Aetna Specialty CareRx

Aetna Specialty CareRx is a pharmacy benefit/insurance plan that covers certain specialty drugs. You may get your first fill of these drugs at a retail pharmacy. To achieve best coverage, all refills must come from an in-network specialty pharmacy, like Aetna Specialty Pharmacy^®. Your plan may require you to get your refills through Aetna Specialty Pharmacy. Please review your plan documents for more about the requirements and limitations of your pharmacy plan.

Depending on your plan, you will either have the “Aetna Specialty CareRx – Self Injectables, Infused and Oral Drug List” or the “Aetna Specialty CareRx – Self Injectables Drug List”. Your drug list shows you which specialty drugs are covered by your Aetna Specialty CareRx pharmacy benefit plan.

• 2012 Aetna Specialty CareRx – Self Injectables, Infused and Oral Drug List  (PDF, 724 KB)
  (Effective as of January 1, 2012)
  
• 2012 Aetna Specialty CareRx – Self Injectables Drug List  (PDF, 688 KB)
  (Effective as of January 1, 2012)
  

Frequently Asked Questions 

• Understanding Aetna Specialty CareRx 
  
• Impacted Drugs 
  
• How to order your medication 
  
• What you can expect to pay 

Understanding Aetna Specialty CareRx

What is Aetna Specialty CareRx? 
Aetna Specialty CareRx refers to a pharmacy benefit plan design for certain specialty drugs. You may get your first fill of these drugs at a retail pharmacy. To achieve best coverage, all refills must come from an in-network specialty pharmacy, like Aetna Specialty Pharmacy. Your plan may require you to get your refills through Aetna Specialty Pharmacy. Please refer to your plan documents to learn more.

What is Aetna Specialty Pharmacy?
Aetna Specialty Pharmacy is specialty pharmacy that is a subsidiary of Aetna. Aetna Specialty Pharmacy offers specialty medications and ongoing support for members with certain high-cost, high-risk chronic health conditions.

What is the Aetna Specialty CareRx drug list?
There are two different lists. Depending on your plan, you will either have the “Aetna Specialty CareRx – Self Injectables, Infused and Oral Drug List” or the “Aetna Specialty CareRx – Self Injectables Drug List”. Although the names of these lists are very similar, the differences are important. This is especially true if you will need specialty drugs that are taken by mouth or specialty drugs that are given by infusion. An infusion takes place when a liquid solution is introduced into the body through a vein, for example.

Your drug list shows you which specialty drugs are covered by your Aetna Specialty CareRx pharmacy benefit plan. You may get your first fill of these drugs at a retail or specialty pharmacy. To achieve best coverage, all refills must come from an in-network specialty pharmacy, like Aetna Specialty Pharmacy. Your plan may require you to get your refills through Aetna Specialty Pharmacy.

You should review your plan documents for more detail about the requirements and limitations of your pharmacy benefits plan.

Impacted Drugs 

What is a specialty drug?
Specialty drugs are unique. They treat chronic health conditions (such as hemophilia, rheumatoid arthritis, multiple sclerosis and cancer). They can be expensive and retail pharmacies often do not carry them. A specialty drug may need to be refrigerated and it should be delivered quickly. A specialty drug can be injected, infused or taken by mouth.

When you take these types of drugs, you should be monitored closely. As with many specialty drugs, there is a risk for side effects. So a pharmacist or nurse should check in with you often during your treatment.

It is important to take your specialty drugs just how your doctor has prescribed. Aetna Specialty Pharmacy is available to offer you the specialty medications and extra support you need throughout your treatment.

The drugs impacted by Aetna Specialty CareRx are considered specialty drugs, as defined by Aetna. They are covered under you plan of benefits, as described in your summary of coverage.

What kind of drugs are impacted by Aetna Specialty CareRx?
It depends on what your plan says. Your plan with Aetna Specialty Care Rx might apply certain requirements to a variety of specialty drugs – drugs that can be injected, drugs that are infused or oral drugs you take by mouth. These specialty drugs are subject to the “Aetna Specialty CareRx –Self-Injectables, Infused and Oral Drug List”. Or, your plan might only apply to specialty drugs that are self-injected. These specialty drugs are subject to the “Aetna Specialty CareRx –Self-Injectables Drug List”. Either way, you must follow your plan’s guidelines for the drugs covered under the “specialty drug” classification.

See which drugs are impacted by your Aetna Specialty CareRx plan: 

• Aetna Specialty CareRx – Self-Injectables, Infused and Oral Drug List  (PDF, 724 KB)
• Aetna Specialty CareRx – Self-Injectables Drug List  (PDF, 688 KB)

How to order your medication

How do I order drugs on the Aetna Specialty CareRx drug list?
If you require one or more of the drugs on your Aetna Specialty CareRx drug list, your doctor can order it for you. To get the highest level of benefits from your prescription drug coverage, you need to get these drugs from a participating specialty pharmacy, like Aetna Specialty Pharmacy.

Please know that there are two different versions of the Aetna Specialty CareRx drug list: one that includes self-injectable specialty drugs only and one that includes self-injectable, infused and oral specialty drugs. You should review your plan documents for more detail about which drug list your plan refers to.

Remember these tips to get the most from your specialty prescription drug coverage: 

• Your coverage is not limited to drugs on this list.
• Some drugs on this list may not be covered by your specific Aetna benefits plan.
• You may get the first fill of the drugs on this list at a retail or specialty pharmacy. Depending on your pharmacy plan, you may need to pay a copayment or coinsurance.
• You must get refills from a participating specialty pharmacy, like Aetna Specialty Pharmacy. This will ensure that you get the most from your prescription drug coverage.
• If your doctor supplies and administers these drugs, he or she may continue to do so. Your drug may continue to be covered by your medical plan. Depending on your medical plan, you may need to pay a copayment or coinsurance.
• Please review your benefits plan for more detail.

What do I do if I need to place an urgent order?
When you use Aetna Specialty Pharmacy, a complete order is delivered within 24 to 48 hours of confirming it, or as scheduled to meet your needs. If your prescription is missing information or if it requires precertification, this can impact your delivery time, even in urgent situations.

In emergency situations, please contact your doctor. If appropriate, Aetna Specialty Pharmacy has the ability to coordinate a same-day delivery. Or, they may be able to help you get a short-term supply of your medication from a retail pharmacy near to you.

How can I place an order with Aetna Specialty Pharmacy?
You or your doctor can send in your prescription order. It’s easy and fast. Choose one of the following ways to submit:

• Fax - Your doctor may fax your prescription to 1-866-FAX-ASRX (1-866-329-2779).
  
• Mail - You or your doctor may mail your prescription order to: Aetna Specialty Pharmacy, 503 Sunport Lane, Orlando, FL 32809. If you mail in your own prescription, please send it along with a completed Patient Profile Form  (PDF, 69 KB). To access this form, visit www.AetnaSpecialtyRx.com and click "Enroll"
  
• Phone - Your doctor may also call and speak to one of our registered pharmacists at 1-866-782-ASRX (1-866-782-2779) during our normal business hours of 8 a.m. until 7 p.m. ET.

What are the advantages of ordering through Aetna Specialty Pharmacy?
With Aetna Specialty Pharmacy, you get a personal care plan and ongoing support

• Nurses and pharmacists who specialize in your needs can offer help 24 hours a day, every day.
• Care coordinators work with you to help your order process quickly.
• Insurance and claims specialists help you to maximize your benefits plan.
• Service representatives reach out to you or your doctor to set up your refills.

Aetna Specialty Pharmacy’s standard is to fill medications for no more than a 30-day supply 
A smaller supply lets them check your progress more often. If your medication or dose changes between refills, a smaller supply can help prevent waste and may save you money. Aetna Specialty Pharmacy can only dispense what your benefits plan allows. Any out-of-pocket costs will also depend on your benefits plan.

Aetna Specialty Pharmacy offers other helpful services, including: 

• Free, secure delivery within 48 hours of confirming your order, or later if you request.
• Delivery to your home, doctor’s office or any other location you choose.
• Package tracking to ensure prompt delivery of your order.
• Self-injection training/education about your condition and medication.
• Flexible payment options for out-of-pocket costs, when necessary.
• Free injection supplies, such as needles, syringes, alcohol swabs, adhesive bandages and Sharps containers for needle waste, if needed.

When using Aetna Specialty Pharmacy, when can I expect to receive my order?
You will receive your medication with 24 to 48 hours of your order being confirmed. Or, your order will be scheduled for delivery to meet your specific needs. This means that if you request to receive your medication a week after your order is confirmed, Aetna Specialty Pharmacy can accommodate that request. If your prescription is missing information or if it requires precertification, this can impact your delivery time. For more information, visit www.AetnaSpecialtyRx.com.

When using Aetna Specialty Pharmacy, where will my order be delivered?
Aetna Specialty Pharmacy processes the order and ships specialty drugs to an agreed-upon address (determined by you and your doctor). This may be your home, your doctor’s office or any other location you choose. A package tracking program watches your order throughout the delivery process to make sure it arrives on time.

Is Aetna Specialty Pharmacy the only place I can order specialty drugs from?
Depending on your drug, you may be able to get some self-injectables from either Aetna Specialty Pharmacy or a participating retail pharmacy. Using Aetna Specialty Pharmacy may be a better choice for you because you will get support from registered nurses, pharmacists, care coordinators, and insurance and claims specialists. Aetna Specialty Pharmacy may also reduce your out-of-pocket costs, depending on your plan design. (All applicable copays apply.)

What you can expect to pay

How are Aetna Specialty CareRx drugs covered - by my pharmacy or medical benefit plan?
If you take a drug subject to the Aetna Specialty CareRx benefit design, that is prescribed by your doctor with a prescription, but injected by you or your caregiver(s), it will be covered by your Aetna Pharmacy benefit plan.

If you take a drug subject to the Aetna Specialty CareRx benefit design, that is given without a prescription, or if your doctor supplies the drug for you and gives you your injection, it will be covered by your Aetna Medical benefit plan. Drugs commonly given without a prescription or supplied directly by your doctor are noted on the Aetna Specialty CareRx drug lists with a plus sign (+) next to the drug name.

Please note that self-injectable drugs not subject to the Aetna Specialty CareRx Drug lists are covered under your ordinary pharmacy benefit, not your Aetna Specialty CareRx benefit. These drugs currently include, for example, Byetta, Glucagon, Symlin, Epinephrine Kits, Erectile dysfunction drugs, Insulin, Imitrex and Miacalcin. They are subject to your pharmacy benefit’s appropriate copay.

How can I be sure I’m covered for drugs on the Aetna Specialty CareRx drug lists?
Keep these tips in mind:

•  Know where to go - To get the most from your benefits plan, get your specialty drugs from a participating specialty pharmacy, like Aetna Specialty Pharmacy.
  
• Talk to your doctor - Some of the drugs in the Aetna Specialty CareRx – Self-Injectable Drug List and the Aetna Specialty CareRx – Self-Injectable, Infused and Oral Drug List are marked with a plus sign (+) next to the drug name. If you require one of these particular drugs, and if your doctor supplies and administers the drug to you, he or she may continue to do so without requiring you to get refills through a specialty pharmacy. In these instances, the drug will be covered under your medical plan.
  
• Check the price online - Depending on your plan, you may be required to pay a copay or coinsurance. These are your out-of-pocket costs. To check the current price you may need to pay out of pocket, use our Price-A-Drug^SM tool. To access it, go to www.aetna.com and log into Aetna Navigator^®, your secure member website. Look for our Cost of Care tools.
  
• Your drug may need to meet other criteria to be covered - Some of the drugs on the Aetna Specialty CareRx lists require precertification. This means they will not be covered unless your doctor asks us to approve this drug for you, and that your situation meets our criteria for using this drug. This applies to drugs that:
  • Are often taken in the wrong way
  • Should only be used for certain conditions
  • Often cost more than other drugs that are proven to be just as effective

What will my copayment be?
If Aetna Specialty CareRx drugs are covered under your pharmacy benefit, they may be subject to the copayment or co-insurance that applies to your pharmacy plan. This is in addition to any applicable plan deductibles. This means you may have to pay out-of-pockets costs.

If covered under your Aetna Medical benefits, these medications may involve a copayment, like your other medical benefits, in addition to any applicable deductibles, depending on your plan.

For more questions on your copayment, please refer to your certificate of coverage. To access it, visit www.aetna.com and log in to your secure member website, Aetna Navigator. You may also contact Member Services toll-free at the phone number on your Aetna Member ID card.

Will I have a different copay for a brand or generic drug? A preferred or non-preferred drug?
Based on your prescription plan, you may have different copayments for brand and generic specialty drugs. This means you may pay different copay or co-insurance levels.

Drugs subject to the Aetna Specialty CareRx benefit design may also be preferred or non-preferred. Depending on your plan, your pharmacy copayment may be lower for a preferred drug than for a non-preferred drug.

For more information, visit our Medication Search tool. To access it, visit www.aetna.com and log in to your secure member website, Aetna Navigator. You can also refer to your plan documents. Or, call Member Services toll-free at the phone number on your Member ID card.