Pharmacy benefits

Network update effective September 1, 2013

Aetna Better Health wants to let you know of a change to our prescription drug network. As of September 1, 2013, Walgreens will be added back into our network. In addition to your local Walgreens pharmacies, we have the following drugstores in our network. They are all ready to serve you.

  • CVS
  • Target
  • Wal-Mart
  • Jewel-Osco Pharmacy

If you need medicine, your provider will choose a drug from our list of preferred drugs.

  • Your provider will write you a prescription. Ask your provider to make sure that the medicine is on the list.
  • Take the prescription to a network pharmacy to have it filled.
  • Show your Aetna Better Health member ID card at the pharmacy. As long as you show your member ID card and use medicines from the preferred drug list, you will not have to pay for your prescriptions.

You can find a network pharmacy in your area or you can call Member Services toll free at 1-866-212-2851. Ask the representative to help you find a network pharmacy in your area.
All prescriptions must be filled at a network pharmacy. Prescriptions filled at other pharmacies will not be covered.

You can look to see if your medicines are on the preferred drug list also called the formulary. You can also call Member Services toll free at 1-866-212-2851. Have a list of your prescriptions ready when you call. Ask the representative to look up your medicines to see if they are on the list.

You now have the ability to use the new Formulary Search Tool to find out which medications are on the formulary drug lists. You can search by drug name or drug class. The search tool will show formulary status, generic alternatives and if there are any requirements, such as prior authorization, quantity limits or age limits. The formularies can change.

Formulary Updates

If your medicine is not on the preferred drug list, there are some things you can do.

  • Ask your provider for a similar drug that is on the list.
  • Ask your provider to ask Aetna Better Health to cover your drug through the prior authorization process. Your provider will know how to do this

Over-the-counter-drugs (OTC’s) - Aetna Better Health also covers certain OTC’s. Some of these may have rules about whether they will be covered. If the rules for that drug are met, Aetna Better Health will cover the drug. Most over-the-counter drugs must have a prescription for them to be covered at no cost to our members.

You can look to see if your over-the-counter medicines are on the preferred drug list. You can also call Member Services toll free at 1-866-212-2851. Have a list of your over-the-counter medicines ready when you call. Ask the representative to look up your medicines to see if they are on the list

Aetna Better Health Specialty Drugs are filled by CVS Health Specialty Pharmacy. A Specialty pharmacy fills drugs but has other services to help you. The Specialty Drug Program has special services for you:

  • You can talk to a Pharmacist 24 hours a day, seven days a week
  • Disease-specific education and counseling are available by CVS
  • Care Coordination for you and your doctor
  • Delivery of Specialty drugs to your  home and/or your doctor’s office is available for drop off and pick up at any CVS Pharmacy location (including those inside Target stores*)

You can contact CVS Specialty Pharmacy at 1-800-237-2767; TTY/TDD: 1-800-863-5488 from 7:30 a.m. (EST) to 9:00 p.m. (EST) time, Monday – Friday. CVS Specialty Pharmacy will assist you in filling your specialty drug. The specialty drug list is available here.

 

Additional Pharmacies in the specialty network:

Biovarix Pharmacy: Phone: 1-855-427-4682

Orsini Pharmaceuticals: Phone: 1-847-734-7373

Walmart Pharmacies (Specialty Only): Phone: 1-877-453-4566

 

Specialty Medication Frequently Asked Questions

Mail order prescriptions
If you take medicine for an ongoing health condition, you can have your medicines mailed to your home. Aetna Better Health works with a company called CVS Caremark, to give you this service which is available at no cost to you.
If you choose this option, your medicine comes right to your door. 
Here are some other features of home delivery:

  • Pharmacists check each order for safety.
  • You can order refills by mail, by phone, or online.
  • You can talk with pharmacists by phone at any time 24 hours a day, 7 days a week.

You can sign up for this service in one of three ways:

  • CVS Caremark toll free at 1-855-271-6603 Monday to Friday between 8 a.m. and 8 p.m., Eastern Time. They will help you sign up for home delivery. If you say it is OK, CVS will call your provider to get your prescription. If you have trouble hearing, call CVS Caremark TTY toll free at 1-800-231-4403.
  • Go online. Then log in and sign up for CVS Mail Order. If you say it's OK, CVS Caremark will contact your provider to get a prescription.
  • Ask your provider to write a prescription for a 90 day supply with up to one year of refills. You  then complete the mail order services form and mail it to CVS Caremark along with the prescription.

Mail the form to:

CVS CAREMARK
PO BOX 94467
PALATINE, IL 60094-4467

CVS Caremark Mail Order Service Form English / Spanish

Your medicine bottle label says how many refills you can have. If your provider or dentist has not ordered refills and you think you may need a refill, you must call him or her at least five days before your medicine runs out. When you call, ask your provider or dentist about getting a refill. They may want to see you before giving you a refill.

Aetna Better Health wants you to be as healthy as possible. This includes being informed about the different medicines you may need to take. To help you, we have included a list of questions you should always ask your provider when he or she gives you a prescription.

  • Why am I taking this medicine? What is it supposed to do for me?
  • How should the medicine be taken? When? For how many days?
  • Are there any side effects or possible allergic reactions to this medicine?
  • What should I do if I have a side effect or allergic reaction?
  • What will happen if I don't take this medicine?

Carefully read the drug information the pharmacy gives you with your medicine. It will tell you what you should and should not do while taking the medicine. If you still have questions after you get your medicine, ask to speak with the pharmacist or call your provider.