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Aetna medicare prescription drug claim form 2026

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3.9 out of 5

28 votes

The document is a Prescription Drug Claim Form for Aetna Pharmacy Management, intended for members to manually file claims for prescription drugs. It outlines the necessary steps for both members and pharmacists to complete the form accurately, including required information and signatures. The document also includes warnings about fraudulent claims and legal consequences for providing false information.

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Click ‘Get Form’ to open the Aetna Medicare Prescription Drug Claim Form in our editor.
Begin by filling out the member information at the top of the form. Include your Aetna ID number, Rx Group Number, name, gender, birthdate, address, and telephone number.
Indicate the reason for manually filing these claims by checking the appropriate box. If necessary, provide additional explanations on a separate sheet.
Attach detailed prescription receipts or ask your pharmacist to complete the remaining sections of the form. Ensure that all required fields are filled out accurately.
Once completed, review all entries for accuracy and sign where indicated. Your signature confirms that all information is correct.
Finally, mail the completed claim form to Aetna Pharmacy Management at the provided address.

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Versions	Form popularity	Fillable & printable
2011	3.9 Satisfied (28 Votes)
2006	4.9 Satisfied (50 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the CMS 460 Medicare form?

AND SUPPLIER AGREEMENT (CMS-460) To sign a participation agreement is to agree to accept assignment for all covered services that you provide to Medicare patients.

How to claim a prescription claim form?

To apply for a refund, print the refund claim form, or get one from your Local Health Office, or call 0818 22 44 78. Post the completed claim form to the address given on the form. You can check the status of your application for a refund at drugspayment.ie.

Does Aetna Medicare cover prescriptions?

If youre enrolled in Medicare Part A and/or Part B, your Aetna Direct or Open Access (plan code JN) plan will automatically enroll you in Aetna Medicare Rx offered through SilverScript, a Medicare Part D prescription drug plan (PDP). This could mean saving on your prescription costs.

What is a pharmacy claim form?

Prescription Drug Claim Form. This claim form is to be used for reimbursement on covered medications provided by pharmacies.

What is a 1490 form?

1490S-Patients Request for Medical Payment.

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What is the form for Medicare prescription claim?

Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your member ID card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form.