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Aetna Medicare Rx® Plan (PDP) Pharmacy Directory

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Aetna Medicare Rx® Plan (PDP) Pharmacy Directory Aetna Medicare Rx® Plan (PDP) Pharmacy Directory Connecticut/Massachusetts/ Rhode Island/Vermont www.aetnamedicare.com S5810_D_PE_MM_00643 CMS Approved 08/11/2010 Aetna Medicare Rx® Plan (PDP) Pharmacy Directory This booklet provides a list of Aetna Medicare Rx plan’s network pharmacies. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. To get current information about Aetna Medicare Rx plan’s network pharmacies in your area, please visit our website at www.aetnamedicare.com or call our Member Services at the toll-free number on the back of your Member ID card, 8:00 am to 8:00 pm, 7 days a week. (TTY/TDD users should call 1-888-760-4748.) Beneficiaries must use network pharmacies to access their prescription drug benefit. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2012. This directory is current as of October 8, 2010. A stand-alone prescription drug plan with a Medicare contract Translation of this material into another language may be available. For assistance, please call Member Services at: 1-877-238-6211, (TTY/TDD: 1-888-760-4748). Puede estar disponible la traducción de este material en otro idioma. Para ayuda, por favor llame a Servicios al Miembro al: 1-877-238-6211, (TTY/TDD: 1-888-760-4748). S5810_D_PE_MM_00643 CMS Approved 08/11/2010 Introduction This booklet provides a list of Aetna Medicare Rx plan’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Aetna Medicare Rx plan’s formulary. If you have additional questions, please call our Member Services at 1-877-238-6211, 8 am to 8 pm, 7 days a week. TTY/TDD users should call 1-888-760-4748. Or, visit www.aetnamedicare.com. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Aetna Medicare Rx plan. In most cases, your prescriptions are covered under Aetna Medicare Rx plan only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy to fill your prescription. You can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. For Aetna Medicare Rx individual plans shown in the table below (does not apply to employer group plans): Preferred pharmacies are pharmacies in our network in which our plan has negotiated lower cost-sharing for its plan members for covered prescription drugs than at other network pharmacies. However, you will still have access to lower drug prices at these other network pharmacies than at out-of- network pharmacies. You may go to either of these types of network pharmacies to receive your covered prescription drugs. If you are an Aetna Medicare Rx individual plan member who resides in one of the states listed below, please refer to the table for your preferred pharmacy benefit. Preferred Pharmacy Applicable States Preferred Pharmacy Benefit HEB For members of Aetna TX 3-month retail supply for 2.5x copays Medicare Rx Essentials®, Plus® and Premier® plans Costco AK, AZ, CA, CO, FL, HI, ID, IL, For members of Aetna Reduced 1-month copays for tiers 1-4; MI, NM, NV, NY, OH, OR, UT, Medicare Rx® - Costco Plus 3-month retail supply for 2.5x copays VA, WA Plan only Aetna Medicare Rx Plan’s Network Pharmacies To find a network pharmacy near your home, look under the pharmacy section of your choice (for example, “Retail”). The state, county and city are listed alphabetically in each plan pharmacy section. Network pharmacies that support electronic prescribing are indicated with . I Plan de farmacia Aetna Medicare Rx® (PDP) Directorio de farmacias Este folleto ofrece una lista de las farmacias que pertenecen a la red del plan Aetna Medicare Rx. Este directorio probablemente no incluye todas las farmacias que pertenecen a la red. Se puede haber agregado o retirado farmacias de la lista después de la impresión del directorio. Para obtener información actual sobre las farmacias que pertenecen a la red del plan de farmacia Aetna Medicare Rx en su área, por favor visite el sitio de Internet www.aetnamedicare.com o llame a Servicios al Miembro al número de teléfono sin cargo que aparece en la parte de atrás de su tarjeta de identificación del miembro entre 8:00 a.m. y 8:00 p.m., los 7 días de la semana. (Los usuarios TTY/TDD deben llamar al 1-888-760-4748.) Los beneficiarios deben usar las farmacias que pertenecen a la red para obtener acceso a su beneficio de medicamentos bajo receta. Los beneficios, listado, red de farmacias, primas, copagos y/o coseguros pueden cambiar el 1 de enero de 2012. Este directorio es válido desde el 8 de octubre de 2010. Un plan de farmacia independiente con un contrato de Medicare Este material puede estar disponible en otro idioma. Para obtener ayuda, por favor llame a Servicios al Miembro al: 1-877-238-6211 (TTY/TDD: 1-888-760-4748). II S5810_D_PE_MM_00830 CMS Approved 08/20/2010 Introducción Este folleto ofrece una lista de las farmacias que pertenecen a la red del plan de farmacia Aetna Medicare Rx. Para obtener una descripción completa de su cobertura de farmacia, incluyendo como obtener sus medicamentos bajo receta, por favor revise la Evidencia de Cobertura y el listado de medicamentos del plan de farmacia Aetna Medicare Rx. Si tiene preguntas adicionales, por favor llame a Servicios al Miembro al 1-877-238-6211, entre 8 a.m. y 8 p.m., los 7 días de la semana. Los usuarios TTY/TDD deben llamar al 1-888-760-4748. También puede visitar el sitio de Internet www.aetnamedicare.com. Las farmacias de esta lista se conocen como "farmacias que pertenecen a la red" porque tenemos un contrato con ellos para proporcionar medicamentos bajo receta a los miembros del plan. Una farmacia que pertenece a la red es una farmacia donde los beneficiarios obtienen los medicamentos bajo receta provistos por el plan Aetna Medicare Rx. En la mayoría de casos, sus medicamentos son cubiertos por el plan Aetna Medicare Rx sólo si los obtiene en una farmacia que pertenece a la red o a través de nuestro servicio de entrega de medicamentos por correo. Si va a una, no es necesario que continúe yendo a la misma farmacia para obtener sus medicamentos bajo receta. Puede ir a cualquiera de nuestras farmacias que pertenecen a la red. También le entregaremos medicamentos bajo receta en las farmacias que no pertenecen a la red bajo ciertas circunstancias descritas en su Evidencia de Cobertura. Para los planes individuales de Aetna Medicare Rx mostrados en el cuadro de abajo (no aplica a los planes de grupo del empleador): Las farmacias preferidas son las farmacias que pertenecen a nuestra red con las que nuestro plan ha negociado una participación de costos más baja en la compra de medicamentos bajo receta para los miembros del plan en comparación a otras farmacias que pertenecen a la red. Sin embargo, aún tendrá acceso a precios más bajos por los medicamentos en las demás farmacias que pertenecen a la red que en las farmacias que no pertenecen a la red. Puede ir a cualquiera de estas farmacias que pertenecen a la red para recibir sus medicamentos bajo receta. Si es miembro de un plan individual de Aetna Medicare Rx y reside en uno de los estados indicados abajo, por favor consulte el cuadro para ver cuál es su beneficio de farmacia preferida. Farmacia Preferida Estados Aplicables Beneficio de Farmacia Preferida HEB Para los miembros de los Suministro de 3 meses por un copago TX planes Aetna Medicare Rx de dos veces y medio Essentials®, Plus® y Premier® Costco AK, AZ, CA, CO, FL, HI, ID, IL, Copagos reducidos de 1 mes para los Sólo para los miembros del MI, NM, NV, NY, OH, OR, UT, niveles 1 a 4; suministro de 3 meses plan Aetna Medicare Rx® – VA, WA por copagos de dos veces y medio Costco Plus Farmacias que pertenecen a la red del plan Aetna Medicare Rx Para encontrar una farmacia que pertenece a la red cerca de usted, mire la sección de farmacias de su elección (por ejemplo "Venta"). El estado, condado y ciudad aparecen listados en orden alfabético en cada sección del plan de farmacia. Las farmacias que pertenecen a la red que reciben recetas médicas electrónicas se indican con . S5810_D_PE_MM_00830 CMS Approved 08/20/2010 III List of Participating Chain Pharmacies by State STOP & SHOP PHARMACY eߑ .................... (800) 767-7772 CONNECTICUT 711 (TTY / TDD) ߑ Chain RX A & P SUPERFOODMART PHARMACY eߑ ... (866) 443-7374 TARGET PHARMACY e ............................ (800) 440-0680 711 (TTY / TDD) (800) 755-5852 (TTY / TDD) CVS PHARMACY eߑ .................................. (800) 746-7287 WAL-MART PHARMACY ........................... (800) 925-6278 711 (TTY / TDD) 711 (TTY / TDD) ߑ RITE AID PHARMACY eߑ ........................... (800) 748-3243 WALGREENS e ....................................... (800) 925-4733 711 (TTY / TDD) 711 (TTY / TDD) SAM’S PHARMACY ................................... (800) 925-6278 711 (TTY / TDD) VERMONT eߑ STOP & SHOP PHARMACY .................... (800) 767-7772 ߑ 711 (TTY / TDD) CVS PHARMACY e .................................. (800) 746-7287 eߑ 711 (TTY / TDD) TARGET PHARMACY ............................ (800) 440-0680 ߑ (800) 755-5852 (TTY / TDD) RITE AID PHARMACY e ..........................
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