Staying on track with your medicine is the key to achieving your best health
If you’re taking medicine daily, or only for a short period of time, we want to make it simple for you to see what’s covered and what you’ll pay. In short, you’ll have options to make the most of your prescription coverage.
And with your online plan tools, you can find what you need fast.
Find out if your medication is covered
If you're taking medication, you can see if the Aetna prescription drug benefits cover it.
You can search for a network pharmacy near you using our online provider directory tool. Enter the type of pharmacy and your ZIP code or city and state. In the drop down list select Aetna National Pharmacy Network.
To find a specialty pharmacy, select Aetna Specialty Pharmacy Network in the drop down list.
Call an Aetna Health Concierge at 1-855-496-6289 to find out if your medication is on the Aetna Preferred Drug Guide (also known as a “drug formulary”). What you pay for each prescription depends on the plan you choose. See your enrollment materials for details.
You can also search for your medicine using theFormulary Look Up tool.
We need to review and approve some prescriptions to be sure they’re covered.
Some drugs are very expensive and alternatives may be available. For those drugs, we review the medical case and decide whether to cover the drug as prescribed. We call this “precertification”* because we certify coverage before you buy it. Our doctors research the latest clinical data and may suggest an option. Your doctor can call us to ask for precertification.
*In Texas, precertification is known as “pre-service utilization review.” It is not “verification” as defined by Texas law.
You may have to try one drug before you can try another
Step therapy means you have to try one or more drugs before a "step-therapy" drug is covered. You must first try one or more of the alternative drugs. These alternative drugs are used to treat the same conditions, but cost less.
Your doctor might want you to skip a step-therapy drug for medical reasons. If so, you, someone helping you or your doctor can ask for an exception.
Precertification and Step-therapy programs may differ by state
The drugs on the Aetna Preferred Drug Guide, Formulary Exclusions, Precertification, Quantity Limit and Step-therapy lists are subject to change. The precertification, quantity limits and step-therapy drug coverage review programs are not available in all service areas. For example, precertification and step- therapy programs do not apply in Indiana. Step therapy does not apply in New Jersey.
Save money with generic drugs
Don't pay more for your medications. Ask for generics when they're available.
Generic drugs are usually covered at a lower cost to you.
A generic drug is the same as a brand-name drug in dose, use and form. They are FDA approved and safe to use. Generic drugs usually cost much less than the brand-name versions.
Preferred Generic: You pay the lowest cost for drugs in this level.
Preferred Brand: You pay a slightly higher cost for drugs in this level.
Non-Preferred Brand and Generic: You pay the highest cost for drugs in this level.
PPACA Drug: When certain conditions are met, drugs covered under the Patient Protection Affordable Care Act (also known as Health Care Reform) are available at no cost.
Brand with Generic Alternatives: You may pay the copay plus the difference between the brand and generic cost.
Contact a Health Concierge at 1-855-496-6289 for help understanding the formulary tiers.
To find your specific prescription drug costs refer to your enrollment material.
Get important information about coverage limits
The plan does not cover every prescription drug. It may also limit coverage on certain drugs.
Please read carefully before deciding whether this plan is right for you:
This plan will not pay more than the overall maximum benefit during the coverage year. See your enrollment materials for details.
After you reach your maximum benefit for the year, the plan will not pay any more toward the cost of your care or treatment. Your doctor or pharmacist can bill you for what the plan does not pay. Some drug therapy may cost more to treat than this plan will cover.
Coverage may be limited to specific quantities per prescription and/or time period.
The coverage for your drug (including tier or coverage restrictions) is subject to change and may differ at the time of purchase.
There may be other specifics of the plan that are important to you. Some limit what the plan will pay.
If you have questions about your plan, including coverage limits, call an Aetna Health Concierge at 1-855-496-6289.