Aetna Better Health covers prescription medications and certain over-the-counter medicines when you write a prescription for members enrolled in the Integrated Care Program
Prescriptions, Drug Formulary and Specialty Injectibles
Check the current Aetna Better Health formulary before writing a prescription for either prescription or over-the-counter drugs. If the drug is not listed, a Pharmacy Prior Authorization Request form must be completed before the drug will be considered. Please also include any supporting medical records that will assist with the review of the prior authorization request.
Aetna Better Health members must have their prescriptions filled at a network pharmacy to have their prescriptions covered at no cost to them.
Step Therapy and Quantity Limits
The step therapy program requires certain first-line drugs, such as generic drugs or formulary brand drugs, to be prescribed prior to approval of specific second-line drugs. Drugs having step therapy are identified on the formulary with “STEP.”
Certain drugs on the Aetna Better Health formulary have quantity limits and are identified on the formulary with “QLL” The QLLs are established based on FDA-approved dosing levels and on national established/recognized guidelines pertaining to the treatment and management of the diagnosis it is being used to treat.
To request an override for the step therapy and/or quantity limit, please fax a Pharmacy Prior Authorization Request form and any supporting medical records that will assist with the review of the request to 1-855-684-5250.
CuraScript Specialty Medications
CuraScript is a specialty pharmacy that provides oral and injectable drugs that are not often available at local retail pharmacies. View the list of drugs that are available through CuraScript.
Prior authorization is required for specialty drugs. Please use the Specialty Medication Authorization Form. Aetna Better Health will review the request for medical necessity. If the request is approved, the provider will be notified of the review decision via fax.
Specialty drugs are typically delivered to the provider's office or the member's home within three business days from CuraScript's receipt of the prescription.
Mail Order Prescriptions
Aetna Better Health offers mail order prescription services through Express Scripts, Inc. (ESI). Members can access this service in one of three ways.
By calling ESI toll free at 1-866-698-1325/TTY 1-800-899-2114 Monday through Friday between 8 a.m. and 5 p.m., Central time. They will help the member sign up for home delivery. If the member gives permission, ESI will call the prescribing provider to get the prescription.
By going to StartHomeDelivery.com. The member can log in and sign up for Home Delivery online. If the member gives permission, ESI will call the prescribing provider to get the prescription.
By asking you, their provider, to write a prescription for a 90-day supply with up to one year of refills. Then the member calls ESI and asks ESI to mail them a Home Delivery order form. When the member receives the form, the member fills it out and mails ESI the prescription and the order form. Forms should be mailed to:
Home Delivery Service
PO Box 52101
Phoenix, AZ 85072-2101