Pharmacy
Pharmacy
Prior authorization
Aetna Better Health requires prior authorization for certain drugs on the formulary drug list and for all non-formulary drug requests. You may now request prior authorization of most drugs via phone by calling the Aetna Better Health Pharmacy Prior Authorization team at 1-866-212-2851. You can also print the required prior authorization form below and fax it along with supporting clinical notes to 1-844-242-0908.
Use the Non-formulary Prior Authorization request form if the drug you are requesting is not listed. Most drugs will require use of the Non-formulary Prior Authorization. Contact the Aetna Better Health Pharmacy Prior Authorization team at 1-866-212-2851 if you would like a service authorization request form faxed to you.
These are fax forms for drugs in our prior authorization program. Click on the drug name to download the prior authorization request form.
Formulary Updates
Step Therapy Chart
Illinois PA Guideline Chart
The formulary is a list of drugs that are generally covered under the plan as long as they're medically necessary. The formulary also lists the availability of generic substitutes. The formulary can change.
You now have the ability to use the new Formulary Search Tool to find out which medications are on the formulary drug lists. You can search by drug name or drug class. The search tool will show formulary status, generic alternatives and if there are any requirements, such as prior authorization, quantity limits or age limits. The formularies can change.
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Prior Authorization Forms A - L
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To quickly find a prior authorization form, click CTRL F on your keyboard and type in the form name.
Antipsychotics (Ages 8 and under)
Dipeptidyl Peptidase-4 Inhibitors
Fentanyl Transmucosal IR Agents
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Prior Authorization Forms M - Z
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To quickly find a prior authorization form, click CTRL F on your keyboard and type in the form name.
Non-Calcium Based Phosphate Binders
Pulmonary Arterial Hypertension Agents
Somatostatin Analogs and Somoavert
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Prior Authorization Guidelines
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Specialty Medications
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Aetna Better Health Specialty Drug Program is managed through CVS Health Specialty Pharmacy. The Specialty pharmacies fill prescriptions and ship drugs for complex medical conditions, including hepatitis C, multiple sclerosis, hemophilia, rheumatoid arthritis and most cancer drugs. Medications provided through CVS specialty pharmacy include injectable, oral and inhaled drugs.
The Specialty Drug Program provides care management services to your members, including:
- 24 hours a day, seven days a week access to a pharmacist
- Disease-specific education and counseling by the CareTeamTM. The CareTeamTM are clinical professionals who review dosing and medication schedules, identify injection issues, provide education of potential side effects and provide information to help your patient to manage their medical condition.
- Care coordination
- Delivery of Specialty drugs to your patient’s home and/or your office in temperature-controlled packaging with the required supplies, i.e. needles, syringes, and alcohol wipes or patients can be directed to drop off and pick up most of their prescriptions at any CVS Pharmacy location (including those inside Target stores*)
Contact CVS Specialty Pharmacy at 1-800-237-2767 from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday – Friday. CVS Specialty Pharmacy will assist you in filling your patient’s specialty drug. Prior Authorization (PA) still applies to specific specialty drugs. You can check our health plan website Opens In New Window to confirm PA requirements on the medications listed below.
Specialty medications can be delivered to the provider’s office, member’s home, or other location as requested.
Additional Pharmacies in the specialty network:
Biovarix Pharmacy: Phone: 1-855-427-4682
Orsini Pharmaceuticals: Phone: 1-847-734-7373
Walmart Pharmacies (Specialty Only): Phone: 1-877-453-4566