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877-318-1764If you opt in to the Aetna Medical Plan, you will automatically be enrolled in the Aetna Rx plan. You will also only have one medical health insurance card with contact information for both your medical and pharmacy coverage. Please call the Benefits office at 877-318-1764.
The APCN PLUS – CORE and APCN PLUS – HIGH DEDUCTIBLE plans all include prescription drug coverage through Aetna Rx.
As part of a broader network, you now have the flexibility and convenience to fill maintenance drug prescriptions by mail order or retail (CVS).
How it Works
The Aetna prescription drug plan requires that all maintenance drugs be filled using either a home delivery mail-order pharmacy or at CVS Pharmacy retail locations. Mail-order or CVS Pharmacy retail locations allow up to a 90-day supply of maintenance drugs, whereas a 30-day supply is standard for retail pharmacy pick-ups. Please note, extended retail supply is allowed for certain drugs due to packaging and clinical exceptions. A maintenance prescription can be filled three times in a retail pharmacy and still have it covered under the plan. You will then have the option to switch your next maintenance medication refill over to CVS Pharmacy (retail location) or home delivery mail-order pharmacy. If you have your maintenance medication prescription filled a fourth time at a retail pharmacy and do not opt out, you will be charged the total cost of the drug.
Access to your prescription plan is part of your overall Aetna Medical plan, which means you have one health insurance card for both Medical and Rx needs. Present your Aetna health insurance card at a participating retail pharmacy, Aetna Specialty pharmacy, or through a home delivery mail-order pharmacy.
Money-Saving Tips
- Mandatory Maintenance Choice Program allows employees to continue to refill their long-term (maintenance) medications taken for chronic conditions such as high blood pressure or cholesterol at a lower out-of-pocket cost. Employees filling a maintenance drug must fill a 90-day supply at a CVS Pharmacy or through mail order. Effective July 1, 2023 employees will no longer be able to opt out of this program.
- National Expansion of Maintenance Choice Program: Effective October 1, 2023, the Maintenance Choice® program will include Costco Pharmacy and several independent pharmacies, in addition to CVS Pharmacy and CVS Caremark® Mail Service Pharmacy (collectively, the “Select Participating Pharmacies”). Member Experience:
- Beginning October 1, 2023, members who have the Maintenance Choice ® will be able to fill certain 84+ day supply of maintenance medications at Select Participating Pharmacies.
- All members can log into Aetna.com to find Select Participating Pharmacies covered under their plan by using the pharmacy locator tool or to start home delivery by mail.
- Not all versions of Maintenance Choice ® will be available in all states due to varying regulatory requirements. See below for specific impacts in Florida, Minnesota, Oklahoma, Tennessee, and West Virginia.
- State of Florida: The Mandatory plan design for Maintenance Choice® will not be permitted for Florida residents. Effective January 1, 2024, Florida residents of clients that have implemented the Mandatory Maintenance Choice® plan design will be opted out and will not be required to fill in 84+ day supplies of maintenance medications.
- State of Minnesota: Earlier this year, CVS Caremark solicited pharmacy locations within the state of Minnesota to join the Maintenance Choice® program, since that time several independent pharmacies have decided to participate. This change did not impact client cost or member costs.
- State of Oklahoma: CVS Caremark previously removed the Maintenance Choice® program in the state of Oklahoma and it will remain discontinued.
- State of Tennessee: CVS Caremark will allow Tennessee pharmacy locations that agree to accept standard terms and conditions to participate in the Maintenance Choice®. Client pricing may be impacted by pricing terms mandated by the state. This change will not impact member costs.
- State of West Virginia: CVS Caremark is required to discontinue the Maintenance Choice program in West Virginia. For clients with residents in West Virginia, we will be implementing a custom Retail 90 extend day supply network. To provide these benefits to your members as quickly as possible, we are preparing to activate this option broadly. If you do not want this update applied to your plan, please notify us by October 13, 2023.
- Solution for Clients with Members Filling in West Virginia: A West Virginia (WV) Custom Retail 90 extended-day supply (EDS) network will be available. It includes all West Virginia pharmacies (not just CVS) that currently participate in our Retail 90 network and permits members to fill an 84+ day supply of their medication.
- Impact to Your Plan Covering West Virginia Residents
- Once this solution is implemented, 84+ day supply claims may be processed at in-network pharmacies other than CVS in West Virginia.
- The new WV Custom Retail 90 EDS network may be subject to pricing terms mandated by the state.
- This solution does not offer the same client pricing as Maintenance Choice.
- Mail orders will remain available for West Virginia members.
- Benefit to West Virginia Members
- This solution provides optionality and greater access for members to fill prescriptions in either 30-day or 84+ day supplies from any in-network retail or mail pharmacy of their choice.
- The member cost share for an 84+ day supply at retail will be the same as the mail cost share. There will be no impact on the 30-day member cost share.
- Members will be notified of this change
- Members will be able to find an in-network pharmacy that’s convenient for them by calling the number on the back of their member ID card and speaking with Customer Care.
- Clients that Opt-out of the Solution
- If clients choose to opt out of this solution by October 13th, members will be limited to only fill up to 83 days of maintenance medications with state-mandated or retail pricing.
- Choose Generic Program
- Choosing a generic drug can help reduce employee’s out-of-pocket costs. With this program, if a generic prescription is available and the employee chooses to get the brand instead, there will be a difference in cost between the brand and generic and the applicable plan copay.
Get help
Go to www.aetna.com, or call customer service at 800-922-5863
Both the Minimum Coverage and Enhanced Minimum Coverage plans include enhancements of telemedicine and the AWP Value Rx discount program. The only difference between the plans is the additional reimbursement toward covered expenses. Both plans are provided by Nationwide, and all new employees will receive enrollment information within the first 30 days of hire.
AWP Value Rx* – Provided by CerpassRx
The AWP Value Rx program is designed to provide substantial savings on your prescription drug expenses. This plan will help you identify affordable generic and brand name drugs by therapeutic class.
- Generic and brand name drugs for which a discounted price has been negotiated
- Over 58,000 participating pharmacies nationwide
- No maximum annual benefit, deductible or claim forms.
*The AWP Value Rx is a non-insurance discount program
