Medicare at 1-800-633-4227 (TTY 1-877-486-2048) or Aetna at 1-800-642-0013 (TTY: 711) to find network pharmacies accessible to you. Or go on Aetna’s website and click on “Search for a provider.” Getting the network price at a pharmacy no longer in the network and requesting reimbursement are temporary solutions. If you want to stay with the Aetna plan, find a network pharmacy to get your prescriptions at the network price for the remainder of the year.
  4. Change to a different plan. Call Medicare at 1-800-633-4227 (TTY 1-877-486-2048) and tell the customer service representative that you relied on inaccurate information on the Medicare Plan Finder and are now negatively affected. If you need help finding another plan, ask the representative for comparable plans. If you change plans, your new plan will be effective the first day of the following month.
Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.