How Can I Find Out If My Prescription Drugs Are Covered by my Aetna Plan?

Last Updated : 10/21/20184 min read

If you’re enrolled in an Aetna Medicare Prescription Drug Plan or an Aetna Medicare Advantage Prescription Drug plan, this article will help you learn about the plan’s formulary (list of prescription drugs the plan covers). Find out if your prescription drugs are covered under your plan.

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What’s a formulary?

Every Medicare Prescription Drug Plan, including Aetna’s plans, has its own formulary, which is a list of prescription drugs the plan covers. The same is true of Aetna Medicare Advantage Prescription Drug plans.

Formularies are typically organized in “tiers,” with higher-priced drugs in the higher-numbered tiers. The prescription drugs in the lowest tier are usually generic drugs; you typically pay the least for these medications. Medications in higher tiers are usually brand-name formulations, with the highest tiers reserved for expensive specialty drugs.

Each plan has its own formulary and costs, so be sure to check your Aetna Medicare Prescription Drug Plan formulary to see make sure it covers your prescription drugs. Please note that a plan’s formulary may change at any time. You will receive notice from your plan when necessary.

How can I find out if my prescription drug is included in the Aetna Medicare Prescription Drug Plan formulary?

Aetna has several online tools to help you find out whether your medications are covered:

  • If you have an online account with your plan’s member portal, you can log in at any time to see if your prescription drug is included in the plan’s formulary.
  • If you don’t have an Aetna member portal account, but know which plan you have, you can use to enter your state, select your plan, and view your Aetna Medicare Prescription Drug Plan’s formulary. This tool also includes the latest coverage determinations, or changes to the plan’s prescription drug coverage.
  • If you are shopping for plans, or aren’t sure which plan you have, this Aetna Medicare Prescription Drug Plan formulary search tool lets you enter your medication and search by plans that include it in the formulary.
  • To see a complete list of all prescription drugs currently included in the different Aetna MedicareAdvantage Prescription Drug plan and Aetna Medicare Part D Prescription Drug Plan formulary guidelines, refer to this Aetna pharmacy and prescription drug guide.

Please keep in mind that Aetna, as a private company contracted with Medicare to provide benefits under the Medicare program, may make changes to its formularies at any time, but must notify you in writing in advance of any changes. This is the case with any Medicare-approved health insurance company that offers Medicare prescription drug coverage. If a medication you take is currently included on your plan’s formulary, but will be removed in an upcoming change, you are entitled to one 60-day supply of the medication under the old formulary rules and at the same cost to you.

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If you have questions at any time about your Aetna Medicare formulary or how to use your plan benefits, you can call the Aetna Customer Service department at 1-800-282-5366 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days a week, from October 1 – February 14 and 8 a.m. to 8 p.m., local time, Monday – Friday, from February 15 – September 30.

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