2022 Comprehensive Formulary Aetna Medicare (List of Covered Drugs) GRP B2 PLUS 5 Tier PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Your Summary of Benefits tells you the drug costs for tiers. 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. 2. Use our helpful resources to find plans by ZIP code, see if your doctor or medicine is covered and more. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Its important to review your plan information carefully. All Rights Reserved. This plan covers select insulin pay $35 copay. Some drugs on the formulary have a utilization management requirement or limitation you need to follow. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Your Payer Express log-in may be different from your Aetna secure member site log-in. This search will use the five-tier subtype. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Formulary and drug lists. The information you will be accessing is provided by another organization or vendor. Index of Drugs 105. . These requirements and limits may include step therapy. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. Do you want to continue? September-December 2022 Medicare Part B Step Therapy Preferred Drug list. Check our drug list (formulary) to see which drugs are covered by your Aetna Medicare plan. If Drug A does not work for you, the plan will then cover Drug B. You'll need to know your pharmacy plan name to complete your search. Theres a lot more information on changes to our drug list (formulary), prior authorization, step therapy, quantity limits, exceptions and transition rules. *This pharmacy is a pharmacy in our network in 2022. 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. 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. Aetna handles premium payments through Payer Express, a trusted payment service. A formulary is a list of drugs covered by a Medicare plan. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. All Rights Reserved. TTY users should call 711. Official Medicare site. If you do not intend to leave our site, close this message. While SilverScript plans may be used at Walgreens, the savings may not be as high as they would at a preferred in-network pharmacy such as CVS. Drug List 2022 Aetna Specialty Drug List 1011950-01-01 (4/22) How to use this guide You may fill these drugs at an in--network specialty pharmacy. Sylvia Walters never planned to be in the food-service business. Reprinted with permission. 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. Yes, I'm a memberNo, I'm looking for a plan. Aetna handles premium payments through InstaMed, a trusted payment service. 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. 2. For producers; For providers; Espaol ; . Treating providers are solely responsible for medical advice and treatment of members. See if your drug has one of these special requirements. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. A formulary does not cover all prescription drugs. 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). Employer- and group-sponsored retiree plans vary. Applicable FARS/DFARS apply. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Others have four tiers, three tiers or two tiers. Links to various non-Aetna sites are provided for your convenience only. Tier 1 - Preferred generic drugs that are commonly prescribed. The information you will be accessing is provided by another organization or vendor. SilverScript has a total of five tiers: Preferred Generics: Tier 1 has the lowest costs for preferred generic medications. Enter your ZIP code to get started. All Rights Reserved. Members should discuss any matters related to their coverage or condition with their treating provider. Aetna Medicare Advantage plans in 2023 are offered in several states with the option of an HMO or a PPO plan. Here you'll also find information about the Medicare Extra Help program, answers to frequently asked questions about . Overview of what Medicare drug plans cover. CVS Caremark may also contract with other plans. 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. Click the link below to learn about our transition process to see if youre eligible for a temporary supply of medication. Requesting an Exception: Some subtypes have five tiers of coverage. Both A and C. If submitted after the first month of eligibility, the effective date for enrollments in the Initial Enrollment Period (IEP) must be the first of the month following the month the enrollment is submitted. Your InstaMed log-in may be different from your Caremark.com secure member site log-in. These are special requirements developed by a team of doctors and pharmacists. 2022 SilverScript Choice Part D plan formulary 2022 SilverScript Plus plan formulary ; 2022 SilverScript SmartRx plan formulary Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Dual Eligible Special Needs Plans (D-SNP). It also lists them in alphabetical order. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. Your InstaMed log-in may be different from your Caremark.com secure member site log-in. Aetna SilverScript Medicare Part D prescription drug plans (PDP) cover a wide variety of medications, all of which can be found in the SilverScript formulary. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Complete the steps below to get a full list of all covered drugs. The cost of Aetna SilverScript plan premiums in 2022 are: Plan pricing can depend on location and other factors, so contact a licensed insurance agent for a more personalized quote. Drug tier copay levels 9. If we do, you will need to pay the cost-share that applies to drugs in Tier 4 (Non-preferred drug). A formulary is a list of prescription drugs covered by a plan. CPT only copyright 2015 American Medical Association. The Appointment of Representative form is on CMS.gov. You can compare Part D Medicare drug plans available where you live to see what plans cover your drugs. Using preferred locations in the Aetna pharmacy network can help you maximize your savings. 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. To find out exactly which drugs are covered by Medicare Part D plans in your area, request a free plan quote online or call to speak with a licensed Medicare insurance agent. If the requested premium payment method is Social Security deductions, __________________. When billing, you must use the most appropriate code as of the effective date of the submission. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Asking for coverage of a drug that is not on the formulary is sometimes called asking for a formulary exception. Tier 5 - Specialty drugs that are the most expensive drugs on the list and may require special handling or close monitoring. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Medicare Part B Preferred drug list Aetna Medicare Advantage plans that offer prescription drug coverage (MAPD) Some medically administered Part B drugs may have additional requirements or limits on coverage. CPT is a registered trademark of the American Medical Association. Si tu intencin no era salir del sitio web, cierra este mensaje. Aetna handles premium payments through InstaMed, a trusted payment service. Your Summary of Benefits tells you the drug costs for tiers. In this review, we explore Aetna vs. Blue Cross Blue Shield Medicare plans. If you do not intend to leave our site, close this message. You are leaving our Medicare website and going to our non-Medicare website. An Aetna Medicare formulary typically lists drugs grouped by the types of medical conditions they are used to treat. SilverScript Plus (PDP) (S5601-107-0) Benefits & Contact Info. 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). Links to various non-Aetna sites are provided for your convenience only. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You can show the formulary to your doctor for assistance finding a similar drug that is covered. Unlisted, unspecified and nonspecific codes should be avoided. Why choose ${company} Medicare Solutions? No fee schedules, basic unit, relative values or related listings are included in CPT. 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). For 2022, Aetnas SilverScript plans were rated an overall weighted average of 4.29 stars.1 Four stars is considered above average. Your benefits plan determines coverage. Applicable FARS/DFARS apply. No fee schedules, basic unit, relative values or related listings are included in CPT. True. Next to each drug you will see the tier that the drug belongs to. Reprinted with permission. Treating providers are solely responsible for dental advice and treatment of members. Visit the secure website, available through www.aetna.com, for more information. Select a state below to update coverage details. Drug list 10. Expedited medical exceptions. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If you do not intend to leave our site, close this message. Aetna Medicare Advantage Prescription Drug (MA-PD) plans earned an overall rating of 4.29 stars out of five for 2022, placing it "above average" versus the competition. 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. Tip: A formulary shows the prescription drugs that are covered by a particular Part D plan. The ABA Medical Necessity Guidedoes not constitute medical advice. CPT is a registered trademark of the American Medical Association. In case of a conflict between your plan documents and this information, the plan documents will govern. 2021 Standard Opt Out Plan, 2022 Standard Opt Out Plan with ACSF How Part D . 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. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. In certain circumstances*, you or your prescriber can request a medical exception for a non-covered drug. Search our Pharmacy Clinical Policy Bulletins for the following commercial formulary plans: Advanced Control Plans-Aetna, Aetna Health Exchange Plans, and Standard Opt Out Plans-Aetna. 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. When billing, you must use the most appropriate code as of the effective date of the submission. Links to various non-Aetna sites are provided for your convenience only. This policy enables you to work with your doctor to either transition to a new drug or request an exception to continue your current drug. 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. Its possible that a SilverScript formulary may vary slightly depending on the location in which the plan is sold. If you do not intend to leave our site, close this message. Download a free copy of the SilverScript PDP formulary for your plan, or browse the plan formularies to see if your drugs are covered. Each main plan type has more than one subtype. 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. If your employer is offering an Aetna pharmacy plan and you're considering one, ask your HR department for the plan name. If youre an Aetna member, you can find this information in your Summary of Benefits and Coverage (SBC). Want to see options for a different location? 2023 PDP-Finder: Medicare Part D (Drug Only) Plan Finder; PDP-Compare: 2022/2023 Medicare Part D plan changes; 2023 MA-Finder: Medicare Advantage Plan Finder; 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 . You'll find drug tiers and any special rules, like prior authorizations. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Search our formulary for covered drugs and get the information you need. . For more recent information or other questions, please contact Aetna Medicare Member Services at 1-866-241-0357 Pharmacy Clinical Policy Bulletins for all other formulary plans are available by calling the number on the back of the members ID card. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. These restrictions are detailed early in the formulary and can include things like needing prior authorization from Aetna or limits on the quantity of drugs that can be covered at one time. Your medicine matters. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Generally, if you are taking a drug on our 2022 formulary that was covered at the beginning of the year, we will not discontinue or reduce coverage of the drug Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. January 2022. Our Medicare prescription formulary shows the drugs we cover, which tier a drug is on, limits or requirements and mail-order availability. Instead, use the link below. 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. For more recent information or other questions, please contact Customer Care at 1-844-345-4577, 24 hours a day, 7 days a week. CPT only Copyright 2020 American Medical Association. Aetna sells three different SilverScript plans, and the Aetna Medicare drug formulary may vary slightly from one plan to another. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. All services deemed "never effective" are excluded from coverage. These include some prescription vitamins and generic erectile dysfunction drugs. Their purpose is to help members use drugs safely and in a cost-effective manner. Have questions about Medicare prescription drug formularies? The member's benefit plan determines coverage. Walgreens is a standard in-network pharmacy. It may be different from your Aetna secure member site login. If you're an Aetna member, you can find this information in your Summary of Benefits and Coverage (SBC). CPT only copyright 2015 American Medical Association. Disclaimer of Warranties and Liabilities. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Aetna SilverScript Rx plans cover prescription drugs that include everything from generic and commonly prescribed medications to name-brand specialty drugs. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. A formulary is a list of drugs covered by a Medicare Part D plan. Pharmacy Criteria. It also shows the tier a drug is on, and any limits or requirements. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. We have different CPBs for Pennsylvania Medicaid. https://www.aetnamedicare.com/documents/individual/2022/star_rating/STAR_2022_H5521_000_EN.pdf. If you do not intend to leave our site, close this message. Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). However, a formulary must meet the minimum standards and requirements of Medicare Part D coverage. CVS is a preferred in-network pharmacy. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. We can help you look up your plan and what it covers. Members should fax form to 1-866-388-1766. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. The member's benefit plan determines coverage. 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. 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. Learn about formularies, tiers of coverage, name brand and generic drug coverage. The member's benefit plan determines coverage. An Aetna SilverScript plan can be used alongside your Original Medicare (Part A and Part B) coverage. The formulary will tell you if your drug has one of these requirements, such as: If you take more than the recommended amount, you will need to request a Prior Authorization (described above). 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. Aetna SilverScript plans are accepted at thousands of pharmacies all over the U.S. including both chain and individual locations. For language services, please call the number on your member ID card and request an operator. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Under this policy . Always check with your individual plan first to confirm the participating pharmacy locations in your area. Each main plan type has more than one subtype. So, weve made it easy to find covered drugs and costs for all Aetna prescription drug plans. All services deemed "never effective" are excluded from coverage. 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). Search our Pharmacy Clinical Policy Bulletins for the following commercial formulary plans: Advanced Control Plans-Aetna, Aetna Health Exchange Plans, and Standard Opt Out Plans-Aetna. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. In certain cases we make a formulary exception to cover a drug not on our formulary. You'll also learn more about the requirements and limitations of your pharmacy Get the right Medicare drug plan for you. Not all types of plans are available in all areas. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. 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. 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). 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. It shows the drugs we cover, the tier a drug is on, any limits or requirements and mail order availability. You and your doctor can ask the plan to make an exception for you and cover the drug. 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. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This Agreement will terminate upon notice if you violate its terms. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule. The AMA is a third party beneficiary to this Agreement. They are not available through search. Check our drug list. What Medicare Part D drug plans cover. Federal law prohibits a Part D plan from covering certain types of drugs, including: SilverScript Plus (PDP) includes coverage for some excluded drugs not typically covered by a Medicare Prescription Drug Plan. You are now being directed to CVS Caremark site. The ABA Medical Necessity Guidedoes not constitute medical advice. The AMA is a third party beneficiary to this Agreement. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Includes PPO, HMO, HMO-POS medical plans with or without drugs. This formulary was updated on 10/01/2021. Generally, the lower the tier, the less you pay. 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. 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. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). It shows the drugs we cover, the tier a drug is on, any limits or requirements and mail order availability.

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