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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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