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
(114 pages, 1,432kb)
| Key: |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| KEPPRA XR |
Addition |
|
Tier 3 |
| RENVELA |
Addition |
|
Tier 3 |
| VOLTAREN GEL |
Addition |
|
Tier 3, QL=34 grams/day |
Date of Change: February 1, 2009
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| TRILIPIX |
Tier Reduction |
|
Tier 3 |
Date of Change: May 1, 2009
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| BESIVANCE |
Addition |
|
Tier 4 |
| CETRAXAL |
Addition |
|
Tier 4 |
| GELNIQUE |
Tier Reduction |
|
Tier 3 |
| NITRO-BID |
Addition |
|
Tier 4 |
Date of Change: September 1, 2009
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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
| Drug Name | Change Type | Alternative | What You Need to Know |
| 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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