Aetna Medicare Advantage Prescription Drug (MAPD) PPO Plan: Questions and Answers

 

In September, we announced that beginning January 1, 2023, there will be one medical and prescription drug plan: the Aetna Medicare Advantage Prescription Drug (MAPD) PPO Plan. This new plan will replace your current plan, whether you’re currently enrolled in the UnitedHealthcare MAPD Plan or one of the MAPD HMO Plans (Aetna, Health Alliance, or Humana). Since that announcement, several questions we’ve received have been about your prescription drug coverage. Therefore, we’ve put together a short list of FAQs to address your concerns.

Frequently Asked Questions for Prescription Drugs

Which pharmacies can I use to fill my prescriptions?

You can use any pharmacy within the CVS Caremark network to fill your prescriptions. The CVS Caremark network includes many pharmacies including Walgreens, Walmart, and Hy-Vee. To see a complete list of pharmacies in your area, visit stateofillinois.aetnamedicare.com. Under “Find a doctor & prescription drugs,” choose “Find a pharmacy.”

How will I fill my mail order prescriptions?

Mail order prescriptions will be handled through the CVS Caremark Mail Service Pharmacy. Click here, to find out more information on this service.

Will Aetna know which prescription drugs I’m already taking?

Yes. To provide the smoothest transition possible, your current MAPD plan will provide your new Aetna MAPD PPO plan a list of your current medications—those you fill through retail and mail order.

Will Aetna honor pre-authorizations for prescriptions that I’ve already been given?

Yes. When Aetna obtains your list of current medications, Aetna will identify those medications which require pre-authorization and will work with you to ensure little to no interruption in your service.

Will the cost of my prescription drugs change significantly?

There will not be significant changes. However, you may see some changes.

• If you are currently in the UnitedHealthcare MAPD PPO plan, your copayments for each tier will stay the same. • If you are currently in one of the MAPD HMO plans, you will see a slight increase in copayments for each tier. • Regardless of your current coverage, it’s important to note that formulary drug listings vary from one plan to another. As a result, your current medication may change tiers in 2023. See the formulary or call 855-223-4807 for more information.

Which prescription drugs are covered on the Aetna MAPD PPO plan’s formulary?

To view the list of covered prescription drugs, visit Aetna’s formulary online or call 855-223-4807.

I had extra help paying for my drugs before, will that change?

Medicare determines who is eligible for “Extra Help” to pay prescription drug costs for those with limited income and resources. Your enrollment in the Aetna Medicare Advantage and Prescription Drug plan will not change that. If you do not receive Extra Help today and would like to check if you qualify: If you automatically qualify for “Extra Help,” Medicare will mail you a letter. You will not have to apply. To see if you qualify for getting “Extra Help,” call the Social Security Office at 1-800-772-1213, 8 AM – 7 PM, Monday through Friday. TTY users should call 800-325-0778.

Your formulary doesn’t list include [non-part D drugs] or [drugs for erectile dysfunction, vitamins & minerals, drugs to promote fertility, drugs for weight loss, drugs for cosmetics/hair growth, and cough/cold drugs]. These have always been covered under my plan. Will they still be covered?

Yes. The State has provided supplemental benefits to cover these non-Part D drugs. These drugs will be included on the non-Part D supplemental benefit list, which will be available online after October 1st.

I use a Veterans Affairs (VA) pharmacy. May I continue to get my prescriptions filled at a VA pharmacy?

No. Veterans Affairs (VA) pharmacies are not permitted to be part of a Medicare Part D pharmacy network. The federal government does not allow you to get benefits from more than one government program at the same time. If you are eligible for VA benefits, you can still use VA pharmacies under your VA benefits. Each time you get a prescription filled, compare your benefit through Aetna to your VA benefit to determine the best option for you.   

For Prescription Drug Coverage Links, Click: https://cms.illinois.gov/content/dam/soi/en/web/cms/benefits/trail/documents/2022/Prescription%20Drug%20FAQ%20092722%20final.pdf