1. health and fitness
2. drugs

000001
SAMPLE A SAMPLE
333 E WETMORE RD
4TH FLOOR
TUCSON, AZ 85705
Pharmacy 1
123 Main St
Tucson, AZ 85718
1235551234
Pharmacy 2
456 Main St
Tucson, AZ 85705
4565557890
Pharmacy 3
123 Somewhere St
Tucson, AZ 85715
3215553216
Pharmacy 4
123 Somwhere Else Rd
Tucson, AZ 85713
1231231234
Pharmacy 5
123 Aloha Cir
Tucson, AZ 85714
3213214321
WALGREENS DRUG STORE
1415 W River Rd
Tucson, AZ 857045829
5202932713
ALBERTSONS PHARMACY
5085 N La Canada Dr
Tucson, AZ 857041508
5206960325
WALGREEN DRUG STORE
1351 W Prince Rd
Tucson, AZ 857053114
5208877154
WALGREENS DRUG STORE
3180 N Campbell Ave
Tucson, AZ 857192302
ADDITIONAL REASONS FOR DISCLOSURE
We may use or disclose health information about you in providing you with treatment alternatives,
treatment reminders, or other health-related benefits and services. We also may disclose such
information in support of:
Plan Administration – to your employer, when we have been informed that appropriate language has
been included in your plan documents, or when summary data is disclosed to assist in bidding or
amending a group health plan.
Research – to researchers, provided measures are taken to protect your privacy.
Business Associates – to persons who provide services to us and assure us they will protect
the information.
Industry Regulation – to state insurance departments, boards of pharmacy, U.S. Food and Drug
Administration, U.S. Department of Labor and other government agencies that regulate us.
Law Enforcement – to federal, state and local law enforcement officials.
Legal Proceedings – in response to a court order or other lawful process.
Public Welfare – to address matters of public interest as required or permitted by law (e.g., child
abuse and neglect, threats to public health and safety, and national security).
DISCLOSURE TO OTHERS INVOLVED IN YOUR HEALTH CARE
We may disclose health information about you to a relative, a friend, the subscriber of your health
benefits plan or any other person you identify, provided the information is directly relevant to that
person’s involvement with your health care or payment for that care. For example, if a family member or
a caregiver calls us with prior knowledge of a claim, we may confirm whether or not the claim has been
received and paid. You have the right to stop or limit this kind of disclosure by calling the toll-free
Member Services number on your ID card.
If you are a minor, you also may have the right to block parental access to your health information in
certain circumstances, if permitted by state law. You can contact us using the toll-free Member Services
number on your ID card – or have your provider contact us.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
In all situations other than those described above, we will ask for your written authorization before using
or disclosing personal information about you. If you have given us an authorization, you may revoke it at
any time, if we have not already acted on it. If you have questions regarding authorizations, please call
the toll-free Member Services number on your ID card.
Your Legal Rights
The federal privacy regulations give you the right to make certain requests regarding health information
about you. You may ask us to:
§ Communicate with you in a certain way or at a certain location. For example, if you are covered as an
adult dependent, you might want us to send health information to a different address from that of
your subscriber. We will accommodate reasonable requests.
January 1, 2004
SAMPLE A SAMPLE
333 E WETMORE RD
4TH FLOOR
TUCSON, AZ 85705
Dear SAMPLE A SAMPLE
Welcome to the Aetna Rx Savings CardE, a Medicare-Approved Drug Discount Card designed to help
you save money on prescription drugs. Your membership is effective the first day of the month following
receipt of the attached member ID card.
Please note that, while the Aetna Rx Savings Card is approved by Medicare, it is not a Medicare benefit.
The Aetna Rx Savings Card is not intended to replace prescription drug benefits obtained through
participation in insurance plans, such as a Medicare Advantage plan (formerly Medicare+Choice),
a Medigap policy, Medicaid, or an employer or retiree plan.
Be sure to review all the materials in this packet for important information, including:
n
n
n
n
n
Membership ID Card: Provides you with access to discounts on all brand-name and generic prescription
drugs except those excluded by the Centers for Medicare & Medicaid Services (CMS).
Pharmacy Directory: Lists Aetna Rx Savings Card preferred pharmacies where you can purchase your
discounted prescription drugs and, if you qualify, use your Additional Assistance Credit of up to $600.
Member Handbook: Explains how the Aetna Rx Savings Card works.
Discount Drug List: Lists the top 100 prescription drugs used by people eligible for Medicare, which
you will also receive at a discount.
Notice of Privacy Practices: Describes how medical information about you may be used and disclosed
and how you can get access to this information.
In order to receive discounts through your card, your prescription must be filled at any Aetna Rx Savings
Card pharmacy nationwide.
For a list of Aetna Rx Savings Card pharmacy locations in other areas, or to receive discounted prescription
drug pricing, call Member Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD:
1-888-339-7322), Monday through Friday, 8 a.m. to 4:30 p.m.
For more information about Medicare benefits and services, call 1-800-MEDICARE (1-800-633-4227).
TTY users may call 1-877-486-2048.
Thank you for enrolling in the Aetna Rx Savings Card.
Sincerely,
Aetna Rx Savings Card
Discounts vary by drug. Contact the Aetna Rx Savings Card to find out if your prescription drug is covered
and the discounted price.
Medical Security Card Company is the Aetna Rx Savings Card Administrator.
30
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
7P-40329 (4/22/04)
3
How Aetna Uses and Discloses Personal Information
In order to provide you with insurance coverage or discount programs, we need personal information
about you, and we obtain that information from many different sources – particularly your employer or
benefits plan sponsor, other insurers, HMOs or third-party administrators (TPAs), and health care
providers. If you are enrolled in the Aetna Rx Savings Card, Aetna may not use or disclose personal
information about you to market other products or services that are not related to the Aetna Rx Savings
Card. In administering your health benefits and providing mail-order pharmacy services, we may use and
disclose personal information about you in various ways, including:
Health Care Operations: We may use and disclose personal information during the course of running
our health business – that is, during operational activities such as quality assessment and improvement;
licensing; accreditation by independent organizations; performance measurement and outcomes
assessment; health services research; and preventive health, disease management, case management and
care coordination. For example, we may use the information to provide disease management programs
for members with specific conditions, such as diabetes, asthma or heart failure. Other operational
activities requiring use and disclosure include administration of reinsurance and stop loss; underwriting
and rating; detection and investigation of fraud; administration of pharmaceutical programs and
payments; transfer of policies or contracts from and to other health plans; facilitation of a sale, transfer,
merger or consolidation of all or part of Aetna with another entity (including due diligence related to
such activity); and other general administrative activities, including data and information systems
management, and customer service.
Payment: To help pay for your covered services, we may use and disclose personal information in a
number of ways – in conducting utilization and medical necessity reviews; coordinating care; determining
eligibility; determining formulary compliance; collecting premiums; calculating cost-sharing amounts; and
responding to complaints, appeals and requests for external review. For example, we may use your
medical history and other health information about you to decide whether a particular treatment is
medically necessary and what the payment should be – and during the process, we may disclose
information to your provider. We also mail Explanation of Benefits forms and other information to the
address we have on record for the subscriber (i.e., the primary insured). In addition, we make claims
information contained on our Aetna NavigatorTM health site and telephonic claims status sites available
to the subscriber and all covered dependents. We also use personal information to obtain payment for
any mail-order pharmacy services provided to you.
Treatment: We may disclose information to doctors, dentists, pharmacies, hospitals and other health
care providers who take care of you. For example, doctors may request medical information from us to
supplement their own records. We also may use personal information in providing mail-order pharmacy
services and by sending certain information to doctors for patient safety or other treatment-related
reasons.
Disclosures to Other Covered Entities: We may disclose personal information to other covered entities,
or business associates of those entities for treatment, payment and certain health care operations
purposes. For example, we may disclose personal information to other health plans maintained by your
employer if it has been arranged for us to do so in order to have certain expenses reimbursed.
4
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
29
Para recibir esta notificación en español por favor llamar al número gratuito de Member Services
(Servicios a Miembros) que figura en su tarjeta de identificación.
This Notice of Privacy Practices applies to Aetna’s insured health benefits plan, the Aetna Rx Savings
CardE, and its mail-order pharmacy. It does not apply to any plans that are self-funded by an employer.
Your employer will be able to tell you if your plan is insured or self-funded. If your plan is self-funded,
you may want to ask for a copy of your employer’s privacy notice.
This notice describes how medical information about you may be used and disclosed and how
you can get access to this information. Please review it carefully.
Aetna1 considers personal information to be confidential. We protect the privacy of that information in
accordance with federal and state privacy laws, as well as our own company privacy policies.
This notice describes how we may use and disclose information about you in administering your
benefits, and it explains your legal rights regarding the information.
When we use the term “personal information,” we mean financial, health and other information about
you that is nonpublic, and that we obtain so we can provide you with insurance coverage or discount
programs. By “health information,” we mean information that identifies you and relates to your medical
history (i.e., the health care you receive or the amounts paid for that care).
This notice will become effective on May 3, 2004.
1 For purposes of this notice, “Aetna” and the pronouns “we, “us” and “our” refer to all of the HMO
and licensed insurer subsidiaries of Aetna Inc., including the entities listed on the last page of this
notice, as well as our mail-order pharmacy. These entities have been designated as a single affiliated
covered entity for federal privacy purposes.
28
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Table of Contents
Welcome to the Aetna Rx Savings CardE ..........................................................................................7
Aetna Rx Savings Card Description .....................................................................................................7
Additional Assistance Credit ...........................................................................................................7
§ How to Qualify for an Additional Assistance Credit .......................................................................8
§ Applying for an Additional Assistance Credit.................................................................................8
§ Using an Additional Assistance Credit ...........................................................................................8
Pharmacies that Accept the Aetna Rx Savings Card......................................................................9
§ Filling Prescriptions When Traveling ..............................................................................................9
Aetna Rx Savings Card Discount Drug List ...................................................................................10
Annual Enrollment Fee .................................................................................................................10
Discount Prices on Prescription Drugs ..........................................................................................11
Aetna Rx Savings Card Mail-Order Pharmacy..............................................................................11
Your Aetna Rx Savings Card Membership ........................................................................................11
Disenrolling from the Aetna Rx Savings Card .............................................................................12
Enrolling in a New Medicare-Approved Drug Discount Card.....................................................12
§ Annual Coordinated Election Period ............................................................................................12
§ Special Election Period ................................................................................................................12
Penalties for Disenrolling Outside of the Annual Coordination or Special Election Periods ...13
Reapplying for a New Medicare-Approved Drug Discount Card ...............................................13
Aetna Rx Savings Card Service Area .............................................................................................13
Other Services from Aetna .................................................................................................................14
What to do if You Have Problems or Complaints ............................................................................14
How to Help Protect Yourself and Medicare from Fraud ................................................................15
Frequently Asked Questions ..............................................................................................................15
Glossary ...............................................................................................................................................17
6
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Welcome to the Aetna Rx Savings CardA
We are pleased to welcome you as a member of the Aetna Rx Savings Card, a Medicare-Approved
Drug Discount Card.
While approved by Medicare, the Aetna Rx Savings Card is not a Medicare benefit. It is not intended to
replace prescription drug benefits you may currently receive through insurance plans such as Medicare
Advantage (formerly Medicare+Choice) plans, Medicare supplement insurance plans (also known as
“Medigap”), or employer or retiree plans.
Rather, the discount prices you receive through the Aetna Rx Savings Card will be in addition to
prescription coverage you may receive under your current Medicare Advantage or Medigap plan.
For example, if your current Medicare Advantage plan offers unlimited generic prescription drug coverage
with a copay, but no brand-name coverage, you may continue to pay your copay for generic drugs. And,
with the Aetna Rx Savings Card, you will also have access to savings on covered brand-name drugs.
This handbook explains:
§ how you can access savings on prescription drugs through the Aetna Rx Savings Card;
§ your rights and responsibilities as an Aetna Rx Savings Card member;
§ our responsibilities to you.
The information in this booklet is valid from June 1, 2004, through December 31, 2005, or until we no
longer offer the Aetna Rx Savings Card, whichever comes later.
Aetna Rx Savings Card Description
The Aetna Rx Savings Card is designed to help you save money on brand-name and generic prescription
drugs at any Aetna Rx Savings Card pharmacy nationwide, or through the Aetna Rx Savings Card
mail-order pharmacy.
To access your member discount, simply present your prescription and member ID card at any Aetna Rx
Savings Card pharmacy. If you are purchasing prescriptions other than those excluded by the Centers for
Medicare & Medicaid Services (CMS), you will automatically receive Aetna’s negotiated discount or the
pharmacy’s customary price, whichever is lower.
To replace a damaged or lost member ID card, please call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
ADDITIONAL ASSISTANCE CREDIT
If you meet specific income requirements, Medicare may provide you with an Additional Assistance Credit
of up to $600 per year to help pay for prescription drugs obtained through the Aetna Rx Savings Card.
This credit is not a replacement for any current prescription coverage you may have, so you should not
cancel your current drug coverage if you qualify for an Additional Assistance Credit.
26
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
7
How to Qualify for an Additional Assistance Credit
You may qualify for an Additional Assistance Credit if:
Name
Dosage
Discounted
Price Per Unit*
§ you do not have other health insurance with any prescription drug coverage (except a Medicare
Advantage plan or a Medigap policy); and
Metformin HCL
500mg tablet
$0.4578
Metoprolol
50mg tablet
$0.3538
§ your income is no more than $12,569 if you are single, (or, in Alaska, no more than $15,701;
in Hawaii, no more than $14,445); or
Paroxetine HCL
20mg tablet
$2.2466
§ your income is no more than $16,862 if you are married (or, in Alaska, no more than $21,074;
in Hawaii, no more than $19,386); this includes your income and your spouse’s income.
Potassium CL
10meq cap SA
$0.2423
Prednisone
5mg tablet
$0.0321
Propoxy-N/APAP
100-650 tab
$0.3719
Propranolol
20mg tablet
$0.2241
Ranitidine
150mg tablet
$1.0140
Spironolactone
25mg tablet
$0.3000
Sulfamethoxazole/TMP
DS tab
$0.5871
Terazosin
5mg capsule
$1.5413
Timolol
0.5% gel/solution
$5.4740
Tramadol HCL
50mg tablet
$0.5389
Trazodone
50mg tablet
$0.3674
Triamterene/HCTZ
37.5/25 CP
$0.3177
Trimox
500mg capsule
$0.2474
Verapamil
240mg tablet SA
$1.0010
Warfarin Sodium
5mg tablet
$0.5413
§ you have Medicare Part A and/or Part B; and
If you qualify for an Additional Assistance Credit, you will be eligible as long as the Medicare-Approved
Drug Discount Card exists (through December 31, 2005, or to the end of the program, whichever is
later). However, if you are found to have provided fraudulent information on your enrollment form, or
you leave the Aetna Rx Savings Card and are not eligible to enroll in another Medicare-Approved Drug
Discount Card, you will no longer be eligible for an Additional Assistance Credit.
If you qualify for an Additional Assistance Credit, Medicare will also pay the annual enrollment fee
for your Medicare-Approved Drug Discount Card.
Applying for an Additional Assistance Credit
To apply for an Additional Assistance Credit, you will need to fill out a form similar to the enrollment
form you used to apply for the Aetna Rx Savings Card. The form asks questions about your current
health care coverage and your income level. To obtain a form or learn more about applying for an
Additional Assistance Credit, call Member Services toll free at 1-866-895-1649 (for the hearing
impaired, call TDD: 1-888-339-7322). You may also call Medicare at 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.
Using an Additional Assistance Credit
An Additional Assistance Credit may only be used at pharmacies that accept the Aetna Rx Savings Card.
Aetna will manage this credit for you. Every time you get a prescription filled using your Aetna Rx Savings
Card, you can ask the pharmacist to inform you of your current Additional Assistance Credit amount.
You may also obtain this information by calling Member Services toll free at 1-866-895-1649 (for the
hearing impaired, call TDD: 1-888-339-7322).
As long as you are an Aetna Rx Savings CardE member, any Additional Assistance Credit amount you do
not use in 2004 will be available to you in 2005. For example, if you have $90 remaining as of December
31, 2004, you will be able to add it to your 2005 amount for a total Additional Assistance Credit of up
to $690.
And as long as you have an Additional Assistance Credit, you will be required to pay coinsurance when
using your Aetna Rx Savings Card. The amount you pay will depend on your annual income* level:
§ if you are single and your annual income for 2004 is no more than $12,569 (or, in Alaska, no more
than $15,701; in Hawaii, no more than $14,445), your coinsurance will be 10 percent of the cost of
your prescription drugs.
8
TOP 50 GENERIC DRUGS (METFORMIN HCL – WARFARIN SODIUM)
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
* Discounts vary by drug and region. Contact your pharmacist or Member Services to find out the
discounted price for your prescription drugs.
The above list of drugs is subject to change. It includes discounted retail pharmacy pricing obtained on
February 4, 2004. The Aetna Administrator will update the CMS website (www.medicare.gov) weekly
with its drug pricing information. You may also call 1-800-MEDICARE (1-800-633-4227) for more
information. TTY users should call 1-877-486-2048.
Aetna Rx Savings Card is a prescription drug discount card that is approved by Medicare but is not a
Medicare benefit. Aetna Rx Savings Card is not intended to replace prescription drug benefits obtained
through participation in insurance plans, including a Medicare Advantage plan (formerly Medicare+
Choice), a Medigap policy, Medicaid, or an employer or retiree plan.
Medical Security Card Company is the Aetna Rx Savings Card Administrator.
“Aetna” is the brand name used for products and services provided by one or more of the Aetna group
of subsidiary companies.
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
25
TOP 50 GENERIC DRUGS (CEPHALEXIN – MECLIZINE)
§ if you are married and your annual income (plus your spouse’s income) is no more than $16,862
(or, in Alaska, no more than $21,074; in Hawaii, no more than $19,386), your coinsurance will be
10 percent of the cost of your prescription drugs.
Name
Dosage
Discounted
Price Per Unit*
Cephalexin
500mg capsule
$0.7968
Clonidine HCL
0.1mg tablet
$0.1404
Digitek–
125mcg tablet
$0.1836
Digoxin
125mcg tablet
$0.1836
Diltiazem HCL
240mg cap SA
$1.7430
Doxazosin Mesylate
4mg tab
$0.6493
Doxycycline
100mg capsule
$0.8013
Enalapril Maleate
10mg tab
$0.6968
Fluoxetine
20mg capsule
$1.7343
Folic Acid
1mg tablet
$0.0663
Furosemide
40mg tablet
$0.1037
Gemfibrozil
600mg tablet
$0.7718
Glipizide Er
5mg tablet
$0.3460
Glyburide
5mg tablet
$0.5615
Aetna Rx Savings CardE pharmacies in your area are listed on the inside cover of this packet. You may also
use Aetna Rx Savings Card pharmacies nationwide. To request a list of pharmacies in other areas, call
Member Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
Hydrochlorothiazide
25mg tb
$0.0674
If you are currently using an unlisted pharmacy and you are:
Hydrocodone/APAP
5/500 tab
$0.1280
Isosorbide MN
30mg tab SA
$0.9483
§ Native American and using a pharmacy that is owned or operated by the Indian Health Service,
Indian tribes, or urban Indian organizations; or
Klor-Con
10meq tablet
$0.2599
§ a resident in a skilled nursing facility or other nursing facility;
Klor-Con
M20 tablet
$0.4497
Levothroid
100mcg tablet
$0.2346
Levoxyl
50mcg tablet
$0.3106
Lisinopril
10mg tablet
$0.6461
Lisinopril-HCTZ
20/12.5 tab
$0.7796
Meclizine
25mg tablet
$0.0717
* Discounts vary by drug and region. Contact your pharmacist or Member Services to find out the
discounted price for your prescription drugs.
§ if you are single and your annual income is no more than $9,310 (or, in Alaska, no more than
$11,630; in Hawaii, no more than $10,700), your coinsurance will be 5 percent of the cost of
your drugs.
§ if you are married and your annual income (plus your spouse’s) is no more than $12,490 (or,
in Alaska, no more than $15,610; in Hawaii, no more than $14,360), your coinsurance will be
5 percent of the cost of your drugs.
Once your total Additional Assistance Credit has been used, you will continue to receive your member
discount when using your Aetna Rx Savings Card at designated pharmacies.
* Income includes retirement and disability benefits, plus any other sources you would include in your
adjusted gross income for tax purposes.
PHARMACIES THAT ACCEPT THE AETNA RX SAVINGS CARD
To receive your member discount, or use an Additional Assistance Credit (if you qualify), you must fill
your prescriptions at a pharmacy that accepts the Aetna Rx Savings Card.
you may obtain more information by calling Member Services toll free at 1-866-895-1649 (for the
hearing impaired, call TDD: 1-888-339-7322). You may also call Medicare at 1-800-MEDICARE
(1-800-633-4227). TTY users should call 1-877-486-2048.
If you reside in an assisted living facility, you should speak with a facility representative to find out if and
how you may use the Aetna Rx Savings Card to receive prescription drug discounts.
Filling Prescriptions When Traveling
When traveling, be sure to use Aetna Rx Savings Card pharmacies so you can take advantage of your
member discount and Additional Assistance Credit (if you qualify).
To avoid paying full retail price at a pharmacy that does not accept the Aetna Rx Savings Card, you can
locate Aetna Rx Savings Card pharmacies near your travel destination by calling Member Services toll free
at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
Before traveling, it’s also a good idea to plan ahead and pack an adequate supply of your
prescription drugs.
24
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
9
AETNA RX SAVINGS CARD DISCOUNT DRUG LIST
Aetna has provided you with a printed list of the top 100 prescription drugs used by people eligible for
Medicare, as well as their proper dosages, on page 21. These drugs are offered at a discount through the
Aetna Rx Savings Card. Information on other prescription drugs available at discount prices with the
Aetna Rx Savings Card can be obtained by calling Member Services toll free at 1-866-895-1649 (for the
hearing impaired, call TDD: 1-888-339-7322).
The list is divided into two sections:
§ Brand-Name Drugs: Drugs that are produced and sold under the names created by the companies
that manufacture them.
§ Generic Drugs: Drugs that are produced and sold under their chemical names.
Generic drugs must meet the same FDA standards for safety and effectiveness as their brand-name
counterparts, which means they must:
§ contain the same active ingredients as the brand-name equivalent;
§ have the same amount of active ingredients as the brand-name equivalent;
§ carry the same label information as the brand-name equivalent.
And, while some generic drugs may be identical to their equivalent brand-name counterpart, they
usually cost less.
Aetna Rx Savings Card pharmacies must inform you of the price difference between a brand-name
prescription drug and its generic equivalent, if available. If the prescription drug your doctor prescribes is
excluded by the Centers for Medicare & Medicaid Services (CMS), you will pay the pharmacy’s full retail
price. To avoid doing this, you or your physician, on your behalf, may call the Aetna Rx Savings Card toll
free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322) to confirm whether
your prescription is covered. If not, your physician may then determine if a drug that is covered may be
effective for your condition.
Name
Dosage
Discounted
Price Per Unit*
Neurontin
300mg capsule
$1.3015
Nexium
40mg capsule
$4.1231
Norvasc
5mg tablet
$1.4536
Plavix
75mg tablet
$4.0038
Pravachol
20mg tablet
$2.9006
Premarin
0.625mg tablet
$0.8990
Prevacid
30mg capsule DR
$4.1958
Protonix
40mg tablet EC
$3.3660
Synthroid
100mcg tablet
$0.4421
Toprol XL
50mg tablet SA
$0.6886
Vioxx
25mg tablet
$2.6520
Xalatan
0.005% eye drops
$20.5498
Zetia
10mg tablet
$2.3763
Zithromax
250mg Z-pak tab
$7.2497
Zocor
20mg tablet
$4.2126
Zoloft
50mg tablet
$2.5287
TOP 50 GENERIC DRUGS (ALBUTEROL – CARBIDOPA/LEVO)
Important note: Prescription drugs and prices covered by the Aetna Rx Savings Card discount are
subject to change. To ensure you have the most recent information, call Member Services toll free at
1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
Name
Dosage
Discounted
Price Per Unit*
Albuterol
90mcg inhaler
$0.8823
Allopurinol
300mg tablet
$0.4302
ANNUAL ENROLLMENT FEE
Amitriptyline HCL
25mg tab
$0.2202
If you enrolled in the Aetna Rx Savings Card program and did not qualify for an Additional Assistance
Credit, you were required to pay a $30 annual enrollment fee. In 2005, you may be required to pay
another annual enrollment fee up to $30. We will notify you later this year about whether you will be
required to pay a 2005 enrollment fee and, if so, how much it will be.
Amoxicillin
500mg capsule
$0.2399
Atenolol
50mg tablet
$0.5151
Captopril
25mg tablet
$0.5424
Carbidopa/Levo
25/100 tab
$0.5201
If you qualify for and receive an Additional Assistance Credit, Medicare will pay your annual
enrollment fee for you.
Important note: If you fail to pay your annual enrollment fee, Aetna has the right to automatically
disenroll you from the Aetna Rx Savings Card.
10
TOP 50 BRAND-NAME DRUGS (NEURONTIN – ZOLOFT)
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
* Discounts vary by drug and region. Contact your pharmacist or Member Services to find out the
discounted price for your prescription drugs.
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
23
TOP 50 BRAND-NAME DRUGS (AMBIEN – MIRALAX)
DISCOUNT PRICES ON PRESCRIPTION DRUGS
Name
Dosage
Discounted
Price Per Unit*
Ambien
10mg tablet
$2.7011
Aricept
10mg tablet
$4.5640
Avapro
150mg tablet
$1.5075
Bextra
10mg tablet
$2.9019
Celebrex
200mg capsule
$2.7404
Celexa
20mg tablet
$2.3864
Ciprofloxacin HCL
500mg tab
$5.2580
Combivent
1 inhaler
$3.9241
AETNA RX SAVINGS CARD MAIL-ORDER PHARMACY
Coreg
6.25mg tablet
$1.6314
Coumadin
5mg tablet
$0.7863
Cozaar
50mg tablet
$1.4622
Detrol LA
4mg capsule
$2.9113
You may also use the Aetna Rx Savings Card mail-order pharmacy to order discounted prescription
drugs through the mail. Once your order is placed, the Aetna Rx Savings Card mail-order pharmacy will
deliver your prescription drugs right to your door in seven business days. To place an order or inquire
about a delayed shipment, please call the Aetna Rx Savings Card mail-order pharmacy toll free at
1-866-612-3862 (for the hearing impaired, call TDD: 1-888-339-7322).
Diovan
80mg tablet
$1.5436
Diovan HCT
160/12.5mg tab
$1.8065
Evista
60mg tablet
$2.4907
Flomax
0.4mg capsule SA
$1.8239
Fosamax
70mg tablet
$16.9180
Glucotrol XL
5mg tablet SA
$0.4298
Glucovance
5/500mg tab
$1.0054
Hyzaar
50-12.5 tablet
$1.4622
Lanoxin
125mcg tablet
$0.1674
Levaquin
500mg tablet
$9.3014
Lexapro
10mg tablet
$2.0350
Lipitor
10mg tablet
$2.2738
Lotensin
20mg tablet
$1.0278
Lotrel
5/20mg capsule
$2.0846
Miralax
powder
$0.0725
* Discounts vary by drug and region. Contact your pharmacist or Member Services to find out the
discounted price for your prescription drugs.
22
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
The amount you pay when you pick up your prescription will vary according to the type of prescription
drug you purchase. You will usually pay a lower price when you receive a generic drug, and your
pharmacist is required to tell you if there is a price difference between a brand-name drug and the
equivalent generic drug.
Remember, if you go to a pharmacy that does not accept the Aetna Rx Savings Card, you will not be able
to use your discount to purchase your prescription or use your Additional Assistance Credit (if you qualify).
The Aetna Rx Savings Card covers all brand-name and generic prescription drugs except those excluded
by the Centers for Medicare & Medicaid Services (CMS). For a list of the top 100 prescription drugs used
by people eligible for Medicare, see page 21. For a list of Aetna Rx Savings CardE pharmacies, please call
Member Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
Please note that prescription drug prices are subject to change and may vary by pharmacy, geographic
location or enrollee. When purchasing covered prescriptions with your Aetna Rx Savings Card, you will
automatically receive Aetna’s negotiated discount or the pharmacy’s customary price, whichever is lower.
To compare Aetna’s negotiated discount with that offered by other Medicare-Approved Drug Discount
Cards, visit www.medicare.gov and select the “Medicare Price Comparison” tool.
Your Aetna Rx Savings Card Membership
Your membership in the Aetna Rx Savings Card is effective from the date of your enrollment until either
December 31, 2005, or we no longer offer the Aetna Rx Savings Card, whichever comes later. In 2005,
you will receive information about how to transition into Part D, a prescription benefit that will be added
to the Original Medicare plan in 2006. It is anticipated that you will be able to enroll in the new Medicare
Part D benefit as early as January 1, 2006.
Members may only be enrolled in one Medicare-Approved Drug Discount Card, such as the Aetna Rx
Savings Card, at a time. You may, however, be enrolled in other drug discount cards that are not
Medicare approved. For more information, including finding out which drug discount cards are Medicare
approved, call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Or visit www.medicare.gov and select “Prescription Drug and Other Assistance Programs.”
Important note: If you are a member of a Managed Care plan, such as a Medicare Advantage plan
(formerly Medicare+Choice), and it offers an Exclusive Medicare-Approved Drug Discount Card, you
will automatically be enrolled in that card. If you do not want the Medicare Advantage (formerly
Medicare+Choice) exclusive card, you must call your plan’s Customer Service department. If you
disenroll from your Managed Care plan’s exclusive card, you will not be eligible to enroll in
another Medicare-Approved Prescription Drug Discount Card. Call your Managed Care plan’s
Customer Service department for more information.
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
11
DISENROLLING FROM THE AETNA RX SAVINGS CARD
While you may disenroll from the Aetna Rx Savings CardE program at any time, certain restrictions may
apply (see “Enrolling in a New Medicare-Approved Drug Discount Card,” below).
To disenroll, you are required to send a letter or email stating your reason for disenrollment. Your letter
should be sent to Aetna Administrator, 333 E. Wetmore Rd., 4th Floor, Tucson, AZ 85705. Your email
should be sent to [email protected].
CAN I SAVE MORE WHEN I BUY GENERIC DRUGS?
Aetna Rx Savings Card members can save money when purchasing generic prescription drugs versus
brand-name prescription drugs.
Example:
Type
Name
Dose
Quantity
Price
ENROLLING IN A NEW MEDICARE-APPROVED DRUG DISCOUNT CARD
Brand Name:
Glucovance
5/500mg tablet
30
$29.82
Annual Coordinated Election Period
If you wish to enroll in another Medicare-Approved Drug Discount Card, you may do so during the
Annual Coordinated Election Period from November 15 through December 31, 2004. If you do so, both
your disenrollment from the Aetna Rx Savings Card and your enrollment into the new
Medicare-Approved Drug Discount Card will be effective on January 1, 2005. Any Additional Assistance
Credit amount you may have left when you disenroll from the Aetna Rx Savings Card will automatically
transfer to your new Medicare-Approved Drug Discount Card. In addition, if you receive an Additional
Assistance Credit, Medicare will pay any annual enrollment fee charged by your new card. If you do not
receive an Additional Assistance Credit, your new card may charge you an annual enrollment fee.
Generic Equivalent:
Glyburide
5mg tablet
30
$15.85
Special Election Period
If you disenroll from the Aetna Rx Savings Card at any other time for one of the special reasons listed below,
you will be given a Special Election Period and will be allowed to enroll in another Medicare-Approved Drug
Discount Card at any time until the program ends, or December 31, 2005, whichever is later.
You will qualify for a Special Election Period only if:
§ you move out of the Aetna service area; or
§ you enter or leave a skilled nursing facility (such as a nursing home); or
You Save:
$13.97 (47%)
It’s important to note that generic drugs must meet the same FDA standards for safety and effectiveness
as their brand-name counterparts, which means they must:
§ contain the same active ingredients as the brand-name equivalent;
§ have the same amount of active ingredients as the brand-name equivalent;
§ carry the same label information as the brand-name equivalent.
To determine how much you might save by purchasing a specific generic prescription drug, consult
your pharmacist. For more information about generic drug pricing, call Member Services toll free at
1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
Top 100 Prescription Drugs Used by People Eligible for Medicare
The Aetna Rx Savings Card provides a variety of discounts for various days’ supplies and quantities of
prescription drugs. If you receive 30 tablets of 40mg Accupril, for example, you will pay the following:
§ you enroll in, or disenroll from, a Medicare Managed Care plan, such as a Medicare Advantage
plan (formerly Medicare+Choice), that offers a Medicare-Approved Drug Discount Card; or
Name
Dose
§ Aetna stops offering this discount card.
Accupril
40mg tablet
For example, if you move outside of the Aetna Rx Savings Card service area and would like to enroll in
a new Medicare-Approved Drug Discount Card, you must disenroll from the Aetna Rx Savings Card and
request a Special Election Period. During this Special Election Period, you will be able to enroll in a new
card with a service area that includes your new address.
If one of these situations applies to you, you can enroll in a new Medicare-Approved Drug Discount Card
at any time until the program ends, or December 31, 2005, whichever is later. Any Additional Assistance
Credit amount you may have left when you disenroll from the Aetna Rx Savings Card will automatically
transfer to your new Medicare-Approved Drug Discount Card. In addition, if you receive an Additional
Assistance Credit, Medicare will pay any annual enrollment fee charged by your new card. If you do not
receive an Additional Assistance Credit, your new card may charge you an annual enrollment fee.
Quantity
30
x
Discounted
Price Per Unit
$1.1959
=
Total
Discounted Price
$35.88
TOP 50 BRAND-NAME DRUGS (ACCUPRIL – AMARYL)
Name
Dosage
Discounted
Price Per Unit*
Accupril
40mg tablet
$1.1959
Actonel
35mg tablet
$15.5078
Advair
250/50 diskus
$2.2827
Allegra
80mg tablet
$2.2382
Alphagan P
0.15% eye drops
$7.7458
Altace
5mg capsule
$1.3596
Amaryl
4mg tablet
$1.0700
* Discounts vary by drug and region. Contact your pharmacist or Member Services to find out the
discounted price for your prescription drugs.
12
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
21
What Prescription Drugs Does the Aetna Rx Savings Card Cover?
The Aetna Rx Savings Card offers discounts on all brand-name and generic prescription drugs except
those excluded by the Centers for Medicare & Medicaid Services (CMS). CMS excluded drugs include,
but are not limited to:
§ those used for anorexia, weight loss or weight gain;
§ those used to promote fertility;
§ those used for cosmetic purposes or hair growth;
§ those used for the symptomatic relief of cough and colds;
§ prescription vitamins and mineral products, except prenatal vitamins and fluoride preparations;
§ nonprescription drugs;
§ outpatient drugs for which, as a condition of sale, the manufacturer requires associated test or
monitoring services be purchased exclusively from the manufacturer or its designee;
§ Barbiturates;
PENALTIES FOR DISENROLLING OUTSIDE OF THE ANNUAL COORDINATED OR
SPECIAL ELECTION PERIODS
If you enroll in a Medicare Managed Care plan, such as a Medicare Advantage plan (formerly
Medicare+Choice), that offers an Exclusive Medicare-Approved Drug Discount Card to its members, you
will no longer be eligible for, and will be automatically disenrolled from, the Aetna Rx Savings Card. Your
disenrollment from the Aetna Rx Savings Card will take effect on the last day of the month prior to your
new Medicare Advantage plan’s effective date and you will be eligible for a Special Election Period. During
this Special Election Period, you will be automatically enrolled in your Managed Care plan’s Exclusive
Medicare-Approved Drug Discount Card. If you decide that you do not want to enroll in your Managed
Care Plan’s Exclusive Medicare-Approved Drug Discount Card, call your plan’s Customer Service
Department and ask not to be enrolled. If you choose not to enroll in your Medicare Managed Care
plan’s card, however, you will not be eligible to enroll in another Medicare-Approved Drug
Discount Card. Call your Managed Care plan’s Customer Service Department for more information.
If you disenroll from the Aetna Rx Savings Card outside of the Annual Coordinated Election Period and
you do not qualify for a Special Election Period, you will be automatically disqualified from enrolling in
any Medicare-Approved Drug Discount Card program and will lose any unused Additional Assistance
Credit amount you may have left.
REAPPLYING FOR A NEW MEDICARE-APPROVED DRUG DISCOUNT CARD
§ Benzodiazepines.
To access your member discount when purchasing drugs that are not excluded by CMS, simply present
your prescription and member ID card at any Aetna Rx Savings CardE pharmacy nationwide. You will
automatically receive Aetna’s negotiated discount or the pharmacy’s customary price, whichever is lower.
Please note that discounts may vary based on pharmacy, geographic location or enrollee.
For your information, we’ve listed the top 100 prescription drugs used by people eligible for Medicare,
along with their most frequently prescribed doses and our discounted price per unit, on pages 21
through 25. The list is divided into two sections: the first lists the 50 most frequently purchased
brand-name prescription drugs; the second lists the 50 most frequently purchased generic prescription
drugs.
For more information about Aetna Rx Savings Card discount drugs, to find out if a specific drug is
covered, or to determine the price of a drug, please call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322), Monday through Friday, 8 a.m. to 4:30 p.m.
WHERE CAN I FIND UP-TO-DATE DRUG PRICING?
The Aetna Rx Savings Card offers discounts on all brand-name and generic prescription drugs except
those excluded by CMS. To obtain the most up-to-date discount prices, including Medicare price
comparison information, call Member Services toll free at 1-866-895-1649 (for the hearing impaired,
call TDD:1-888-339-7322) or visit www.medicare.gov.
If you disenroll from the Aetna Rx Savings Card during 2004 and wish to enroll in another
Medicare-Approved Drug Discount Card for 2005, you will be required to reapply. If you think you are
eligible to receive an Additional Assistance Credit, you must apply or reapply for the credit. You may also
be required to pay a new annual enrollment fee if you do not qualify for the Additional Assistance Credit.
If you reapply and are considered eligible for a new Medicare-Approved Drug Discount Card during the
Annual Coordinated Election Period, the earliest effective date of that card, and receipt of any Additional
Assistance Credit (if you qualify), will be January 1, 2005. If you reapply for an Additional Assistance
Credit later than March 31, 2005, your credit will be prorated. For example:
Eligibility Date
Amount Medicare Will Pay
Jan. 1 - March 31, 2005
$600
April 1 - June 30, 2005
$450
July 1 - Sept. 30, 2005
$300
Oct. 1 - Dec. 31, 2005
$150
Important note: If you disenroll during 2005, and are not eligible for a special enrollment period, you
will be ineligible for enrollment in any Medicare-Approved Drug Discount Card and will not qualify for
any Additional Assistance Credit.
AETNA RX SAVINGS CARDE SERVICE AREA
To be an Aetna Rx Savings Card member, you must reside in Aetna’s service area, which includes all 50
states and Washington D.C. If you move to a location outside of the Aetna Rx Savings Card service area
you will be disenrolled. If you wish to enroll in a new Medicare-Approved Drug Discount Card, you will
qualify for a Special Election Period.
20
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
13
Other Services from Aetna
In addition to prescription drug discounts and the opportunity to receive an Additional Assistance Credit
through the Aetna Rx Savings Card, Aetna is pleased to provide our members the following services at
no additional cost:
§ Vitamin AdvantageF: A program that allows enrollees to save on the purchase of over-the-counter
vitamins and nutritional supplements. These products are available through special arrangements with
three vendors: Amerifit, Inc., InterNatural and WebVitamins, Inc. To access this additional benefit
please visit www.aetna.com/products/natural_al_99.html.
§ Aetna InteliHealth’s Drug Resource Center: A web-based resource that provides enrollees with
access to important medication information, including an “Ask the Pharmacist” option. To access
this additional benefit please visit www.intelihealth.com.
Aetna, in conjunction with Aetna Rx Savings CardE pharmacies, will also provide you with drug
utilization evaluation information at no additional cost. This includes notifying Aetna Rx Savings Card
pharmacies of potential drug therapy conflicts, including medication errors and adverse drug reactions
from prescriptions you receive through the Aetna Rx Savings Card. The immediate identification and
resulting intervention of these potential conflicts will result in a higher quality of care for you. For more
information, talk to your pharmacist or call Member Services toll free at 1-866-895-1649 (for the
hearing impaired, call TDD: 1-888-339-7322).
What to do if You Have Problems or Complaints
If, at any time, you have concerns or problems related to the Aetna Rx Savings Card, you have the right
to file a “grievance” or complaint.
For example, you may file a grievance if:
§ you have a problem calling Aetna Rx Savings Card Member Services;
§ you are unhappy with the service from Aetna or an Aetna Rx Savings Card pharmacy;
§ one of the Aetna Rx Savings Card pharmacies:
> fails to sell you a prescription drug at or below the advertised discount price. Prescription drugs and
prices covered by the Aetna Rx Savings Card are subject to change. To ensure you have the most
recent information, call Member Services toll free at 1-866-895-1649 (for the hearing impaired,
call TDD: 1-888-339-7322);
> will not apply the balance of your Additional Assistance Credit or fails to inform you of the
Additional Assistance Credit amount you have left;
> does not charge you the lower of the Aetna negotiated discount or the pharmacy’s customary price;
> fails to inform you of the difference in price between your brand-name prescription drug and a
generic equivalent, if available.
14
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Medicare-Approved Drug Discount Cards: Cards offered by Aetna or other entities to help people with
Medicare save money on their prescription drugs. These cards are not offered by the Medicare program.
Medicare Managed Care Plan: Available in some areas of the country, most Medicare Managed Care
plans offer health care coverage only when you go to doctors, specialists, or hospitals on the plan’s list or
network. Some plans must cover extras, like prescription drugs. Through a Medicare Managed Care plan,
your health care costs may be lower than they would be with the Original Medicare plan.
Medicare Prescription Drug Benefit (Part D): In 2006, Medicare will offer a prescription drug benefit,
called Part D, as part of the Medicare program. Until 2006, Aetna and other private companies are
offering drug discount cards that have been approved by Medicare. In 2006, the Medicare prescription
drug benefit will replace the Medicare-Approved Drug Discount Cards.
Medigap Policy: A Medicare supplement insurance policy sold by private insurance companies to fill the
“gaps” in the Original Medicare plan. Except in Massachusetts, Minnesota, and Wisconsin, there are 10
standardized plans, labeled Plans A through J. Medigap policies only work in conjunction with the
Original Medicare plan.
Special Election Period: If you disenroll from the Aetna Rx Savings Card for one of the special reasons
listed below, you will be given a Special Election Period and will be allowed to enroll in another
Medicare-Approved Drug Discount Card any time until the program ends or December 31, 2005,
whichever comes later.
You will be given this Special Election Period only if:
§ you move out of the Aetna Rx Savings Card service area; or
§ you enter or leave a skilled nursing facility (such as a nursing home); or
§ you enroll in, or disenroll from, a Medicare Managed Care Plan; or
§ Aetna stops offering the Aetna Rx Savings Card.
For more information about complaints or grievances, call Member Services toll free at 1-866-895-1649 (for
the hearing impaired, call TDD: 1-888-339-7322), Monday through Friday, 8 a.m. to 4:30 p.m., or write
to us at: Aetna Rx Savings Card, Aetna Administrator, 333 E. Wetmore Rd., 4th Floor, Tucson, AZ 85705.
You may also contact Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call
1-877-486-2048.
If you file a complaint, Aetna must be fair in how we handle it. We cannot discriminate against you or
mistreat you because you made a complaint.
How to Help Protect Yourself and Medicare from Fraud
If you believe you were not charged the correct price for a prescription drug, or if you believe your
Additional Assistance Credit was applied toward a prescription you never obtained, contact the
pharmacist or Member Services at 1-866-895-1649 (for the hearing impaired, call TDD:
1-888-339-7322). If you are not satisfied after speaking with the pharmacist or Aetna, and you still
suspect fraud, you should call the Office of the Inspector General for the Department of Health and
Human Services, which investigates health care fraud, toll free at 1-800-HHS-TIPS (1-800-447-8477).
Frequently Asked Questions
What is the Aetna Rx Savings Card?
Medicare is contracting with private companies that voluntarily agree to offer Medicare-Approved Drug
Discount Cards, such as the Aetna Rx Savings Card, which provide members with access to savings on
covered prescription drugs when using designated pharmacies.
Who is eligible for the Medicare-Approved Drug Discount Card?
To qualify for a Medicare-Approved Drug Discount Card, you:
§ must have Medicare Part A and/or Medicare Part B; and
§ cannot have outpatient prescription drug coverage under Medicaid (sometimes called Medical Assistance).
For more information on the eligibility criteria for this card, call Member Services at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322). You may also call Medicare at
1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Aetna Rx Savings Card is a prescription drug discount card that is approved by Medicare but is not
a Medicare benefit. Aetna Rx Savings Card is not intended to replace prescription drug benefits obtained
through participation in insurance plans, including a Medicare Advantage plan (formerly Medicare+Choice),
a Medigap policy, Medicaid, or an employer or retiree plan. Discounts vary by drug. Contact the Aetna Rx
Savings Card to find out if your prescription drug is covered and the discounted price.
18
Who is eligible for an Additional Assistance Credit?
If you meet specific income requirements you may be eligible to receive an Additional Assistance Credit
of up to $600 per year from Medicare to help pay for prescriptions obtained through the Aetna Rx
Savings Card.
To qualify for an Additional Assistance Credit, you must:
§ have Medicare Part A and/or Part B; and
Medical Security Card Company is the Aetna Rx Savings Card Administrator.
§ not have other health insurance with any prescription drug coverage (except a Medicare Advantage
plan [formerly Medicare+Choice] or a Medigap policy); and
“Aetna” is the brand name used for products and services provided by one or more of the Aetna group
of subsidiary companies.
§ have an income that is no more than $12,569 if you are single (or, in Alaska, no more than $15,701;
in Hawaii, no more than $14,445), or $16,862 if you are married (or, in Alaska, no more than
$21,074; in Hawaii, no more than $19,386; this includes your income and your spouse’s income).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
15
For more information on the eligibility criteria for an Additional Assistance Credit, call Member Services
toll free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322). You may also call
Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Will I save on all of my prescription drugs with the Aetna Rx Savings Card?
The Aetna Rx Savings Card covers all brand-name and generic prescription drugs except those excluded
by the Centers for Medicare & Medicaid Services (CMS). For a list of the top 100 prescription drugs used
by people eligible for Medicare, see page 21.
How will I know if the Discount Drug List changes?
To find out more about prescription drugs covered in this program and their current prices, call Member
Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322), or access
an online listing at www.medicare.gov. Please note that the drug prices provided through the Aetna Rx
Savings Card have a date indicating when they last changed and when they may change again.
What if my doctor changes my prescription(s) after I sign up?
If your doctor prescribes a drug that is not covered by the Aetna Rx Savings Card, or, if your doctor
changes your prescription(s) after you sign up, you or your physician, on your behalf, may call the Aetna
Rx Savings Card toll free at 1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322) to
confirm whether your prescription is covered. If not, your physician may then determine if a drug that is
covered may be effective for your condition.
Can I go to any pharmacy?
In order to get discount prices through the Aetna Rx Savings Card, or to use an Additional Assistance
Credit (if you qualify), you must fill your prescriptions at any Aetna Rx Savings CardE pharmacy
nationwide. Aetna has included a list of designated pharmacies in your area (based on your zip code or
county) on the inside cover of this packet. For a list of Aetna Rx Savings Card pharmacies in other areas,
call Member Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD:
1-888-339-7322). (See page 9 for more information.)
Can I switch from the Aetna Rx Savings Card to another Medicare-Approved Drug Discount Card?
You may disenroll from the Aetna Rx Savings Card at any time. To disenroll, send a letter or email stating
your reason for disenrollment. Your letter should be sent to Aetna Administrator, 333 E. Wetmore Rd., 4th
Floor, Tucson, AZ 85705. Your email should be sent to [email protected].
Depending on your reason for disenrolling, you may not be able to enroll in a new Medicare-Approved
Drug Discount Card right away. If you qualified for an Additional Assistance Credit, you may also lose
any remaining amount. (See page 13 for more information.)
What if I have a complaint about Aetna?
If you have concerns or problems related to the Aetna Rx Savings Card, or you are unhappy with Aetna’s
service, you may file a complaint (or “grievance”) by calling Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322), Monday through Friday, 8 a.m. to 4:30 p.m.
You can also call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
(See page 14 for more information).
16
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
What should I do if I need a prescription filled in an emergency?
If you need to have a prescription filled in an emergency, please be sure to keep a receipt of the
prescription. As soon as you are able, you should call Member Services for more information at
1-866-895-1649 (for the hearing impaired, call TDD: 1-888-339-7322).
How can I get more information?
For help or more information about the Aetna Rx Savings Card, you may:
§ Call Member Services toll free at 1-866-895-1649 (for the hearing impaired, call TDD:
1-888-339-7322), Monday through Friday, 8 a.m. to 4:30 p.m.
§ Write to us at: Aetna Rx Savings Card, Aetna Administrator, 333 E. Wetmore Rd., 4th Floor, Tucson,
AZ 85705.
§ Send us an email at [email protected].
§ Visit our web site at: www.aetna.com.
§ Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
§ Visit www.medicare.gov and select “Prescription Drug and Other Assistance Programs.”
Glossary
Aetna Rx Savings CardE Pharmacy: An Aetna Rx Savings Card pharmacy is contracted to offer Aetna Rx
Savings Card members the ability to purchase drugs at a discount. Aetna Rx Savings Card members who also
qualify for an Additional Assistance Credit can only use this credit at an Aetna Rx Savings Card pharmacy.
Annual Coordinated Election Period: The period from November 15 to December 31, 2004, during
which you may switch from one Medicare-Approved Drug Discount Card to another, with changes
taking effect January 1, 2005.
Brand-Name Drugs: Drugs that are produced and sold under the names created by the companies that
manufacture them.
Discount Drug List: The discount drug list includes the top 100 prescription drugs used by people
eligible for Medicare (see page 21), which you can receive at a discount through the Aetna Rx Savings
Card. To learn more about how the Aetna Rx Savings Card can help you access discounts on all
brand-name and generic prescription drugs, except those excluded by the Centers for Medicare &
Medicaid Services (CMS), call Member Services toll free at 1-866-895-1649 (for the hearing impaired,
call TDD: 1-888-339-7322).
Generic Drugs: Drugs that generally cost less than their brand-name counterparts, yet have the same
active ingredient formula and are rated by the Food and Drug Administration (FDA) to be as safe and
effective as brand-name drugs.
Grievance: A complaint you may have about the Aetna Rx Savings Card or the way Aetna Rx Savings
Card pharmacies are serving you.
Medicaid: A joint federal and state program that helps with medical costs for some people with low
incomes and limited resources. Medicaid programs vary from state to state, but most health care costs
are covered if you qualify for both Medicare and Medicaid.
Questions? Call Member Services toll free at 1-866-895-1649
(for the hearing impaired, call TDD: 1-888-339-7322).
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