Preventive Medications Feature

Transcription

1 Preventive Medications Feature Aetna HealthFund Health Savings Account Health Insurance Plans Reducing your out-of-pocket costs for the medications you need (1/06)

2 January 6 Jennifer s cholesterol level puts her at risk for health problems such as heart disease and a stroke. Her doctor has prescribed Zocor, a cholesterol-lowering medication, to help manage her high cholesterol. Jennifer fills her Zocor prescription monthly. Zocor is a brand drug on Aetna s formulary list and costs $130 at Aetna s discounted rate. Jennifer has not yet met her deductible, but she has the preventive medications feature, which means her deductible is waived and she is allowed to fill her prescription using the prescription drug coinsurance benefit. The plan pays 70% ($91) and Jennifer s coinsurance is 30% ($39), which she pays out of pocket and does not apply toward her deductible. January 22 Jennifer s doctor prescribes the antibiotic Cipro to treat Jennifer s sinus infection. Cipro is a brand formulary drug and its discounted rate is about $170. Because Cipro is not a preventive drug and Jennifer has not yet met her deductible, her coinsurance benefit does not yet apply. She pays the $170 out of pocket, which is applied to her deductible. February 6 Jennifer refills her prescription for Zocor, and because she has the preventive medications feature, the deductible is waived and the prescription drug coinsurance benefit provides coverage. The plan pays 70% ($91) and Jennifer pays 30% ($39) out of pocket, which does not apply toward her deductible. Jennifer continues to refill her prescription for Zocor through the end of the year. Each month, the deductible is waived and her share of coinsurance is 30% or $39 each month. November 15 Jennifer gets another sinus infection and her doctor again prescribes Cipro. Because she has filled other prescriptions throughout the plan year and has met her deductible, her plan pays 70% ($119) and Jennifer pays the 30% ($51) out of pocket. Date Medication Cost Preventive Medication Deductible Plan Pays Jennifer s Share 1/6 Zocor $130 Yes Waived $91 $39 (70%) (30%) 1/22 Cipro $170 No Not met $0 $170 (100%) 2/6 Zocor $130 Yes Waived $91 $39 (70%) (30%) 11/15 Cipro $170 No Met $119 $51 (70%) (30%) March through Zocor $130 x 10 months Yes Waived $91 x 10 months $39 x 10 months December = $1,300 = $910 = $390 Jennifer has paid a total of $689 out of pocket for her medications. Because she has $1,000 in her HSA at the end of the year, Jennifer decides to reimburse herself by withdrawing $689 from her HSA. Jennifer also could have used her Visa HSA debit card throughout the year to pay for her prescriptions at the time of purchase. As long as she had enough funds in her HSA at that time to cover the cost, the funds would have been automatically debited from her HSA account and paid to the pharmacy. This example is for illustrative purposes only and does not reflect events experienced by an actual participant.

3 If you have certain conditions such as hypertension, high cholesterol, diabetes, asthma and osteoporosis, you ll be interested in a special feature that can help you manage the cost of the medications you need. If you enroll in an Aetna HealthFund Health Savings Account (HSA) health insurance plan, the preventive medications feature provides coverage for the medications you need without first meeting your deductible.* That means that you can get certain preventive medications at the same copay or coinsurance that would normally apply once you ve met your deductible. We understand how important it is to take the medications prescribed by your doctor. The Aetna HealthFund preventive medications feature makes it easier for you to do that. Here s an example of how the feature works with an HSA plan: Jennifer** enrolled in an Aetna HealthFund HSA plan that includes threetier prescription drug coverage. This means that once Jennifer meets her deductible, she will pay 20% of the cost for generic drugs, 30% for brand formulary drugs, and 50% for nonformulary medications. Her prescription drug plan will pay the balance. However, for preventive drugs, she will receive the three-tier drug coverage without meeting her deductible first. Jennifer s Plan Deductible: $1,000 HSA Contributions: $1,000 Medical Coinsurance: 90% Prescription Drug Coinsurance: 20/30/50% Refer to the following list for the preventive medications that are included in this program. *Your deductible is what you pay for eligible medical expenses before your health insurance plan s coinsurance benefit begins. **This example is for illustrative purposes only and does not reflect events experienced by an actual participant. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna company that underwrites or administers benefits coverage is Aetna Life Insurance Company. Policy forms issued in Oklahoma include: GR23 and/or GR29.

4 2006 Preventive Medications for HSA Plans LOWEST TIER MIDDLE TIER HIGHEST TIER Prefered generic medications Preferred brand-name medications Non-preferred brand and generic medications LOW MIDDLE HIGHEST ACE INHIBITORS (high blood pressure, diabetes, heart failure) BENAZEPRIL CAPTOPRIL ENALAPRIL FOSINOPRIL LISINOPRIL MOEXIPRIL QUINAPRIL ALTACE ACCUPRIL ACEON CAPOTEN LOTENSIN MAVIK MONOPRIL PRINIVIL UNIVASC VASOTEC ZESTRIL ANTIHYPERLIPIDEMICS (high cholesterol) CHOLESTYRAMINE CLOFIBRATE GEMCOR GEMFIBROZIL LOVASTATIN PREVALITE ANTIDIABETIC DRUGS (diabetes) ACETOHEXAMIDE CHLORABETIC CHLORPROPAM IDE GLIPIZIDE GLIPIZIDE ER GLIPIZIDE XL GLYB/METFORM GLYBURID MCR GLYBURIDE GLYCRON METFORMIN TOLAZAMIDE TOLBUTAMIDE HIGHEST continued DYMELOR ECK GLUCOSE EQUATE GLUCO FC GLUCOSE FORTAMET FP GLUCOSE GE GLUCOSE GLIBENCLAMID GLUCAGEN GLUCAGON ADVICOR ANTARA LESCOL LESCOL XL NIASPAN ER TRICOR TRIGLIDE VYTORIN WELCHOL ZOCOR ACTOS AVANDAMET AVANDIA HUMALOG HUMALOG MIX HUMULIN HUMULIN L HUMULIN N HUMULIN N PN HUMULIN R LANTUS NOVOLOG MIX NOVOLOG GLUCOPHAGE GLUCOSE GLUCOTROL GLUCOTROL XL GLUCOVANCE GLUTOSE GLYNASE GLYSET GNP GLUCOSE HCA GLUCOSE OSTEOPOROSIS DRUGS (osteoporosis) ACTONEL AREDIA FORTEO BONIVA FOSAMAX ALTOCOR ALTOPREV ATROMID S CHOLESTIN CHOLOXIN COLESTID COLESTID FLA CRESTOR FENOFIBRATE LIPEX LIPITOR LOCHOLEST LOFIBRA LOPID LORELCO MEVACOR NIASPAN PRAVACHOL PRAVIGARD PROBUCOL QUESTRAN ZETIA AMARYL B-D GLUCOSE BL GLUCOSE BYETTA CHLORPROPAM CVS GLUCOSE DD GLUCOSE DE GLUCOSE DEX4 GLUCOSE DEX4 POUCH DEXTROTAB DIABETA DIABINESE DR GLUCOSE ILETIN I LEN ILETIN I NPH ILETIN I REG ILETIN II ILETIN II RG INSTA-GLUCOS INSULASE ORINASE PRECOSE RA GLUCOSE CALCIMAR CALCITONIN DIDRONEL FOSAMAX PLUS GANITE MIACALCIN PAMIDRONATE PAMIDRONTAT SKELID ZOMETA LOW MIDDLE HIGHEST LOW MIDDLE HIGHEST BETA-BLOCKERS (high blood pressure, heart attack prevention) ACEBUTOLOL ATENOLOL BETAXOLOL BISOPROL FUM LABETALOL METOPROLOL NADOLOL PINDOLOL PROPRANOLOL SORINE SOTALOL AF SOTALOL HCL TIMOLOL MAL COREG BETAPACE BETAPACE AF BLOCADREN CARTROL CORGARD INDERAL INDERAL LA INNOPRAN XL KERLONE LEVATOL LOPRESSOR PRONOL SECTRAL SOTALOL HCL TENORMIN TIMOLOL TOPROL XL TRANDATE VISKEN ZEBETA CALCIUM CHANNEL BLOCKERS (heart disease, high blood pressure) AFEDITAB CARTIA XT DILT-CD DILTIA XT DILTIAZEM DILTIAZEM XR FELODIPINE NICARDIPINE NIFEDIAC CC NIFEDICAL XL NIFEDIPINE TAZTIA XT VERAPAMIL CARDIZEM LA ADALAT ADALAT CC CALAN CALAN SR CARDENE CARDENE SR CARDIZEM CARDIZEM CD CARTIA XT COVERA-HS DILACOR XR DYNACIRC DYNACIRC CR ISOPTIN ISOPTIN SR NORVASC PLENDIL POSICOR PROCARDIA PROCARDIA XL SULAR TIAMATE TIAZAC VASCOR VERELAN VERELAN PM BLOOD THINNING AGENTS (coronary artery disease, heart disease, prevention of blood clots causing heart attack or stroke) ANAGRELIDE CILOSTAZOL DIPYRIDAMOLE JANTOVEN TICLOPIDINE WARFARIN AGGRENOX PLAVIX PLETAL ACD-A AGGRASTAT AGRYLIN ANGIOMAX ANTICOAG CPD ARGATROBAN ARIXTRA COUMADIN CPD DICUMAROL DIPRADAM FRAGMIN HEPARIN SOD FRAGMIN INNOHEP INTEGRILIN LOK-PAK LOK-PAK-N LOVENOX MIRADON NORMIFLO ORGARAN PERMOLE PERSANTINE REFLUDAN REOPRO SASH TICLID TRICITRASOL VASCEZE PEDIATRIC VITAMINS W/FLOURIDE TRI-A-VITE TRI-VIT/FL TRI-VITA BET SOLUVITE F TRI-VIT/FL TRI-VIT/FLUO TRIVIT/FLUOR TRI-VIT/FL TRI-VIT/FLUO TRIVIT/FLUOR PRENATAL MULTIVITAMIN W/FE, FA MATERNITY-90 NATAMAR RX PERRY PRENAT PRE-NATAL PRENATAL VIT PRENATAL/FE PRENATAL/ZN RA PRENATAL TERNAMAR VITA-NATAL DIABETIC SUPPLIES (diabetes) BD INSULIN SYR BD LANCET BD PEN NEEDLES FREESTYLE ONE TOUCH PRECISION QID LOW DIURETICS (hypertension) ACETAZOLAMIDE AMILOR/HCTZ AMILORIDE BUMETANIDE CHLOROTHIAZIDE CHLORTHALIDONE DIAQUA FUROSEMIDE HYDROCHLOROTH IAZIDE HYDROMAL INDAPAMIDE LO-AQUA LOQUA METAHYDRIN METHAZOLAMIDE METHYCLOTHIA ZIDE METOLAZONE M-ZIDE PROAQUA ROSE-40 SPIRONAZIDE SPIRONO/HCTZ SPIRONOLACTONE TORSEMIDE TRIAM/HCTZ TRIAMT/HCTZ TRICHLORMETH HIGHEST ALDACTAZIDE ALDACTONE A-NURIC DIUR AQUA BAN M/S AQUA-BAN W/ AQUATENSEN BENDROFLUMET BUMEX CAROZIDE DARANIDE DEMADEX DIAMOX DIAMOX SEQUE DIAQUA-2 DIUCARDIN DIURESE DIUREX DIUREX-2 DIURIL DYAZIDE DYRENIUM EDECRIN ENDURON ESIDRIX EXNA EZIDE GLAUCTABS GLYCITROL HYDONE HYDRODIURIL TRI-VI-FLOR KPN MYNATAL NUTRACARE NUTRICION PRENATAL #2 TYLER PRENAT VITA-NATAL VITL NESTABS ACCUCHEK ASCENSIA ASSURE AUTOLET GLUCOMETER MONOJECT SYR PRESTIGE QUICK-SET SOFTCLIX UNISTIK HYDRO-PAR HYDRO-TABS HYGROTON INTROL ISMOTIC LASIX LOZOL MAXZIDE MAXZIDE-25 MAXZIDE-25MG MICROZIDE MIDAMOR MODURETIC MYKROX MZM NAQUA NATURETIN NEPTAZANE ODRINIL ORETIC OSMITROL OSMITROL VFX OSMOGLYN RENESE SALURON SPIRONO PLUS THALITONE UREAPHIL WASSER ZAROXOLYN ZIDE-50

5 2006 Preventive Medications for HSA Plans LOWEST TIER MIDDLE TIER HIGHEST TIER Prefered generic medications Preferred brand-name medications Non-preferred brand and generic medications LOW MIDDLE HIGHEST LOW MIDDLE ANTIHYPERTENSIVES (high blood pressure) ATENOL/CHLOR BENAZEP/HCTZ BISOPRL/HCTZ CAPTOPR/HCTZ CHLO/METHYLD CHLORO/RESER CLONID/CHLOR CLONIDINE DOXAZOSIN ENALAPR/HCTZ FOSINOP/HCTZ GUANABENZ GUANFACINE HCTZ/RESERP HYDRAL/HCTZ HYDRAL/RES/ HYDRALAZINE HYDROSERP HYDROSERP #1 HYDROSERP #2 HCTZ LISINOP-HCTZ MALLOPRESS MARPRES METHYLD/HCTZ METHYLDOPA METOPRL/HCTZ MINOXIDIL PRAZOSIN HCL PROPRAN/HCTZ QUINARETIC RAUWOLFIA RESER/CHLORO RESERPINE SERPATABS SERPEX TERAZOSIN UNIPRES HIGHEST continued GUANABENZ GUANFACINE H-H-R HYDRAL PLUS HYDRAP-ES HYDROPLUS-50 HYDROPRES HYDRO-RESERP HYDROSERPINE HYLOREL HYSERP HYTRIN INDERIDE INDERIDE LA INSPRA INVERSINE ISMELIN L-DOPRES LEXXEL LONITEN CLORPRES COZAAR DIBENZYLINE DIOVAN DIOVAN HCT HYZAAR LOTREL LOPRESS HCT LOTENSIN HCT METATENSIN MICARDIS MICARDIS HCT MINIPRESS MINIZIDE MINOXIDIL MONOPRIL HCT NITROPRESS ORETICYL PRINZIDE PRISCOLINE QUINARETIC RAUWOLFIA/ RAUZIDE REGITINE REGROTON RENESE-R RONDAMETH 3H W/R ACCURETIC ALDOCLOR ALDOMET ALDORIL-15 ALDORIL-25 ALDORIL-D30 ALDORIL-D50 APRESAZIDE APRESOLINE AQUAPRES R ARFONAD ATACAND ATACAND HCT AVALIDE AVAPRO BENICAR BENICAR HCT CAM-AP-ES CAPOZIDE CARDURA CATAPRES CATAPRES-TTS CLORPRES COMBIPRES-1 COMBIPRES-2 COMBIPRES-3 CORLOPAM CORZIDE DEMI-REGROT DEMSER DIUPRES-250 DIUPRES-500 DIUTENSEN-R ENDURONYL ESIMIL FENOLDOPAM FLUMEZIDE SALUTENSIN SER-A-GEN SER-AP-ES SERATHIDE SERPAZIDE SERP-ESIDRIX TARKA TECZEM CR TENEX TENORETIC TEVETEN TEVETEN HCT TIMOLIDE TRI-HYDROSER UNIRETIC UNI-SERP VASERETIC WYTENSIN ZESTORETIC ZIAC ANTIASTHMATICS (asthma) AIRET ALBUTEROL ASBRON-G BRONCHIAL COPD CROMOLYN SOD D-G DG 200 DIFIL G FORT DILEX-G DILOR DILOR-G DYFILIN-GG DYFLEX-G DY-G DYLINE-GG DYPHYL-G DYPHYL-GG DYPHYLLIN/GG DYPHYLLINE DYPHYLLIN-GG DYPHYSIN EPHEDRINE SU GLYCERYL-T IPRATROPIUM HIGHEST ACCOLATE ACCUNEB ADRENALIN AEROBID AEROBID-M AEROLATE III AEROLATE JR AEROLATE SR ALUPENT ALUPENT INH ALUPENT REF AMI-RAX ANA-GUARD ASBRON-G ASMA ASMALIX ASTHMA ASTHMACON ASTHMAHAL RF ASTHMAHALER ASTHMANEFRIN ATROVENT ATROVENT HFA AZMACORT BECLOVENT BECLOVENT RF BRETHAIRE BRETHAIRE RF BRETHINE BRICANYL BROMCOMAR BRONCAP BRONCHIAL ISOETHARINE JAY-PHYL LIXOLIN NEOTHYLLINE OXTRIPHYLLIN PANFIL-G TEDRIGEN TERBUTALINE THEO/HYD/EPH THEOCAP THEOCHRON THEOCHRON SR THEOCHRON-SR THEOCLEAR-80 THEOCON THEO-G THEOLAIR THEOLATE THEOMAX DF THEOPHEDRITA THEOPHENYLLINE THEOPHYLL-GG THEOPHYLLINE THEOSOL-80 UNI-BRONCHIA BRONCHIAL RF BRONCODUR BRONCOMAR GG BRONCOMAR-1 BRONDELATE BRONDIL BRONELIXIR BRONITIN BRONKAID BRONKAID MIS BRONKEPHRINE BRONKOLIXIR BRONKOMETER BRONKOSOL CHOLEDYL CHOLEDYL SA CLENBUTEROL CONSTANT-T DIFIL-G DILEX-G DILEX-G 200 DILEX-G 400 DILOR DILOR-G DORAPHYLLIN DUO-MEDIHAL DUONEB DYFLEX DYLINE-GG DYLIX DYPHYLLIN-GG ED-BRON G ELIXOPHYL GG ADVAIR DISKUS COMBIVENT DUONEB FLOVENT FLOVENT HFA FLOVENT ROTA FORADIL MAXAIR AUTOH PROVENTIL HFA PULMICORT SEREVENT DIS SINGULAIR UNIPHYL VOSPIRE ER ELIXOPHYL KI ELIXOPHYLLIN EMFASEEM EQUIBRON G FLUNISOLIDE GUIAPHED HYDROPHED INTAL INTAL 112 INTAL 200 INTAL INH IOPHYLLINE ISOLATE CPD ISOPROT CPD ISUPREL ISUPREL GLOS ISUPREL MIST KIE LUFYLLIN LUFYLLIN-EPG LUFYLLIN-GG MARAX MARAX DF MAXAIR INH MEDIHAL-ISO METAPREL METAPREL INH METAPROTEREN MICRONEFRIN MOXY CPD MUDRANE MUDRANE-GG MUDRANE-GG-2 NEOTHYLLINE NEPHRON NORISODRINE NUPHYLL-GG OSCO BRONCH OXTRIPHYLLIN PANFIL-G PHYLLOCONTIN PRIMATENE PROVENTIL RE PULMICORT TU QUADRINAL QUIBRON QUIBRON-300 QUIBRON-T QUIBRON-T SR QVAR RA BRONCHIAL RESPBID RESPIROL S-2 SAV-ON BRONC SB BRONCHIAL SLO-BID GYRO SLO-PHYLLIN SOLU-PHYL GG SOMOPHYLLIN SPIRIVA SUS-PHRINE T.E.P. THEO 250 THEO/EPHE/PB THEO/HYD/EPH THEO-24 THEOBID THEOCHRON THEOCHRON SR THEOCHRON-SR THEOCLEAR-LA THEODRINE THEO-DUR THEO-DUR SPR THEOLAIR-SR THEOLATE S/A THEOLIXIR THEOMAR GG THEOPHYL KI THEOPHYL/D5W THEORAL THEO-VENT THEO-X THSC THEOPHY TILADE TORNALATE TORNALATE IN TORNALATE RF T-PHYL TRUPHYLLINE TRUXOPHYLLIN UNI-DUR UNIPHYL VANCERIL VANCERIL DS VAPONEFRIN VENTOLIN VENTOLIN HFA VENTOLIN ROT VOLMAX V-R BRONCHIA XOLAIR XOPENEX XOPENEX CONC Please remember that this is not a complete list of medications covered under your plan. Because there are thousands of medications included in your pharmacy benefit, we only list the most common ones. If you have any questions about your pharmacy benefit or want to know if a particular medication not listed here is covered under your plan, please visit Aetna s secure website at If you don t have access to our website, call the Member Services number on your ID card.

6 If you need this material translated into another language, please call Member Services at AETNA ( ). Si usted necesita este documento en otro idioma, por favor llame a Servicios al Miembro al AETNA ( ). This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna arranges for the provision of health care services. However, Aetna itself is not a provider of health care services, and therefore, cannot guarantee any results or outcomes. Consult the plan documents (Booklet, Booklet-certificate, Group Policy) to determine governing contractual provisions, including procedures, exclusions and limitations relating to the plan. The availability of a plan or program may vary by geographic service area and by plan design. Health insurance plans contain exclusions and some benefits are subject to limitations or visit maximums. Your plan may include a Preferred Drug List (formulary). A Preferred Drug List is a list of prescription drugs generally covered under your prescription drug benefits plan on a preferred basis subject to applicable limitations and conditions. Your pharmacy benefit is generally not limited to the drugs listed on the Preferred Drug List. The medications listed on the Preferred Drug List are subject to change in accordance with applicable state law. For information regarding how medications are reviewed and selected for the Preferred Drug List, and information about other pharmacy programs such as precertification, please refer to Aetna s website at or the Preferred Drug List. Many drugs, including many of those listed on the Preferred Drug List, are subject to rebate arrangements between Aetna and the manufacturer of the drugs. Aetna receives rebates from the manufacturers of many drugs, including many that are on the Preferred Drug List. These rebates do not reduce the amount you pay for an individual prescription drug. However, they help control the overall costs of prescription drug coverage. Your pharmacy benefit provides coverage for many drugs that are not on this list. Also, in some cases, if you need to pay a percentage of the cost of the drug or an amount to meet a deductible, your costs may be higher for a preferred drug than they would be for a nonpreferred drug. You can find out more about the terms and limitations on your plan by reading your plan documents. You can also contact Member Services. Aetna Health Savings Accounts (HSA) are administered by Aetna Life Insurance Company. Aetna HealthFund HSA may not be available in all states. HSA fees, interest rates and investment options are subject to change without notice. Investment options are not insured by Aetna or the FDIC and may result in loss of principal. This document is not intended to provide tax or investment advice; please consult your independent financial advisor before opening an HSA or making an investment selection. While this material is believed to be accurate as of the print date, it is subject to change (1/06) 2006 Aetna Inc.