Can members use discount drug services (e.g., GoodRx, CostPlus Drugs, manufacturer coupons) and apply the cost paid to their deductible and maximum out of pocket?

Answer: Yes.  Member payment of prescription drugs after applying any possible discounts can be applied to deductible and maximum out of pocket when:

• The prescription would be covered and approved by Aetna.  This is important.  If Aetna does not cover the drug, or the drug would not have been approved due to plan rules, then your payment would not be applied to your plan deductible or maximum out-of-pocket.

What should a member do when having a prescription filled and want to see if a discount drug service can reduce their cost and be applied to their deductible and maximum out of pocket?

Answer: You should be sure to ask the pharmacy to confirm the prescription would be filled/approved by Aetna, and ask what your cost would be.  After looking at any discount drug service you use, let the pharmacist know to apply the discounts.  And then:

(a) if the pharmacist runs the drug through Aetna and applies the discount, then your cost is applied to your deductible and maximum out of pocket.

(b) if the pharmacist does not run the prescription through Aetna as if it is a cash sale, then you will need to submit a claim form to have your payment applied to your deductible and maximum out of pocket.

Important takeaways

1. Always present your insurance card to make sure the prescription is run through your plan to confirm coverage by Aetna.
2. When the prescription claim is run through Aetna, then the plan applies your cost to your deductible and maximum out-of-pocket.
3. When the prescription claim is not run through Aetna, and you have confirmed the drug is covered and approved by Aetna, you will need to submit a claim form.
4. You should always confirm the cost of savings by running it through Aetna.  If it turns out going through Aetna would have cost less for a drug, that’s all they will reimburse.