Open Choice PPO

Discount Prescription Drug Programme (Aetna Pharmacy Management)

The Aetna Pharmacy Management prescription drug programme (APM) is administered by Aetna. APM delivers significant savings both to programme participants and to the Organization because of significant price discounts obtained from participating pharmacies. APM provides the retail pharmacy network as well as a mail order pharmacy through Aetna Rx Home Delivery.

Significant cost savings are passed on to participants in either a participating retail pharmacy or the mail order pharmacy. In respect of drugs obtained at participating retail pharmacies, the discounts are at least 15 per cent off the average wholesale price (AWP) of the drug.

If the physician does not write "Dispense as Written" or "DAW" on the prescription, the pharmacist will fill the prescription with a therapeutically equivalent generic drug if one is available. Discounts for generic drugs are typically higher than for brands, and the discount off the AWP may average 40 per cent or more, depending on the particular generic drug dispensed.

The discount for maintenance drugs obtained by mail through Aetna Rx Home Delivery ranges from 18 per cent to as high as 50 per cent off AWP, depending on whether a generic equivalent to the brand-name drug is dispensed. (Maintenance drugs are drugs used on a continual basis for the treatment of chronic health conditions.) Whenever a prescription carries the words "Dispense as Written" or "DAW", the pharmacist or mail order pharmacy will fill the prescription accordingly and no substitution will be made.

The procedure under which prescription drugs are reimbursed through the Aetna Pharmacy Management programme is as follows: written prescriptions for drugs are presented at a participating pharmacy of one's choice, along with the Aetna card (please refer to Annex 6). The pharmacist will fill the prescription for up to a 30-day supply and charge a co-insurance of 20 per cent based upon the discounted price of the drug. The minimum co-insurance will be the lesser of the cost of the prescription or $5, and the maximium co-insurance amount will never be more than $20 per prescription. No claim form is required for prescriptions filled at participating pharmacies.

Aetna Rx Home Delivery - Aetna's mail order service

Obtaining prescription drugs through Aetna Rx Home Delivery is a simple process. First, ask your physician for a 90-day prescription with up to three refills for each of the medications that you take regularly. Then, complete and mail the Aetna Rx Home Delivery order form together with your original prescription and $15 co-pay, to the address on the order form (do NOT send cash). The order form is submitted with your first prescription only. Order forms can be obtained from the Insurance and Disbursement Service website at http:/www.un.org/Insurance under "Forms and Circulars", or from the Aetna website at http://www.aetna.com. Within the Aetna website, click "Members and Consumers", then "Services and Tools" and then, "Mail Order Drug". Aetna Member Service will also mail or fax you a form if you do not have Internet access.

Your prescriptions will be filled and mailed in a secure package to the address you supply on the order form, within 7 to 10 days after the order is received by Aetna.
Obtaining refills is also easy to do. Each time you receive medications by mail, you will receive a receipt that indicates when you can request a refill. You can request the next refill by phone (1-866-612-3862) or by using the Internet, at www.aetnarxhomedelivery.com/ or, if you prefer, you may use the reorder form that Aetna also encloses in the package with each filled prescription. If you wish to use the Internet, you first need to register on the Aetna Rx Home Delivery Internet site. Registration must be done only once. Please take note that most prescriptions, including refills, expire in one year and sometimes sooner. After the expiration date, you must obtain a new prescription from your doctor and send it to Aetna Rx Home Delivery, even if the old prescription still shows refills remaining.

The cost to you for using Aetna Rx Home Delivery is only $15 per 90-day prescription, as opposed to a possible $60 if filled at a retail pharmacy (based on retail co-pay of $20 per 30-day prescription).

Please also note that Aetna Rx Home Delivery will fill the prescription with a United States-approved generic equivalent, unless the physician has written "Dispense as Written" or "DAW" on the prescription. If the prescription includes this notation from the physician, the prescription will be filled accordingly and you will be charged only the $15 co-pay. If the prescription does not include this notation from the physician, and you request a brand-name drug, then you will be charged the $15 co-pay PLUS the difference in price between the brand-name drug and the generic drug.

As the Aetna prescription drug programme benefit is administered separately by Aetna Pharmacy Management, the annual deductible under the Aetna plan will not be applied to prescription drugs obtained at network pharmacies. At the same time, prescription drug co-payment expenses will not count towards meeting the annual co-insurance limit of $1,000 per individual. Prescription drugs obtained at pharmacies in the United States, but not through network pharmacies, will be reimbursed at 60 per cent and be subject to deductible. In addition, the 40 per cent co-insurance amount will not count towards the annual out-of-pocket limit. Prescription drugs obtained outside the United States will be reimbursed through submission of the standard claim form to the Aetna claims address. In such cases, the annual deductible will have to be met before reimbursement is made, as well as the 20 per cent co-insurance, which will not count towards meeting the annual limit of $1,000.