We can get really stumped out there in the field sometimes when someone is on a lot of medications, or they take medications not on Aetna Medicare’s formulary. What would you do in this case?
Additional resources attached:
Sales & Enrollments
2023 Common Formulary Drug Alternatives
Pard D Coverage Form
Here are some tips and best practices with reviewing medications.
Tip #1. The best way to analyze a person’s medications is through Think Agent. Guide attached on ThinkAgent.
- It also can be helpful to use medicare.gov to view their current plan costs, especially during AEP with shoppers. Find out how their current plan is changing during AEP and how you can save them $.
Tip #2. Don’t assume just because someone is a full dual that their medications are covered.
- Yes, they will cost $0 BUT you MUST make sure all Rx’s are on the formulary and don’t have any rules (ST, PA, QL)
Tip #3. Always enter the medication exactly how it is labeled, including the dosage.
- Pay special attention to CAP (capsule) vs. TAB (tablet) vs. SUP (suppository) vs. SUS (suspension/liquid). Selecting the wrong dosage can cause a medication to come up not covered when it’s indeed covered.
Tip #4. If the generic is coming up not covered, try the brand name instead.
- This is very important right now because most insulin brands are coming out with generics that aren’t on the 2023 formulary yet. We don’t always cover the generics as soon as they come on the market. So, always be diligent and try the brand name instead.
Tip #5. The pharmacy matters so check that too. Is it standard? Preferred?
Tip #6. Know your Rx alternatives for those medications we don’t cover. List attached! Save it. Print it. Keep it handy.
Tip #7. Have some Rx coverage determination forms on hand. (Attached).
I hope this helps when dealing with challenging prescription needs.
This information will also be good to refer to during the upcoming AEP. Please save it, and I will forward 2024 formulary information when it becomes available.
