- Aetna's Discounted Prescription Price - The price that Aetna has negotiated with the pharmacy (when the pharmacy participates in the network) for this drug or, in the case of a self-funded plan, the price the employer's benefit plan has negotiated with Aetna for the drug.
- Amount Not Payable - Expenses that are not covered by the pharmacy plan. For example, some plans require the member to pay the difference between the brand drug and its generic equivalent if the generic is preferred. Or if a member paid for the total cost of the drug and submitted a claim, the difference between what the pharmacy charged and Aetna's contracted rate (or discounted rate) may not be covered.
- Before-Fund Deductible - Amount you must spend out of pocket before benefits will be paid from your fund for covered medical services. This feature displays only if it is part of your employer's plan.
- Copay/Coinsurance - An amount or percentage that health plan members are required to pay for health care products or services in conjunction with their employer's benefits plans.
- Date Processed - The date the prescription claim was processed.
Applies to DMR (direct member reimbursement) claims only.
- Date of Service - The date the prescription was filled by the pharmacy.
- Days Supply - The number of days for which the physician indicated the prescription was to be filled.
- Deductible - The amount of covered expense the member must pay each calendar year (or in some instances the plan year) before the plan begins to pay benefits.
- Drug Name - The name and strength of the medication.
- Member Name - The name and birth date of the family member receiving the medication.
- Paid by Fund - Payments made from your fund portion of your medical plan.
This feature displays only if it is part of your employer's plan.
- Paid by Plan - Payments made from your medical plan.
- Payment Made to - Shows who received payment for the member's claim.
Applies to DMR (Direct Member Reimbursement) claims only.
- Prescription Cost - This is the total cost of the drug for which the member and/or the plan is responsible. This amount can either be Aetna's Discounted Prescription Price or the pharmacy's submitted charge.
- Prescription Number - This is the pharmacy's identifier for the prescription. It can be found on the prescription label.
- Prescription Type - Identifies the drug as brand-name drug or a generic equivalent.
- Remarks - Additional information about items in the claim that were not payable by the pharmacy plan.
- Serviced By - The name of the pharmacy that filled the prescription.
- Submitted Charges - The cost of the drug submitted to Aetna by the pharmacy.
- Total Plan Pays - Total charges paid by the pharmacy plan and any employer-sponsored fund.
- Total Member Responsibility - Total charges member is responsible for paying. This includes any coinsurance or copay, amounts not payable, which include charges that are above reasonable and customary, or differences in cost between brand and generic.
