Information about aetna prescription drug claim form





 
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Prescription Drug Benefits
 

 
 

 
 

Washington State Rx Services
2010 Prescription Drug Benefits

Your prescription drug benefit is managed by Washington State Rx
Services (not Aetna). Washington State Rx Services is a program
administered by the Washington State Health Care Authority.
With Washington State Rx Services, you can:

Pay a flat-rate copay for each prescription.
Fill prescriptions at retail or through mail order.

Receive prescriptions by mail in 10 business days or less.
Refill mail-order prescriptions online or over the phone.

Track your prescription drug history online.
When you have questions regarding your prescription drug coverage,
call Washington State Rx Services at 1-888-361-1612.

Finding a Network Pharmacy
Washington State Rx Services’ pharmacy network includes most
pharmacies in Washington State as well as national chains. Use the
Pharmacy Locator tool or call Washington State Rx at 1-888-361-1612 to
see if your pharmacy is in the network.
Ordering Prescriptions through Mail Order
Wellpartner is Washington State Rx Services’ mail-order pharmacy. To
order a new prescription by mail, your provider can fax in a
prescription or you can mail in the written prescription using
Wellpartner's order form PDF. To order refills, call 1-800-815-3539
or order through your online pharmacy account.

An Easy Way to Check What Drugs Are Covered
Use the new searchable version of the Washington State Rx Preferred
Drug List (PDL), a list of prescription drugs covered under your
prescription drug benefit. Using the searchable PDL, you can find out:
The drug tier level.

If the drug must be precertified.
If there are any limits on its coverage.

Whether there are less expensive alternatives.
How Much Will I Pay for Prescription Drugs in 2010?
The following table shows the copay for each drug tier for 2010. You
can find the tier for your prescription drug by checking the
Washington State Rx PDL or by calling
1-888-361-1612.

At a Network Retail Pharmacy
(copay per 30-day supply)
Through Washington State Rx Services
Mail-Order Pharmacy
(copay per 90-day supply)

Tier 1
Generic drugs
$20 copay

$40 copay
Tier 2
Preferred brand-name drugs

$40 copay
$80 copay

Tier 3
Nonpreferred brand-name drugs and compounded prescriptions
$60 copay
Tier 3 drugs that have a generic equivalent have an ancillary charge.
See below.

$120 copay
Tier 3 drugs that have a generic equivalent have an ancillary charge.
See below.
If the drug costs less than the copay, you pay the lower cost. You can
fill a prescription for up to a 90-day supply at retail, but you will
pay three copays – one copay for each 30-day supply.

Ancillary Charge: You May Pay More for Tier 3 Drugs With a Generic
If a Tier 3 drug has a generic equivalent, you pay the Tier 1 copay
plus the difference between the cost of the brand-name drug and its
generic equivalent.
If you don't know if your Tier 3 drug has a generic equivalent, call
Washington State Rx Services at 1-888-361-1612 or check the PDL.
Generic drugs have the same active ingredient as the more expensive
brand-name version. Ordering generic drugs may save money for you and
the plan.

Should I Buy My Prescriptions at Retail or Through Mail Order?
Prescriptions are limited to a 30-day supply at retail. You can
purchase up to a 90-day supply at retail, but you must pay three
copayments. So if you need more than a
30-day supply, you should consider using the Wellpartner mail-order
pharmacy. If you take a maintenance medication on a continuing basis,
you’ll save money when you buy a 90-day supply through mail order.
How Do I Order Specialty Drugs?
You must order your specialty medications by mail order from BioScrip
by calling 1-877-316-8921 (24 hours a day, 7 days a week). Most
specialty drugs require preauthorization. A patient care coordinator
will contact your provider to review the coverage criteria and
authorize the prescription if the criteria are met. The patient care
coordinator will then work with you to schedule a delivery time and
place for the medication.

Access Your Pharmacy Account
Order drugs online or check your drug history.
Preferred Drug List (formulary)
Check what drugs are covered.

Prescription Price Check Tool
If you have other coverage that is primary, your out-of-pocket costs
may be different.
Pharmacy Locator Tool

Mail-Order Pharmacy Form (PDF)
Prescription Drug Coverage Claim Form (PDF)
Use this form to be paid for drug purchases at non-network pharmacies
or when Aetna is your secondary plan.

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