Drugs and Prescriptions

Welcome To Your New
Aetna Prescription Drug Plan

EPISD’s new Pharmacy Benefit Manager (PBM) effective January 1, 2008 will be Aetna.

Although there is no change to medical premiums or plan design for Plan Year 2008, to include Rx co-pays; please keep in mind the following points as you transition to your new Aetna Pharmacy Benefit

• Review the Aetna Preferred Drug List (Formulary) to determine if your current prescribed medication is on the preferred list.
• Review the Over-the-Counter (OTC) Medication List approved for the Step Therapy Programs. The step therapy program was implemented in October 2005 and will remain in effect. With the Step Therapy Program, the generic Rx Co-Pay applies to certain OTC medication if it is prescribed through the Step Therapy Program. You must present a prescription from your physician for the OTC and pay for it at the pharmacy counter. Be sure that you tell the Pharmacist that EPISD participates in the Step Therapy Program and this OTC is covered at the generic co-pay
• If you currently use the mail order program with Immediate Pharmaceutical Services (IPS), be sure to register as a new participant with the Aetna Rx Home Delivery Program, by completing the Order Form and the Patient Registration Form. If you have a prescription that is currently being filled under the 90-day fill on January 1st, and you have remaining refills, your prescription will not be interrupted. There are only two prescription categories that cannot continue without a new prescription, these are narcotic and compound medications. If you are taking any of these two medications, a new prescription must be obtained from your treating physician. Upon completing your last authorized 90-day prescription with IPS you must complete the Aetna Order Form and Patient Registration Form.

Please review this important
Information about your
Rx Benefit

WHAT IS A PREFERRED DRUG LIST (FORMULARY)?

A Preferred Drug List — also called a formulary —is an extensive list of generic and brand prescription drugs approved by the U.S. Food and Drug Administration (FDA) as safe and effective and considered by Aetna to be cost-effective.
A Pharmacy and Therapeutics (P&T) Committee, which is comprised primarily of physicians and other health care providers who are not Aetna employees, reviews our entire Preferred Drug List on an annual basis. In addition, as brand drugs lose their patents and new generic versions become available on the market, the brand drug may be removed from the Preferred Drug List. Aetna will generally cover the drugs listed in the Aetna Preferred Drug List as long as the drug is medically necessary and plan rules are followed.

WHAT IF YOUR CURRENTLY PRESCRIBED MEDICATION IS NOT ON THE AETNA FORMULARY BUT WAS ON THE RESTAT FORMULARY?

If the medication currently prescribed to you is not on the Aetna Formulary, you may contact your physician to have your prescription changed based on the Aetna Preferred Drug List (formulary), or you may continue with your current medication and pay the applicable co-pay.

PRESCRIPTION PROGRAMS

• EPISD in conjunction with the PBM utilizes the following programs specifically designed to comply with FDA guidelines for safe and effective use of prescription medications:
• Pre-Cert Program – Prescribing Physician must contact Aetna to obtain coverage on certain outpatient Rx. STEP Therapy – Requires that members use a “first line or tier” drug before authorization is granted for more costly “second line or tier drug”
• Quantity Limitations – Manages the quantity of medication that a member can receive in a given period of time for certain medications that are not used on a daily basis, but rather per episode
• Dosage Optimization – May change multiple dose medications to a single dose where appropriate
• Maintenance at Mail-Order – Only maintenance medications are available with mail order services
  
  For more information on these programs or questions regarding your Pharmacy Benefit Manager click here, or visit the Employee Benefits website at www.episdbenefits.org
  

WHAT IS YOUR RETAIL RX-COPAY?

Your Pharmacy Benefit will remain a three tier/open formulary. What that means to you is that your pharmacy benefit covers medications that are on Aetna’s Preferred Drug List (formulary), as well as many that are not.

AETNA RX HOME DELIVERY

Save time and money by ordering your prescription through Aetna’s Mail Order prescription drug service, Aetna RX Home Delivery.  This is an ideal way to obtain your medications that are taken regularly to treat a chronic condition such as arthritis, asthma, diabetes, and heart conditions.  These medications are delivered right to your door.

Easy to use – A simple two step process makes ordering your maintenance medication online easy.

Get Started Today!

Start taking advantage of the benefits of Aetna Rx Home Delivery by following these two easy steps.

Step 1: Obtain a prescription from your doctor for each maintenance medication (typically a 90-day supply) that you or a family member is taking.

Step 2: Complete and mail the Aetna Rx Home Delivery Order Form and Patient Registration Form along with your new prescription(s) and payments to Aetna Rx Home Delivery.

Or: Have your doctor fax your prescription(s) and completed Order Form to 1-866 681-5166.

Refilling Prescriptions

Ordering refills is easy.
There are three methods
to choose from:

By Mail
Complete the Order Form or the Reorder Form and mail with payment in full to the address listed on your form.

Order Form are available online at www.aetna.com/aetnarxhomedelivery and the Reorder Forms will be included with your mail order shipments. Be sure to indicate on the forms which prescription(s) you would like to refill.

By Phone
Call Aetna Rx Home Delivery toll free at 1-800 227-5720 (TDD: 1-800 823-6373). Provide your Aetna member ID number, your prescription number and your credit card number.

Online
Visit www.aetna.com/aetnarxhomedelivery, log in and complete the information requested. You can also track your prescription orders through this website.
When a prescription has no refills remaining, you will receive a Prescription Renewal Form with your final refill shipment. Complete either the Prescription Renewal Form or the Order Form (available online at www.aetna.com/aetnarxhomedelivery). Mail the form, new prescription and payment to Aetna Rx Home Delivery.

Or:
Have your doctor fax your prescription(s) to 1-866 681-5166.

For additional information contact Customer Service

To check the status of an order, place a refill or speak to a pharmacist, call Customer Service at 1-800 227-5720 (TDD: 1-800 823-6373). Customer Service representatives are available: Monday – Friday, 7 a.m. – 11 p.m., Saturday from 8 a.m. – 9:30 p.m., and Sunday from 8 a.m. – 6 p.m. Eastern Time.