Aetna Pharmacy Account Management & Client Support Request Form
Aetna Pharmacy Request Form Instructions
Instructions
Please fill out the form with all information necessary so that the request can be reviewed.
After the form is submitted, you will receive an email confirmation with the tracking number and the name of the team member that will assist with your request.
Required fields are denoted by an asterisk(
*
).
This form is only for clients that have Aetna Pharmacy benefits. If your client has Aetna medical and pharmacy is carved out to another PBM, please contact that PBM directly for pharmacy issues.
Need Help?
For immediate member assistance, call 1-866-893-0927 or email
ClientSupportAetna@CVSHealth.com
Monday through Friday 7am–7pm CST.
If you are having issues or technical difficulties submitting the webform or have feedback or comments,
Click Here
For sales support, such as utilization reviews, RFP support, and estimated savings for pharmacy solutions,
Click Here
.
Your Contact Information
Name
Email Address
Additional Email Address
Use this field if you need to enter a second email address for the team to use when responding to this issue. DO NOT enter a member's email address in either email field.
Is this an escalated request?
Please select...
No
Yes Client out for bid
Yes Executive leadership involvement
Yes Mass rejects for the client
Yes Member is out of medication
Yes Multiple issues for same family
Yes Office of the President (PBM Only)
Yes Plan is on default
Yes Request is for an executive
What department are you from?
Please select...
Aetna Case Manager
Aetna ERT/DOI/Appeals
Aetna Medical Clinical Director
Benefits Installation
Claim Surveillance
Claims Team
Compliance
CVS Mail Order
CVS Specialty
Field Sales/Service Team
IBU Sales/Clinical Team
Internal Audit Team
Member Services
Office of the President (PBM only)
Plan Sponsor Liaison
Privacy Officer
RxAM
Specialty PA (SGM)
What level of support do you need ?
Please select...
Member Specific
Plan Sponsor/Group Level Support
For Sales Support, such as utilization reviews, RFP support, and estimated savings for pharmacy solutions,
Click Here
.
Please Choose Your Type of Request
Please select...
Claim Rework
Complaint for a CVS Retail Pharmacy
DMR/Paper Claim Submission
Eligibility Question/Issue
Fraud/Misbilled Claims
Member Access to Care Question/Issue
Member has a Digital Issue (including mobile app and online MOD refill issues)
Override Request
Plan Benefit Question/Issue
Precert/Appeal Status
Buy Up Program Implementation Support
Client Opting Out of Communications
Eligibility Question/Issue
New Business Implementation Support (including transition files)
Off-Cycle Benefit Change
Plan Benefit Question/Issue
QNOC Communications Update
Report Request
System Coding Question
Terming Client Assistance (including transition files)
Welcome Season Plan Status Inquiry
Member Information
Member Name
DO NOT ENTER SSNs IN THIS FIELD OR ANYWHERE IN THIS FORM!!
Member ID
Member's Date of Birth
Plan Sponsor Information
Plan Sponsor Name
Product
Please select...
Commercial
IFP
Control/Group Number
For Medicare Submissions
Click Here
.
PSU/Account Number
Use 0000000 as the PSU only if there is no active PSU/Account number, otherwise enter the correct PSU for the plan sponsor. If you do not know the plan sponsor's PSU, please
CLICK HERE
to view instructions on how to look it up.
Request Information
Report Details
Funding Type
Please select...
Self-Insured
Fully-Insured
How will the data be shared?
Please select...
Externally
Internally
Internally & Externally
Why is the report needed?
Please describe your request
Attachment
Contact Information