Rx coverage questions? What you need to know

Help your Medicare clients understand their Rx coverage

Use these tips to help retain your Medicare clients and prevent complaints

Aetna-Senior-with-PrescriptionRemind your clients:

  • Aetna and Coventry Rx plans (i.e., MAPD and PDP) require them to use a network of pharmacies to get their prescription drugs.
  • If their Rx plan has a deductible for prescription drugs, it only applies to drugs on tiers 3, 4 and 5.
  • If their Rx plan includes a preferred pharmacy structure, they may be able to save money by using particular pharmacies (called our preferred pharmacies).
  • The Medicare Part D program has 4 benefit stages: the Deductible, Initial Coverage Limit, Gap Coverage and Catastrophic Coverage stages. Your clients’ costs vary depending on which stage they’re in.

Here’s your quick checklist of things to keep in mind

  • Always review the Summary of Benefits with your clients. The Summary of Benefits is an important part of the enrollment kit that summarizes what we cover and what members pay. It also tells you which formulary goes with which plan. Keep in mind: It does not list every service we cover or list every limitation or exclusion.
    • For example, you should check the Summary of Benefits to see if there’s a deductible, and if so, how it would apply to drugs on different tiers.
  • Know where to look for details. The plan’s Evidence of Coverage (EOC) has a complete list of services we cover and detailed information on costs and rules members need to follow. You can find it at www.aetnamedicare.com/benefits.
  • Always check the plan’s formulary (www.aetnamedicare.com/formulary). It shows:
    • The drugs covered by the plan.
    • The tier level of each drug — Generally, the lower the tier, the less you pay.
    • Any special rules for a drug that you’ll need to follow like prior authorization, quantity limits and step therapy.
  • Help your clients locate the nearest preferred and network pharmacies. You can find a network pharmacy when you compare plans and estimate costs (RECOMMENDED). Or you can go to aetnamedicare.com/findpharmacy or coventry-medicare.com/findpharmacy.

The most accurate way to estimate drug costs for Aetna and Coventry Medicare plans is through our website

Just go to aetnamedicare.com/brokers or coventry-medicare.com/brokers and then click Compare Plans & Estimate Costs. (PRO TIP: Save this site to your Favorites.)  From there, you can enter a zip code, select a plan, add drugs and dosages, select a pharmacy, and then see estimated costs. It’ll give your clients the most accurate estimate of what they’ll have to pay at the pharmacy. It lets you:

  • View a month-by-month breakdown of expected costs.
  • See how a deductible will be applied, if applicable.
  • Easily compare different pharmacy costs.
    • HELPFUL HINT: Many of our plans have preferred pharmacies in their networks. Using a preferred pharmacy may help your clients save money. With this tool you can show your clients how much they could save using a preferred pharmacy.

Questions?

We’re here to help. Just contact your local Aetna Medicare broker manager. We’d be happy to share tips for educating your clients about prescription drug benefits. We also encourage you to download and use our how to avoid top member complaints doc as a handy resource.
 

Rx coverage questions? What you need to know
 

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