Members: Is your plan type an Individual or Small Group Essential Drug List plan? Click the “Pharmacy Drug (formulary) List Information” link below and you will arrive at a menu page where you can view your specific Preferred Drug Guide. Here’s where you should be sure to select the guide that shows your actual plan name followed by your state’s abbreviation. For example, if you have an Individual Essential Drug List plan and you live in Texas, select the one that says “Individual Essential Drug List TX.” Please use the search box to search for specific information when viewing a PDF.
Choose a plan type from the below drop down list, then enter the name of a drug that you want to learn more about and click "Continue." You may also refer to your plan documents for a complete description of benefits or call the customer service number on your Aetna member ID card.
The Essential Drug List is a new label to describe what we previously referred to as a closed formulary.
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.
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.
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.