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Medication Search

2015 Aetna Pharmacy Plan Drug List Information


Formulary library

Welcome to the Aetna Pharmacy Plan Drug List Library

Use this page to learn which drugs are covered in your pharmacy plan. Then, you can talk to your doctor about your medicine.

To access your Aetna Pharmacy Plan Drug List, select one of the choices from the drop down boxes below. To see Aetna Pharmacy Plan Drug Lists for 2014 or previous years, scroll down to the bottom of the page.

See your plan summary documents to determine which drug list applies to your plan.

  • For individual pharmacy plans – see Aetna Individual Formulary
  • For information on Small Groups Plans – see Aetna Value Formulary and Aetna Value Plus Formulary
  • For larger group plans for Fully-insured or Self-Insured Plan – see the Aetna Commercial Formulary

Aetna Individual Formulary
Aetna Value Formulary
Aetna Value Plus Formulary
Aetna Premier Formulary
Aetna Premier Plus Formulary
Aetna Commercial Formulary Fully Insured
Aetna Commercial Formulary Self Insured
Chronic and Preventive Drug Lists
Aetna Healthy Action Drug Lists
Health Care Reform No Cost Sharing Drug Lists
Pharmacy Prescription Drug Prior Authorization Request Forms
 

Pharmacy Clinical Criteria (Pharmacy Clinical Policy Bulletins (PCPBs))

Aetna Specialty Pharmacy

Aetna Specialty Pharmacy Medication Request Forms

Prior Year Aetna Pharmacy Plan Drug List Information

Latest changes to the Aetna Pharmacy Plan Drug Lists for Commercial Plans:

  • 2011   
  • 2012   
  • 2013   
  • 2014   
  • Aetna Pharmacy Plan Drug Lists for Commercial Plans:

  • 2011   
  • 2012   
  • 2013   
  • 2014   
  • Aetna Pharmacy Plan Drug Lists for Individual Plans:

  • 2014  
  • Aetna Pharmacy Plan Drug Lists for Small Group Plans:

  • 2014   
  • Aetna Specialty CareRx Drug Lists:

  • 2012   
  • 2013   
  • 2014   
  • Chronic and Preventive Drug Lists:

  • 2012   
  • 2013   
  • 2014   
  • Aetna Healthy Actions Drug Lists:

  • 2013   
  • 2014   
  • Health Care Reform No Cost Sharing Drug Lists:



    Health benefits and health insurance plans are offered, underwritten or administered by: Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156, Aetna Health of California Inc., Aetna Health of the Carolinas Inc., Aetna Health of Illinois Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. Aetna Rx Home Delivery and Aetna Specialty Pharmacy refer to Aetna Rx Home Delivery, LLC, and Aetna Specialty Pharmacy, LLC, respectively. Aetna Rx Home Delivery and Aetna Specialty Pharmacy are licensed pharmacy subsidiaries of Aetna Inc.

    Not all health services are covered. This material is for information only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location and are subject to change. Rebates do not reduce the amount a member pays the pharmacy for covered prescriptions. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Information is subject to change. For more information about Aetna plans, refer to www.aetna.com .

    Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. The availability of a plan or program may vary by geographic service area. Some benefits are subject to limitations or visit maximums.

    Aetna has established a policy to allow exceptions or overrides to certain refill-too-soon limitations. Requests for such exceptions or overrides will be evaluated on a case-by-case basis. While this material is believed to be accurate as of the print date, it is subject to change.

    The term precertification means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company’s clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully-insured HMO and PPO members.

    In accordance with state law, commercial fully-insured members in Louisiana and Texas (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added or removed from the Preferred Drug List, Precertification, Quantity Limits or Step-Therapy Lists during the plan year will continue to have those medications covered at the same benefit level until their plan’s renewal date. In Texas, precertification approval is known as “pre-service utilization review.” It is not "verification" as defined by Texas law.

    In accordance with state law, fully-insured Commercial California HMO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition. In accordance with state law, fully-insured Commercial Connecticut PPO members (except Federal Employee Health Benefit Plan members) who are receiving coverage for medications that are added to the Precertification or Step-therapy Lists will continue to have those medications covered for as long as the treating physician prescribes them, provided the drug is medically necessary and more medically beneficial than other covered drugs. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.