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Medicare Rx Essentials

2009 Aetna Medicare Rx Essentials Plan (PDP)

Here are changes from a recent review of Aetna Medicare's Preferred Drug List (formulary). They are based on findings from the Food and Drug Administration (FDA) and drug makers, and other factors including cost. Changes occur, for example, because new drugs come on the market, we may learn that a prescription drug should now have a lower dose, it's moved to a different cost-sharing level (tier), or a generic version becomes available. We change our list to help provide you with appropriate, affordable drug benefits.

Carefully review the monthly changes below and their effective dates. If you are affected by preferred drug list changes, you will receive a letter explaining the changes. You can also speak with your doctor or pharmacist about the preferred drug list changes. 

View full Aetna Medicare Rx Plan (PDP) 2009 Comprehensive Formulary PDF Icon (114 pages, 1,432kb)

UPPERCASE = Brand-name medications QL = Quantity limits
lower case italics = generic medications ST = Step therapy
Tier 1, 2, 3, 4, 5 = Copay tier level PR = Precertification

 

Date of Change: January 1, 2009

KEPPRA XR Addition   Tier 3
RENVELA Addition   Tier 3
VOLTAREN GEL Addition   Tier 3, QL=34 grams/day

Date of Change: February 1, 2009

APRISO Tier Reduction   Tier 3, QL=4/1 day(s)
ASTEPRO Addition   Tier 4
BYSTOLIC Tier Reduction   Tier 3
calcitonin Addition   Tier 2
calcium acetate Addition   Tier 2
dorzolamide-timolol ophth soln Addition   Tier 2
DRUEZOL Addition   Tier 4
EPIDUO Addition   Tier 4
FORTEO Tier Increase   Tier 5
galantamine sr Addition   Tier 2
HALFLYTELY KIT Addition   Tier 4
hydrocortisone with acetic acid otic solution Addition   Tier 2
levetiracetam Addition   Tier 2
MILLIPRED Addition   Tier 4
MOXATAG Addition   Tier 4
NULYTELY Addition   Tier 4
oxycodone er Addition   Tier 2, QL=4/1 day(s)
PRANDIMET Addition   Tier 4
PROMACTA Addition   Tier 5
PREZISTA 300, 400, 600MG Addition   Tier 5
PREZISTA 75MG Addition   Tier 4
protriptyline Addition   Tier 2
RELISTOR Addition   Tier 5, QL=1/1 day(s)
SANCUSO Addition   Tier 5, PR, QL=4/30 day(s)
stavudine Addition   Tier 2
tobramycin-dexamethasone ophth susp Addition   Tier 2
TRILIPIX Addition   Tier 4
XENAZINE Addition   Tier 5

Date of Change: March 1, 2009

BANZEL 200MG Addition   Tier 4, PR, QL=3/1 day(s)
BANZEL 400MG Addition   Tier 4, PR, QL=8/1 day(s)
CAPOTEN 100MG Addition   Tier 4
carbinoxamine maleate Addition   Tier 2
divalproex Addition   Tier 2
divalproex er Addition   Tier 2
generlac Addition   Tier 2
KAPIDEX Addition   Tier 4, QL=1/day(s)
levetiracetam Addition   Tier 2
PREZISTA 75MG Addition   Tier 4
selfemra Addition   Tier 2, QL=1/day(s)
sulfacetamide sodium ophth soln Addition   Tier 2
sumatriptan succinate tablets Addition   Tier 2, QL=18/30 day(s)
sumatriptan succinate vials Addition   Tier 2, QL=5/30 day(s)
topiramate Addition   Tier 2

Date of Change: April 1, 2009

TRILIPIX Tier Reduction   Tier 3

Date of Change: May 1, 2009

APLENZIN 174MG Addition   Tier 4, QL=2/1 day(s)
APLENZIN 348 and 522MG Addition   Tier 4, QL=1/1 day(s)
AVASTIN Added PR   Tier 5, PR
BLENOXANE Added PR   Tier 5, PR
bleomycin sulfate Added PR   Tier 2, PR
CAMPATH Added PR   Tier 5, PR
carboplatin Added PR   Tier 2, PR
CERUBIDINE Added PR   Tier 4, PR
cisplatin Added PR   Tier 2, PR
cladribine Added PR   Tier 2, PR
daunorubicin Added PR   Tier 2, PR
degarelix 120mg Addition   Tier 5, PR, QL=2/365 day(s)
degarelix 80mg Addition   Tier 4, PR, QL=80/28 day(s)
dexrazoxane Added PR   Tier 2, PR
ELOXATIN Added PR   Tier 5, PR
FLUDARA Added PR   Tier 5, PR
fludarabine Added PR   Tier 2, PR
fluorouracil injection Added PR   Tier 2, PR
LAMICTAL Tier increase lamotrigine Tier 4
mitoxantrone Added PR   Tier 5, PR
MUSTARGEN Added PR   Tier 4, PR
NOVANTRONE Added PR   Tier 5, PR
PHOTOFRIN Added PR   Tier 5, PR
RAPAFLO Tier Reduction, Removed ST   Tier 3, PR
RITUXAN Added PR   Tier 5, PR
thiotepa Added PR   Tier 5, PR
topiramate sprinkle cap Addition   Tier 2
TOVIAZ Addition   Tier 4
ULORIC Addition   Tier 4
VECTICAL Addition   Tier 4
VIMPAT 100, 150, 200MG Addition   Tier 4, PR, QL=2/1 day(s)
VIMPAT 50MG Addition   Tier 4, PR, QL=6/1 day(s)
vinblastine Added PR   Tier 2, PR
vincasar pfs Added PR   Tier 1, PR
vincristine Added PR   Tier 1, PR
ZINECARD Added PR   Tier 5, PR

Date of Change: June 1, 2009

ACANYA Addition   Tier 4
AFINITOR 10MG Addition   Tier 5, PR, QL=2/1 day(s)
AFINITOR 5MG Addition   Tier 5, PR, QL=3/1 day(s)
RYZOLT Addition   Tier 4
topiramate Addition   Tier 2

Date of Change: July 1, 2009

eliphos Addition   Tier 2
EXFORGE HCT Addition   Tier 3, QL=1/1 day(s)
PRISTIQ Tier Reduction   Tier 3, ST, QL=1/1 day(s)
PROCRIT INJ 2000/ML, 3000/ML, 4000/ML Removed QL   Tier 3, PR
REQUIP XL 6MG Addition   Tier 4, QL=4/1 day(s)
risperidone odt Addition   Tier 2, QL=2/1 day(s)
SAVELLA 12.5, 25, 50, 100 Addition   Tier 4, ST, QL=2/1 day(s)
SAVELLA MIS 5-8-42 PAK Addition   Tier 4 QL=55/year
SIMPONI Addition   Tier 5, PR, QL=50/30 day(s)
VIMPAT INJ Addition   Tier 5, PR, QL=40/1 day(s)

Date of Change: August 1, 2009

BESIVANCE Addition   Tier 4
CETRAXAL Addition   Tier 4
GELNIQUE Tier Reduction   Tier 3
NITRO-BID Addition   Tier 4

Date of Change: September 1, 2009

ADCIRCA Addition   Tier 5, PR
ALDARA Tier Reduction   Tier 3
ASACOL HD Addition   Tier 4, QL=6/1 day(s)
bicalutamide Addition   Tier 2
EDLUAR 10MG Addition   Tier 4, QL=1/1 day(s)
EDLUAR 5MG Addition   Tier 4, QL=2/1 day(s)
gavilyte-g Addition   Tier 2
LAMICTAL ODT Addition   Tier 4
MULTAQ Addition   Tier 4
risperidone odt Addition   Tier 2, QL=2/1 day(s)
risperidone odt 4mg Addition   Tier 2, QL=4/1 day(s)
SEROQUEL XR 50MG Addition   Tier 3, QL=6/1 day(s)
VENLAFAXINE ER 37.5, 75, 225MG Tier increase, Added ST venlafaxine Tier 4, ST, QL=1/1day(s)
VENLAFAXINE ER 150MG Tier increase, Added ST venlafaxine Tier 4, ST, QL=2/1day(s)

Date of Change: October 1, 2009

apraclonidine hcl ophth soln Addition   Tier 2
benztropine mesylate inj Addition   Tier 2
CODEINE SULFATE Addition   Tier 4
COLCRYS Addition   Tier 4, QL=4/1 day(s)
EFFIENT 10MG Addition   Tier 4, PR
EFFIENT 5MG Addition   Tier 4, PR, QL=1/1 day(s)
LAMICTAL XR Addition   Tier 4, QL=1/1 day(s)
NUCYNTA Addition   Tier 4, QL=6/1 day(s)
ONGLYZA Addition   Tier 4, QL=1/1 day(s)
oxaliplatin iv soln Addition   Tier 2, PR
ZIPSOR Addition   Tier 4

Date of Change: November 1, 2009

ASTEPRO Addition   Tier 4
clonidine hcl td patch Addition   Tier 2
EMBEDA 20/30/50/60MG Addition   Tier 4, QL=2/1 day(s)
EMBEDA 80/100MG Addition   Tier 5, QL=2/1 day(s)
EXTAVIA Addition   Tier 5
malathion lotion Addition   Tier 2
melphalan hcl Addition   Tier 2, PR
nateglinide Addition   Tier 2
ONSOLIS 200MCG Addition   Tier 5, PR, QL=8/1 day(s)
ONSOLIS Addition   Tier 5, PR, QL=4/1 day(s)
SABRIL POWDER 500MG Addition   Tier 5, PR, QL=6.67/1day(s)
SABRIL TAB 500 MG Addition   Tier 5, PR, QL=6/day(s)
SAPHRIS Addition   Tier 4, QL=2/1 day(s)
tri-lo sprintec Deletion   Tier 2
ULESFIA Addition   Tier 4

See the Aetna Medicare Glossary for unfamiliar terms.

See the Aetna Medicare Rx Find Prescriptions page for more information about Aetna Medicare's preferred drug list (formulary).

(Last updated 10/27/2009)

 

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Page Last Updated: October 1, 2009