Aetna Specialty Pharmacy Leadership Organizational Chart
Aetna Specialty PharmacyLeadership Organizational ChartHARRY TRAVISGeneral ManagerMERY SABALAProject CoordinatorDAVID JESSEHead LegalFRANK STAMLERASRx FinanceTOM LANGSales and BusinessDevelopmentMAURICE JONESITJEAN CARNEYReimbursementREBECCA MITCHEMHead ofPharmacy Ops
Aetna Specialty Pharmacy Overall Guarantee has beenREDACTEDwww.aetna.com
Pharmacy Benefit Management Services Pricing TablesClaims Pricing Offer - Pass-Through Pricing at Retail; Guaranteed pricing at Mail Order/Aetna Specialty PharmacyAetna's offer is based on a total of both Active and Retired (Medicare and Non-Medicare) employees 43,202.Proposing Company:NOTE: Your responses must be based on the requirements provided and in accordance with your responses throughout the RFP and related pricing bid forms.Contract PeriodEmployee GroupCurrent number of livesNetwork/ChannelBroad RetailRetail Specialty and NonSpecialty / 30 DS90-Days Supply RetailRetail Specialty and NonSpecialty 30 DS 1.30 1.30 1.30 1.30 1.30 1.30Day Supply (DS)Number of Network PharmaciesAdministrative Fee (Per Employee and/or Per Retiree Per Month)Year 1Year 2Year 3Year 1Active6,670Retirees36,532Mail OrderSpecialty PharmacyMail Order Non Specialty 0 DSN/ASpecialty 0 DSN/A 1.30 1.30 1.30 0.00 0.00 ctive Guaranteed RatesAnnual Ingredient Cost (AWP) Discount for all Brands (single and multi source brands)REDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3Semi-Annual Ingredient Cost (AWP) Discount Guarantees for all Generics (single and multi source generics)REDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3Annual Ingredient Cost (AWP) Discount for all Single-Source GenericsREDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3Maximum Avg Dispensing Fee/Rx - BrandREDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 1
Network/ChannelDay Supply (DS)Maximum Avg Dispensing Fee/Rx - GenericYear 1Year 2Year 3Broad RetailRetail Specialty and NonSpecialty / 30 DS90-Days Supply RetailRetail Specialty and NonSpecialty 30 DSMail OrderSpecialty PharmacyMail Order Non Specialty 0 DSSpecialty 0 DS 1.45 1.20 1.20 0.15 0.15 0.15 0.00 0.00 0.00 0.00* 0.00* DREDACTEDRebates & Other Manufacturer Revenue100%100%%-ShareGuaranteed Minimum Per Claim - Aetna's Minimum Rebate Guarantee is on a Per Brand Script basis.Active Plan DesignREDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3Retiree Plan DesignREDACTEDREDACTEDYear 1REDACTEDREDACTEDYear 2REDACTEDREDACTEDYear 3ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 2
Pharmacy Benefit Management Services Pricing TablesAdministrative Fee ServicesProposing Company:Aetna Life Insurance CompanyInstructions: Confirm that the following services are included in the administrative fee quoted in the "Rx Pricing Pass-Through" and "EGWP Administrative Fees wrap"worksheets by responding "Yes." If any of these services are: (1) either not offered, and therefore, not included in the quote; or (2) included in the fee, but at an additionalcost, please answer "no" and provide the fee (on a per member per year) in the Specify Charge columnContract PeriodEmployee GroupCurrent number of livesServices Included in Administrative Fee123456789101112131415161718192021Administrative ServicesElectronic claims adjudicationAdjudication of subrogation claimsTransaction fees for claims that are not "paid" (e.g., reversed and rejectedclaims)Member submitted paper claimsMember direct reimbursementPharmacy help deskPharmacy network managementPharmacy reimbursementOnline reporting system software trainingOnline eligibilityOnline eligibility managementMultiple eligibility tapesPaid claims tapeMember database accessClaims accessProfile accessDrug file accessPlan file data (input and maintenance from hard copy)DownloadsCoordination of Benefits - Member-submitted paper claimsCoordination of Benefits - Med-B eligible claimsConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 3Active6,670Yes/NoYear 1Retirees36,532Rx Pricing Pass-ThroughActivesSpecific Charge, if AnyYes/ NoRetireesSpecific Charge, if AnyEGWP Administrative Fee wrapRetireesYes/ NoSpecific Charge, if AnyYesYesYesYesSee EWGP TabsSee EWGP YesYesYesYesYesYesSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP Tabs
ActivesServices Included in Administrative Fee22Additional development and production hours (customized systems protocolsand editing, etc.)23Professional software24Next-day mail delivery25Data feeds for consultant26 Other272829YesYesReporting ServicesElectronic reportOnline reporting (unlimited users)Printed reporting packageConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 4YesYesN/AYesYesYesYou can use prepaid hoursfor ad hoc reporting andother analytic projects.Once prepaid hours areexhausted, a time spentcharge of 200 per hourfor reportgeneration/programmingand 350 per hour foranalytic/consultingservices is charged perproject. Prepaid hours arenot available for use withtechnical programmingstaff. Additional prepaidhours may be purchased inincrements of 10, 25 or 50at the time spent charge of 350 per hour.When we havetemperature sensitivedrugs packaged, weinclude cold packs tomaintain the appropriatetemperature needed. Forthese packages, we shipthem through the UPS twoday delivery service. Forany high dollar value order(drug cost is 1,000 ormore), we ship thepackage overnight throughUPS and require an adultsignature upon delivery.RetireesYesYesYesYesN/AYesYesYesYou can use prepaid hoursfor ad hoc reporting andother analytic projects.Once prepaid hours areexhausted, a time spentcharge of 200 per hour forreportgeneration/programmingand 350 per hour foranalytic/consulting servicesis charged per project.Prepaid hours are notavailable for use withtechnical programmingstaff. Additional prepaidhours may be purchased inincrements of 10, 25 or 50at the time spent charge of 350 per hour.When we have temperaturesensitive drugs packaged,we include cold packs tomaintain the appropriatetemperature needed. Forthese packages, we shipthem through the UPS twoday delivery service. For anyhigh dollar value order(drug cost is 1,000 ormore), we ship the packageovernight through UPS andrequire an adult signatureupon delivery.RetireesSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP Tabs
ActivesServices Included in Administrative Fee30Custom ad-hoc reporting31Other32333435Clinical ServicesStandard supportCoverage Rules Administration Fee (Costs Per Employee / Retiree Per Month) forCurrent Programs. Note: Enter the fees you will charge to administer all of theCurrent Coverage Rules (e.g., prior authorizations currently in place).Coverage Rules Review Fees (Cost Per Coverage Review).Note: Enter below the fees you will charge to review requests for coverage ofmedications subjected to Coverage Rules (e.g., prior authorizations currently inplace).36Prior Authorizations373839404142Quantity LimitsStep TherapiesDose Optimization(s)Standard PBM Appeal (per appeal reviewed)IRO Appeals Administration Fee (per member)IRO Appeals Fee (per appeal reviewed)43Retrospective DUR Savings Opportunity ProgramYesYesSee EWGP TabsYesYesYesYesSee EWGP TabsSee EWGP TabsYesYesYesYesYesYesYesYesYesRetrospective Controlled Substance Excessive Use program4647Fee to add additional groups / account structuresOther Program Fees/Costs (List specifics below):48Intervention program49Product compliance programYesYesYesYesYesConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 5See EWGP TabsSee EWGP TabsSee EWGP TabsYesRetrospective Patient Safety Alert Program45YesYesWe will provide you withprepaid hours for ad hocreporting. Once prepaidhours are exhausted, a timespent charge of 200 perhour for reportgeneration/programmingand 350 per hour foranalytic/consulting servicesis charged per project.N/ARetireesYesYes44We will provide you withprepaid hours for ad hocreporting. Once prepaidhours are exhausted, atime spent charge of 200per hour for reportgeneration/programmingand 350 per hour foranalytic/consultingservices is charged perproject.N/ARetireesWe include the NationalPrecertification List (NPL)for specialty drugs at nocost. You can purchase ourstandard precertificationprogram for an additionalfee of 30 perprecertification.We offer the PrescriptionSavings Program at noadditional cost.We offer the SelectedMembers' ClinicalInformation Lists at noadditional cost.We offer the ControlledSubstance Use Program(CSUP) at no additionalcost.N/AWe offer a variety ofintervention programs atno additional cost.We offer a variety ofcompliance programs atno additional We include the NationalPrecertification List (NPL)for specialty drugs at nocost. You can purchase ourstandard precertificationprogram for an additionalfee of 30 perprecertification.We offer the PrescriptionSavings Program at noadditional cost.We offer the SelectedMembers' ClinicalInformation Lists at noadditional cost.We offer the ControlledSubstance Use Program(CSUP) at no additionalcost.N/AWe offer a variety ofintervention programs at noadditional cost.We offer a variety ofcompliance programs at noadditional cost.See EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP Tabs
505152Services Included in Administrative FeeDevelopment of Clinical Coverage GuidelinesNew Drug or Formulary ReviewOther Program Fees/Costs (List specifics below):ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage e EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP Tabs
Services Included in Administrative FeeMember CommunicationServices Included in Administrative Fee53Member Welcome Package - standard54Member Welcome Package - customized55565758ID cards – standardID cards – dependent (away from home)ID cards – replacementID cards – customized59Claim Forms (e.g., direct member reimbursement, home delivery pharmacy, etc.)606162636465666768Mailing participant communications to members’ home - implementationMailing participant communications to members’ home - ongoingProvider DirectoriesSummary Plan DescriptionsSummary Annual ReportsSummary of Material ModificationsAnnual Benefit StatementsGeneral Letters and Correspondence Sent to EmployeesMember Website- language availability other than EnglishOther (Please list all other member communication materials available, and anycosts, if applicable)69Other Credits/Allowances and Dollars At Risk:70 Program Implementation Credit71 Other Credit(s)/Allowance(s) - Communications annual budgetConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 7ActivesYesYesYesYesYesYesRetireesYesDepending on the level ofcustomization required.YesYesYesYesYesRetireesSee EWGP TabsDepending on the level ofcustomization required.See EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP esYesYesYesYesSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsSee EWGP TabsYesYesSee EWGP TabsSee EWGP Tabs 50,000 for Year 1 25,000 in Years 2 & 3Included with activeIncluded with activeN/AN/A
Pharmacy Benefit Management Services Pricing TablesThis Pricing Table is not scoredSelf-Funded EGWP - Claims Pricing Offer - Pass-ThruProposing Company:Aetna Life Insurance CompanyInstructions: Provide guaranteed rates specific to the CMS-approved networks and rebate and manufacturer revenue contracts.Network/Channel90-Days Supply RetailBroad RetailRetail Specialty and Non-SpecialtyEGWP Only / 30 DS / 30 DS 30 DSMail s Supply RetailBroad RetailMail OrderRetail Specialty and Non-SpecialtyNon-SpecialtyEGWP Plus Wrap Only / 30 DS / 30 DS 30 DS 0 DSSpecialtyPharmacySpecialtyDay Supply (DS) 0 DS 0 DS 0 DSPBM Administrative FeePlease enter the base PBM Administrative Fee, if applicable. Please use the EGWP Administrative Fee worksheet to enter the EGWP fee you will charge to administer an EGWP or EGWPplus Wrap plan for the client. 7.25 7.25 7.25 7.25n/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1 7.25 7.25 7.25 7.25n/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2 7.25 7.25 7.25 7.25n/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Effective Guaranteed RatesAnnual Ingredient Cost (AWP) Discount for all Brands (single and multi source brands)REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Semi-Annual Ingredient Cost (AWP) Discount Guarantees for all Generics (single and multi source generics)REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Annual Ingredient Cost (AWP) Discount for all Single-Source GenericsREDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2REDACTEDREDACTEDREDACTEDREDACTEDn/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Maximum Avg Dispensing Fee/Rx - Brandn/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1n/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2n/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Maximum Avg Dispensing Fee/Rx - Genericn/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 1n/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 2n/aREDACTEDREDACTEDREDACTEDREDACTEDsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPYear 3Rebates & Other Manufacturer Revenue100%%-ShareGuaranteed Minimum Per ClaimRetiree Plan DesignREDACTEDYear 1REDACTEDYear 2REDACTEDYear DREDACTEDn/an/an/asee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPsee EGWPConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 8
Pharmacy Benefit Management Services Pricing TablesThis Pricing Table is not scoredSelf-Funded EGWP with Wrap - Claims Pricing Offer - Pass-ThruProposing Company:Aetna - self-funded enhanced EGWP (no wrap)Instructions: Please provide an all-inclusive administrative fee (on a per Medicare-eligible basis) for all the services listed below. If the fee does not cover one of theservices listed, please indicate "No" and provide the fee. Otherwise, indicate "Yes".Administrative FeesEGWP OnlyYear 2Fee CategoryYear 1Year 3Year 1All-inclusive Administrative Fee (per Medicare-eligible basis)All-inclusive Service Package, which includes all servicesyesyesyesn/abelow except where you specifically indicate otherwiseGeneral Services ("Yes"/"No"). If no, please indicate the fee.Core Service PackageEnrollment MaterialsPre-enrollment CallsNo. Cost mayvary and can bediscussedPost-enrollment CallsfurtherPremium Billing/CollectionTrOOP FacilitationData Collection & ReportingEnrollment Services ("Yes"/"No"). If no, please indicate the fee.Enrollment PacketsEnrollment CardsPre-enrollment Appl MaterialNo. Cost mayvary and can bediscussedPost Enrollment Calls- TotalfurtherAfter Hours CallsNo. A charge of 200 per hourfor reportgeneration/programming and 350 per hourforanalytic/consulting services ischarged perCustomized Reportingproject.Manual Eligibility EntryAnnual Setup Direct Waivers PDPPre-Enrollment CallsGrievance TrackingOther Customized Communications ("Yes"/"No"). If no, please indicate the fee.Member Welcome Kits to include all CMS required materials (EOC, Pharmacy directory, Formulary, ID card, Welcome letter, etc.)CMS required model notices (in response to TRR)Opt out (pre-notification) letterSummary of BenefitsANOCClaim Forms for Mail OrderConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 9EGWP Plus WrapYear 2n/aYear 3n/a
ANOCExplanation of BenefitsInteractive Member WebsitesNegative Formulary Impact LettersAll CMS required enrollment/disenrollment lettersCMS Submissions ("Yes"/"No"). If no, please indicate the fee.PDEEligibility Management ServicesFormularyGrievance SupportMMR reconciliationOther CMS required submissionsOther Support ("Yes"/"No"). If no, please indicate the fee.AuditsData StorageOther--Specify any services with fees that are not listed:ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 10
Additional Services covered under Enhanced / Wrap EGWP ("Yes"/"No"). If no, please indicate the fee.Adjudicate claims at point of sale in coordination with theEGWP PDP benefit in one transaction by using a singleidentification cardAdjudication will be subject to coverage and plan rulesIdentify and submit to CMS claims eligible for the Medicarecoverage gap discount programCoordinate collection from CMS, amounts payable under thegaps coverage discount coverage program and deliver thosefunds to customerFacilitate necessary annual reconciliations for customer in theevent that CMS rejects or denies any claims under discountcoverage gap programProvide reporting of amounts submitted to and paid by CMSon a quarterly basis to customerVaccine Administrationyes, for Part D covered vaccinesPerform annual reconciliation of amounts submitted to andpaid by CMS on behalf of customer, within 120 days of finalreconciliation with CMS and the participating manufacturesConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 11
EXAMPLEPharmacy Benefit Management Services - Pricing ExampleRx Pricing Pass-ThroughContract PeriodEmployee GroupCurrent number of livesYear 1Active6,670Network/ChannelBroad RetailRetail Specialty and NonSpecialty / 30 DS90-Days Supply RetailMail OrderSpecialty PharmacyRetail Non-Specialty 30 DSMail Order Non Specialty 0 DSN/ASpecialty 0 DSN/A 1.50 1.50 1.50 1.5025%15%80%50%25%20% 0.00 0.00 0.00 0.00Day Supply (DS)Number of Network PharmaciesAdministrative Fee (Per Employee and/or Per Retiree Per Month)Year 1Retirees36,532Effective Guaranteed RatesAnnual Ingredient Cost (AWP) Discount for all Brands (single and multi source brands)16%20%Year 1Semi-Annual Ingredient Cost (AWP) Discount Guarantees for all Generics (single and multi source generics)75%75%Year 1Annual Ingredient Cost (AWP) Discount for all Single-Source Generics20%25%Year 1Maximum Avg Dispensing Fee/Rx - Brand 1.50 1.50Year 1Maximum Avg Dispensing Fee/Rx - Generic 1.50 1.50Year 1Rebates & Other Manufacturer Revenue%-ShareGuaranteed Minimum Per ClaimActive Plan DesignYear 1Retiree Plan DesignYear 1Network/ChannelTrended RxTrended AWPBrand (ALL Brands)Generic (ALL Generics)Brand (ALL Brands)Generic (ALL Generics)Discounted Ingredient Cost Dispensing FeesBrand (ALL Brands)Generic (ALL Generics)Rebates% Active of Total Rx% Retiree of Total RxTotalBase Administrative FeesActivesRetireesTotalTotal Administrative ServicesTotal Reporting ServicesTotal Clinical ServicesTotal Member Communications100%100%100%100% 5.00 20.00 25.00 50.00 5.00 20.00 25.00 50.00Broad RetailRetail Specialty and NonSpecialty90-Days Supply RetailRetail Specialty and NonSpecialtyMail OrderSpecialty PharmacyMail Order Non 075,000 20,000,000 22,500,000 125,000,000 90,000,000 12,500,000 15,000,000 37,500,000300,000 16,950,000 6,075,000 100,075,000 22,725,000 9,375,000 3,000,000 31,875,000150,000 50%50%(2,000,000) 50%50%(4,000,000) 50%50%(2,500,000) 30,108225,2875,985Program Implementation CreditPost-Implementation Audit creditOtherTotal 100,00015,000115,000Total Pharmacy Gross CostsTotal Pharmacy Administrative Fee ServicesTotal Fee CreditsTotal Costs Total ts shown in Attachment H2 as Vendor 1.ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 125,0001,000 50%50%(300,000)120,060657,576777,636
EXAMPLEPharmacy Benefit Management Services - Pricing ExampleAdministrative Fee ServicesContract PeriodEmployee GroupCurrent number of livesServices Included in Administrative 5455Administrative ServicesElectronic claims adjudicationAdjudication of subrogation claimsTransaction fees for claims that are not "paid" (e.g., reversed and rejectedclaims)1Member submitted paper claimsMember direct reimbursementPharmacy help deskPharmacy network managementPharmacy reimbursementOnline reporting system software trainingOnline eligibilityOnline eligibility managementMultiple eligibility tapesPaid claims tapeMember database accessClaims accessProfile accessDrug file accessPlan file data (input and maintenance from hard copy)DownloadsCoordination of Benefits - Member-submitted paper claimsCoordination of Benefits - Med-B eligible claimsAdditional development and production hours (customized systems protocolsand editing, etc.)Professional softwareNext-day mail deliveryData feeds for consultantOtherTotal Administrative ServicesReporting ServicesElectronic reportOnline reporting (unlimited users)Printed reporting packageCustom ad-hoc reportingOtherTotal Reporting ServicesClinical ServicesStandard supportCoverage Rules Administration Fee (Costs Per Employee / Retiree Per Month) forCurrent Programs. Note: Enter the fees you will charge to administer all of theCurrent Coverage Rules (e.g., prior authorizations currently in place).Coverage Rules Review Fees (Cost Per Coverage Review).Note: Enter below the fees you will charge to review requests for coverage ofmedications subjected to Coverage Rules (e.g., prior authorizations currently inplace).Prior AuthorizationsQuantity LimitsStep TherapiesDose Optimization(s)Standard PBM Appeal (per appeal reviewed)IRO Appeals Administration Fee (per member)IRO Appeals Fee (per appeal reviewed)Retrospective DUR Savings Opportunity ProgramRetrospective Patient Safety Alert ProgramRetrospective Controlled Substance Excessive Use programFee to add additional groups / account structuresOther Program Fees/Costs (List specifics below):Intervention programProduct compliance programDevelopment of Clinical Coverage GuidelinesNew Drug or Formulary ReviewOther Program Fees/Costs (List specifics below):Total Clinical ServicesMember CommunicationServices Included in Administrative FeeMember Welcome Package - standardMember Welcome Package - customizedID cards – standardConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 13Year 1Active6,670Retirees36,532Rx Pricing Pass-ThroughActivesRetireesYes/ No Specific Charge, if AnyYes / NoSpecify Charge, if esYesYesYesYesYesYesYes .25 per paper claim 15,000 flat esYesYesYesYesYesYesYesYesYesYes 15,091YesYesYesYes 0 0.35 esYesYes 28,014YesYesYes 15,000 flat feeYesYesYes 15,017YesNo .25 per paper claim 0.45 197,273YesYesYes
565758ID cards – dependent (away from home)ID cards – replacementID cards – customized59Claim Forms (e.g., direct member reimbursement, home delivery pharmacy, etc.)606162636465666768Mailing participant communications to members’ home - implementationMailing participant communications to members’ home - ongoingProvider DirectoriesSummary Plan DescriptionsSummary Annual ReportsSummary of Material ModificationsAnnual Benefit StatementsGeneral Letters and Correspondence Sent to EmployeesMember Website- language availability other than EnglishOther (Please list all other member communication materials available, and anycosts, if applicable)Total Member Communication691YesYesNoYes 0.02YesYesYesYesYesYesYesYesConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 14 0.01YesYesYesYesYesYesYesYes 1,601Assumes a small percent of the population will submit paper claimsOther Credits/Allowances and Dollars At Risk:70 Program Implementation Credit71 Other Credit(s)/Allowance(s)YesYesNoYes 4,3841% 15,000 5,0001% 85,000 10,000
ConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 15
Post implementation audit creditConfidentialAttachment F2 - Pharmacy Benefit Management Pricing Tables and ExamplesPage 16
Pharmacy Benefit Management ServicesAnnual Performance GuaranteesOfferor:Aetna Life Insurance Company (Aetna Pharmacy Management)Instructions: Indicate "Accept/Reject" for each Performance Guarantee listed. If you "Reject" a performance standard, please provide an alternative that may be acceptable or provide an explanation as to why a performance standard is notavailable. Please provide your benchmark measurements for each performance guarantee in the column labeled as such.Performance GuaranteeBenchmark MeasurementsReporting FrequencyPenaltyAssessmentAccept / RejectIf "Reject," please provide an alternative to beconsidered or explain why a standard is notavailable.Customer ServiceAverage Call AnsweringTime (excludes IVR)100% of calls will be answered in an average of 30seconds or lessAetna does not offer Average Call Answering TimeQuarterly within 30 days of the end of Annuallyperformance guarantees. Aetna will offer a Telephone the calendar quarter.Service Factor guarantee as an alternative.Benchmark 75.0% within 30 seconds.RejectTelephone Service Factor - Aetna will guaranteethat the telephone service factor will not fall below80.0% of all calls responded to within 30 seconds.Calls BlockedZero percent calls blocked/busy signalAetna does not offer Calls Blocked performanceguarantees.AnnuallyRejectAetna systems currently cannot distinguish amedical-related call from a pharmacy-related call.Call Abandonment Rate3% or less of incoming calls will be abandonedBenchmark 4.0%.(excludes calls terminated by member in 30 seconds)Quarterly within 30 days of the end of Annuallythe calendar quarter.AcceptResponse to writteninquiries95% of written inquiries will be responded to withinfive (5) business days; 100% will be responded towithin ten (10) business daysQuarterly within 30 days of the end of Annuallythe calendar quarter.RejectTAT Response of Internet Inquiries - Aetna willguarantee to provide an initial response rate to98.0% of email inquiries within 24 hours andprovide a resolution to 94.0% of email inquirieswithin 3 calendar days.Response to telephoneinquiries99% of telephone inquiries will be responded to within Benchmark 85.0% within 10 business days andfive (5) business days; 100% will be responded to90.0% within 28 business dayswithin ten (10) business daysQuarterly within 30 days of the end of Annuallythe calendar quarter.RejectTelephone Response Turnaround Time - Aetna willguarantee to respond to 85.0% of all telephoneinquiries within 10 business days and 90.0% within28 calendar days.First-Call Resolution95% of telephone inquiries to vendor's call center will Benchmark 93.0%be resolved at the first point of contact.Quarterly within 30 days of the end of Annuallythe calendar quarter.AcceptMember Call TrackingA summary of the number of member service calls, by Benchmark Summary of calls by category analyzedcall category type, will be documented and analyzed weeklyfor patterns or problems daily/weeklyQuarterly within 30 days of the end of Annuallythe calendar quarter.AcceptID Cards100% of ID cards are mailed within three (3) days ofreceipt of eligibility postingBenchmark ID cards mailed within 10 business daysof receiving eligibility fileQuarterly within 30 days of the end of Annuallythe calendar quarter.RejectID Card Production and Distribution Guarantee Aetna guarantees that it will produce and mail IDcards to plan participants within 7 business days ofreceiving the open enrollment eligibility file.Paper Claims ProcessingTimeAt least 90% of claims will be reimbursed orresponded to within 7 business days and 100% ofclaims will be reimbursed or responded to within 14business daysAt least 90% of members will be satisfied with PBMper annual survey results. Survey will be based on astatistically valid sample of members who have usedthe PBM's Retail network and Mail Order pharmaciesduring the survey measurement period.Benchmark 95.0% within a weighted average of 5Quarterly within 30 days after the end Annuallybusiness days and 99.0% within a weighted average of of the quarter.10 business days.RejectBenchmark 90.0%AcceptTAT Paper Claims - Aetna will guarantee 97.0%within a weighted average of 5 business days and99.5% within a weighted average of 10 businessdays.Member SatisfactionAetna does not offer Response to written inqui
Attachment F2 - Pharmacy Benefit Management Pricing Tables and Examples Page 1 Pharmacy Benefit Management Services Pricing Tables Claims Pricing Offer - Pass-Through Pricing at Retail; Guaranteed pricing at Mail Order/Aetna Specialty Pharmacy Aetna's offer is based on a total of both Act
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company's Human Resources Information Systems were not combined until after the respective . TITLE: SR HR POLICY & CMPL CNSLT . PHONE: 8602734309 . 9 : JonesY2@aetna.com : JonesY2@aetna.com . Title: CVS Pharmacy, Inc. & Aetna Inc. EEO-1 Component 1 Reports 2019 & 2020 Author: CVS Health
SCHOOL EMPLOYEES RETIREMENT SYSTEM OF OHIO : Aetna Choice POS II - HCPII Coverage Period: 01/01/2021-12/31/2021 . Coverage for: Individual Family Plan Type: POS. The Summary of Benefits and Coverage (SBC) document will help you choose a health . plan. The SBC shows you how you and the plan would share the cost for covered health care .File Size: 1MBPage Count: 11Explore furtherAetna Choice POS II - Discontinued as of Jan 1, 2021 .postdocbenefits.stanford.eduAetna Choice POS II Summary of Benefitswww.aetna.comAetna Choice POS II Medical Plan - Marine Corps Communityusmc-mccs.orgPrescription Drug List (Formulary), Coverage . - Aetnawww.aetna.comBENEFIT PLAN What Your Plan Covers and How - Aetnawww.aetna.comRecommended to you b
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Aetna Health Insurance Company of New York is a subsidiary of Aetna Inc., a publicly traded company. AHIC's business is composed solely of out-of-network POS business generated on products issued by its HMO affiliate, Aetna Health Inc. (a New York Corporation) (Aetna
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