Case study: Solving a

medication crisis in the Caymans

The CARE team

Make the most of Aetna International’s Care and

Response Excellence (CARE) team

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Care and Response ExcellenceAetna International

Personalised support with one of the cornerstones of care: medication access and adherence

Meet Sophie and Karen*

Discover how the critical medication needs of a U.S.

family in the Cayman Islands were fulfilled by our CARE

team. See page 5.

*Names changed to protect the identity of our member and family members

International travel and relocation involve a lot of organisation, from plane tickets and packing to accommodation and international private medical insurance. One important aspect of international

travel to consider – and especially relocation – is medication.

Whether you’re managing a chronic disease such as diabetes or a condition such as anxiety, ensuring that you’re sticking to to your medication plan is crucial to your overall health and well-being.

In the throes of booking and planning, many people forget to check whether they have enough medication to cover their trip or initial settling-in period, whether they can access a given drug in their destination and even whether it’s legal there.

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Care and Response ExcellenceAetna International

How we can helpThe Aetna International Care and Response Excellence (CARE) team offers a round-the-clock service to helpmembers get the care support solutions they need in a range of different situations – from pre-trip planningand medical emergencies to finding the right health careprovider and accessing prescribed medication.

Whether you are a globally mobile individual, are relocating to another country or are planning a holiday, the CARE team can help you with all your medication needs, including:

Helping you get an adequate supply for your trip and/or settling-in periodFinding doctors, specialists, hospitals and accessing medication in your destination country

Defining whether medication is available and/or legal in your destination countryIdentifying alternative brands of medicationWhat to do in the event of a medication emergency, if you run out or lose your supply Shipping medication to your destination, if necessaryProviding advice around vaccinations and prophylactic medicationEnsuring your whole family is catered to, plan cover permitting.

While these services are particularly useful to those moving abroad, they can be used at any time to help you stay happy, healthy and productive in your new home.

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Care and Response ExcellenceAetna International

What is the CARE team?Operating internationally, the CARE team proactively outreach to members who live abroad or travel frequently regarding their health needs as well as responding to health issues that arise. The team of expert health care professionals work closely with the member and their treating doctor to prevent and resolve health episodes and emergencies.

Our aim is to make sure you always have access to high quality clinical treatments and ongoing care to support your needs, and the needs of eligible dependant family members.

Meeting your medication needsWhen it comes to ensuring you have access to the right medication when and where you need it, the CARE team works with more than 1.4 million health care partners in our quality global provider network - from doctors and specialists to pharmacies and hospitals.

The CARE team in actionTo give a real-world example of how the CARE team can help you with your medication needs when travelling, living or relocating abroad, meet Sophie* and her mum, Karen* from the U.S.. Their story began when 15-year-old expat Sophie, who has cystic fibrosis, wanted toaccess a new treatment - a high-cost, but not widely available, drug - in their home in the Cayman Islands.

Get in touch with the CARE teamYou can contact the CARE team 24/7/365, simply call the number on the back of your member ID card. For more information about the CARE team and the other benefits and services available throughyour plan, login to (or register for) the Health Hub. – your secure member portal.

It only takes two minutes to register. The Health Hub allows you to access to your documentation, find a provider, make and track claims, accesshealth and wellness information and more.

Medication crisis in the Caymans: Individual support in a complicated crisis

for a catastrophic condition in the Caymans

A 15-year-old with cystic fibrosis gainsaccess to high-cost, limited availability new drug in her Caribbean home

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This is the story of Sophie and Karen* and how Aetna International’s CARE team helped them navigate a complex situation and gain access to high-cost medication in their home abroad. Read their story to see how our members benefit from the expertise andsupport of our CARE team.

While no cures for cystic fibrosis are known, several treatment methods are used.

*Names changed to protect the identity of our member and family members

CatastropheSophie is a 15-year-old American girl living in the Cayman Islands with her family. Sophie has cystic fibrosis, a ‘catastrophic’ condition that affects the lungs as well as other internal organs. Symptoms usually include difficulty breathing, excess mucus and frequent chest infections among many others.

The term ‘catastrophic’ refers to illnesses that are usually life-threatening, often entailing significant disability. Such conditions usually require lengthy hospitalisation with expensive therapies and treatments. Diagnoses of this nature and the high cost of drugs have the power to deplete even a wealthy family’s financial resources unless they’re covered by specialist medical insurance policies.

While no cures for cystic fibrosis are known, severaltreatment methods are used.

Medication crisis in the Caymans: Individual support in a complicated crisis

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Medication crisis in the Caymans: Individual support in a complicated crisis

Meet MaryMary, a Registered Nurse Clinical Team Lead certified in managedcare nursing, has been with Aetna for 11 years. Mary currently supports our customers and members by providing a vast array of services such as Utilisation Management (preauthorisation and concurrent review) and Case Management (condition management, pre-trip planning). Her nursing background also includes long-term care, skilled nursing and paediatric nursing.

Switching medicationAn Aetna International member since 2014, Sophie’s mum Karen got in touch with us in October 2018 to request switching Sophie to a new leading-edge medication, Symdeko, to treat her condition. The Americas CARE team Clinical Team Lead, Mary, picked up the call.

After Mary received the call from Karen, she worked with Sophie’s treating physician to determine that it was in the best interest of Sophie’s health to obtain this drug and helped ensure that it was suitable for her to transition to this medication. However, we discovered that the medication was not only far more difficult to acquire in Cayman but also at a much higher cost than if obtained in the U.S..

The drug’s manufacturer had confined its distribution toa limited number of pharmacies – none of which were in the Cayman Islands. Therefore, it would increase the cost by 170% to $59,528 for a month’s supply to be specially delivered to Cayman. This would negatively impact the member’s finances, something we were keento help avoid.

Plan BWith the limited availability of Sophie’s drug nearby, Aetna International worked with its partners to come up with a plan to help.

At this time, Sophie and her mother were flying to theU.S. every three months for a check-up with a specialist. Therefore, Karen suggested they could pick up the medication from the pharmacy near the doctor’s office.

Mary welcomed the idea and was willing to assist in obtaining the approval for the medication. However, after further research, she realised the pharmacy was out of network, meaning the member would still incur a higher cost. Mary, with the help of Aetna’s pharmacy team, was able to locate a specialty pharmacy in the U.S., within Aetna’s network and on the distribution list for the medication.

Knowing the member was very overwhelmed at this stage, Mary made herself the single point of contact for her, until the issue was resolved. This meant keeping in touch with the member with regular updates on how the situation was being resolved and providing simple steps for the member to follow in order to obtain the medication.

Initially, the plan was for Sophie and Karen to pick up three months’ worth of medication on each U.S. trip. But Sophie didn’t have enough medication to see her through to her upcoming American appointment. She needed the drugs sooner. The situation needed to be managed to avoid it becoming a medical emergency.

Mum Karen happened to be flying to Washington D.C. on a personal trip in the immediate future and suggested that she could fly to the pharmacy in Boston to pick upthe medication. To save Karen going to such lengths, Mary arranged to have the medication sent to a specialty pharmacy in D.C.. This not only helped the member avoid incurring extra travel expense, it helped ensure the medication could be obtained via an in-network pharmacy, thereby also helping to keep costs in check for the member.

Further complicationsThe night before flying to the U.S., Karen called Mary intears. Earlier in the day, she had called the pharmacy in the U.S. who told her she would have to pay 20 percent of the drug cost up front due to their high value.

Mary quickly worked behind the scenes to resolve the issue. Health insurance can be complicated, with differences in co-insurance limits, co-payments anddeductibles affecting aspects of cover. Mary quicklystraightened out the crossed wires and resolved the issues the same day. Karen resubmitted the request to the pharmacy which confirmed that there was noobligation to pay anything up front.

Medication crisis in the Caymans: Individual support in a complicated crisis

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The best health outcomesThe plan worked well. Karen picked up the medication and flew home to Sophie. The potential medicalemergency was averted and Sophie continues to get her medication every three months at her U.S. appointments. Mary continues to be on hand to monitor and support Sophie’s health care needs, supporting the treatment plan to address the underlying causes of the disease and help Sophie manage her symptoms.

With their flexible, collaborative approach, Aetna’s expertCARE team helped the family overcome the challenges presented by living away from home so Sophie could successfully transition from one medication to another. By adopting value-based care initiatives that focus on health outcomes and a better care experience and treatment pathway for people, we help ensure our members can access quality care and service, whether in a preventative, chronic or acute capacity.

For more information about the CARE team and the other benefits and services available through your plan,login to (or register for) the Health Hub.

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Medication crisis in the Caymans: Individual support in a complicated crisis

Are you an employer?Find out more about how Aetna International’s CARE team can help you support your international employees and help to keep them healthy, happy, safe and productive.

The information included in this communication is provided for information purposes only and it is not intended to constitute professional advice or replace consultation with a qualified medical practitioner. Aetna does not diagnose, provide care or

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