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Drug information and resources

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Changes to the drug list (formulary)

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Changes to the drug list (formulary)

We review our drug list on a monthly basis and make changes as necessary. Most changes are positive. An example would be adding new generics that have come on the market.

 

Sometimes we have to make a negative change to our formulary, like if the FDA views a drug as unsafe or if the drug maker removes the drug from the market.

Prior authorization, quantity limits & step therapy

Prior authorization, quantity limits & step therapy

Some drugs have rules you need to follow before we cover them. These include:

 

  • Prior authorization
    You or your doctor needs approval from us before we cover the drug.
  • Quantity limits
    For certain drugs, we limit the amount you can get.
  • Step therapy
    We require you to try another drug first before we cover your drug.

You and your doctor can ask us to make an exception to one of our coverage rules. This includes requesting an exception to a prior authorization, quantity limit or step therapy rule.

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Transition rules

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Transition rules

There may be times where you’re taking a drug that either isn’t on our drug list or has special rules before we cover it. Learn about our transition process to see if you’re eligible for a short-term supply of medication. This temporary supply allows you to work with your doctor to either transition to a new drug or request an exception to continue your current drug.

Disclaimer

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Aetna Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in: Urban Mississippi, Rural Wisconsin, Rural Missouri, Rural Arkansas, Rural Oklahoma, Rural Kansas, Rural Iowa, Rural Minnesota, Rural Montana, Rural Nebraska, Rural North Dakota, Rural South Dakota, Rural Wyoming. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use.

For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at https://www.aetnamedicare.com/pharmacyhelp.

This information is not a complete description of benefits. Call ${dynamicPhone} (TTY: 711) for more information.