Pharmacy
Aetna Better Health’s formulary drug list
The Formulary is a list of drugs chosen by Aetna Better Health and a team of doctors and pharmacists that are generally covered under the plan as long as they are medically necessary. Prescriptions must be filled at an Aetna Better Health network pharmacy, and other plan rules must be followed.
Please review the Formulary for any restrictions or recommendations regarding prescription drugs before prescribing a medication to an Aetna Better Health patient.
You can download the formulary or search the list inside the provider web portal.
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.
Visit Pharmacy Provider Search to view all the Aetna Better Health pharmacy providers.
For Formulary errors please click here to contact us.
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Prior Authorization Forms A - K
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To quickly find a prior authorization form, click CTRL F on your keyboard and type in the form name.
Dipeptidyl Peptidase-4 Inhibitors
Fentanyl Transmucosal IR Agents
Injectable Anticoagulant Agents
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Prior Authorization forms L - 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-Formulary Diabetic Supplies
Opththalmic Prostaglandin Analogs
Pulmonary Arterial Hypertension Agents
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Prior Authorization Guidelines
Network update effective September 1, 2013
Aetna Better Health wants to let you know of a change to our prescription drug network. As of September 1, 2013, Walgreens will be added back into our network. In addition to your local Walgreens pharmacies, we have the following drugstores in our network. They are all ready to serve you.
- CVS
- Target
- Wal-Mart
- Jewel-Osco Pharmacy
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Step therapy and quantity limits
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The step therapy program requires certain first-line drugs, such as generic drugs or formulary brand drugs, to be prescribed prior to approval of specific second-line drugs. Drugs having step therapy are identified on the formulary with “STEP.”
Certain drugs on the formulary have quantity limits and are identified on the formulary with “QLL” The QLLs are established based on FDA-approved dosing levels and on national established/recognized guidelines pertaining to the treatment and management of the diagnosis it is being used to treat.
To request an override for the step therapy and/or quantity limit, please fax the correct pharmacy prior authorization request form and any supporting medical records that will assist with the review of the request to 1-855-684-5250.
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Specialty medication
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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 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
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Mail order prescriptions
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Mail order prescriptions
If your members take medicine for an ongoing health condition, they can have their medicines mailed to their home. Aetna Better Health works with a company called CVS Caremark, to give them this service, which they can get at no cost.
If they choose this option, their medicine comes right to their door. Here are some other features of home delivery:
- Pharmacists check each order for safety.
- They can order refills by mail, by phone, or online.
- They can talk with pharmacists by phone at any time 24 hours a day, 7 days a week.
They can sign up for this service in one of three ways:
- CVS Caremark toll free at 1-855-271-6603 Monday to Friday between 8 a.m. and 8 p.m., Eastern Time. They will help your member sign up for home delivery. As their provider, CVS will call you to get the prescription.
- CVS Caremark will contact you, the provider, to get a prescription.
- Your patient may ask to write a prescription for a 90 day supply with up to one year of refills. They will then complete the mail order services form and mail it to CVS Caremark along with the prescription.
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Over-the-counter drugs
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Over-the-counter-drugs (OTC’s) - Aetna Better Health also covers certain OTC’s. Some of these may have rules about whether they will be covered. If the rules for that drug are met, Aetna Better Health will cover the drug. Most over-the-counter drugs must have a prescription for them to be covered at no cost to our members.
You can look to see if your over-the-counter medicines are on the preferred drug list. You can also call Member Services toll free at 1-866-212-2851. Have a list of your over-the-counter medicines ready when you call. Ask the representative to look up your medicines to see if they are on the list